Don’t do anything…


The NHS is not a hobby. I know, you know… but I’m beginning to wonder…

When The Tinkerman was the boss, his ‘thing’ was a safer NHS. On top of the day job, everyone had to bust a gut to do safe staffing with not enough staff.

His medical examiner programme should have been rolled out today… it’s not. No money, no legislation… too difficult.

The Tinkerman has gone, his priorities fizzled out. SoS’s and their foibles!

I remember Patricia Hewitt stunning the NHS by circumventing the newly-formed NICE procedures and announcing women would have immediate access to unfunded Herceptin, a breast cancer drug…

It’s all good stuff and well meant, but no way to run a chip shop.

No18 is no different. Management by hobby.

His interest is IT so we are busy doing IT. Last week, out of the blue, he announced a £9m bung for people who think they might be able to develop something or other, about data.

Who authorised this use of public money, for that purpose? How will we measure value for money, where’s the business case, who’ll evaluate the outcomes? Dunno.

When he goes, it will fizzle out.

Don’t doubt, Number 19 will have their own contribution to the National Hobby Service. SoS’s should focus on what is important. Why don’t they? Well, the important stuff is usually the too difficult stuff.

It’s ATfD… all too flippin’ difficult.

Chucking £9m down the drain (and that’s what it will be), makes No18 look busy but doesn’t get anywhere near getting busy, about the things we should be getting busy about.

For instance;

The workforce crisis.

Well over 100,000 vacancies, the front-line shot to pieces, rotas have more gaps than a Sudoko grid. As far as I can see, more people are leaving than joining. In consequence, people are having a wretched time.

The newly appointed national workforce lead, bewildered by his task, has announced nothing much will happen until after the Chancellor’s Autumn Statement…

… after which a report will emerge. After that… dunno… blah… blah and 90 nurses a day are leaving.

It looks to me like he’s thrown in the towel. Gone back to running his Trust, which, incidentally, the CQC have denounced as unsafe because he doesn’t have enough staff. Rich…

No18 won’t intervene because to do so would be to admit there’s a problem and it’s all too difficult… enough said.

Next, the pension crisis.

This is complicated and I don’t have the space but the nub; for most experienced doctors it’s not worth working more, filling in the rota blanks, because the additional income screws-up their pension-tax threshold and they get hit with draconian tax payments.

Three quid over the limit might cost £3k in tax. So, they’re staying at home.

Everyone knows it’s bonkers and needs an urgent sort-out.

No 18 won’t intervene because to do so would be to admit there is a… blah… blah… enough said.

The third big issue, debt.

About half of Trusts have structural debt. They’ll never be able to pay it back. More of them will fall into ludicrous ‘special measures’ where NHSI will rob Peter to pay Paul and pillory everyone in the process.

Writing-off public debt is tricky. Converting it to public dividend capital, effectively shares, held by the Treasury, is easy and would create balance sheet headroom for a fresh start.

The debt is not absolved, it is just parked.

No 18 won’t intervene because well, you know… enough said.

The effective use of data, real interoperability and woeful IT procurement, stuff No18 does know about, doesn’t get done because… it’s too difficult.

Don’t ask about the crucial green paper on funding adult social care.

Preoccupations with Brexit maybe a reason, a distraction but not an excuse for not doing the difficult things. Government is paid to govern and that includes the difficult things.

The NHS is not a hobby, not a stepping stone in a career. It is a mission-critical public service that is worthy of more than keen enthusiasts, fiddling. The NHS needs direction not dilettantism.

Focus on what’s important, centre on the difficult stuff… the people, the pounds, the pensions, the pensioners and putting off tough IT problems.

If you can’t do any of that, don’t do anything.

Contact Roy – please use this e-address – roy.lilley
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Reproduced at by kind permission of Roy Lilley.