Leverage…

training primary care NHS leverage

Central London, a day of two halves.

Half of it, jam-packed with people. Busting at the seams as tourists and protesters, flags and placards, vied for pavement and road space.

The other half; cordoned off, the streets empty… waiting for one man and his retinue to swish by.

London has a special visitor in town. As one newspaper put it; Duck, it’s Donald!

President Trump has been shown the best of Britain, cranked up the overtime bill for the Metropolitan Police, insulted the Mayor of London, hacked off the taxi drivers and send shock waves through the NHS…

… If there is to be a trade deal with the US, Donald wants the NHS as part of the package.

He’ll soon be on his way to Ireland. The London Ambulance service can put its emergency plans back on the shelf and we can get back to normal.

Trade deal? Well, we trade with the US now. It’s often said we trade with the US on WTO terms. In reality, we have more than 100 separate bilateral agreements with them. The EU has about 20. There is an interesting fact-checky-type-page on the BBC website, here.

A new deal would have to be negotiated and that would take time. Likely, over a year and signed off by Congress. Would it include healthcare?

It could. Donald has been very smart. He’s a deal maker and you can see what he’s doing…

He knows American involvement with the NHS would be an incursion that few politicians would want and worry most of the public.

He knows we’ll have to have a deal with the US.

He will also know that, the morning of the day he made his announcement, the former health secretary, the present health secretary and various politicians, all said the NHS is off the table.

His negotiating plan will be to insist it’s on the table and only agree to make it off in return for concessions from us, elsewhere.

We might have to decide, what would we be willing to sacrifice to keep the NHS yankee-free?

Tariffs on our cars, tariffs off his Jack Daniel’s. Dunno.

He has been clever and reversed the advantage, forcing us into choices to keep the NHS out of a deal, or compromise to keep the NHS on the table in some form of limited way.

Once that happens the door is open. Maybe we’d concede, US companies could bid for health sector patient facing work, but not be allowed to run whole service?

Then deal-creep sets in…

By saying NHS is off the table we have made a PR gain but a naive negotiating blunder.

Should we be worried?

Not really. Almost all the companies that have tried to do something with the NHS have failed.

• Circle tried to run Hinchingbrooke and ended up paying £5m to get out.

• Serco no longer do anything patient facing.

• Virgin have obviously caught a cold, fallen out with the NHS and sued us.

• Care home operators are having a torrid time… most teetering on the brink of insolvency.

Most hospitals are having money problems, CCGs fare no better, GP practices in melt-down.

If organisations, who don’t have to make a profit, can’t balance their books, how can organisations who have to make a profit manage it.

Could the private sector run hosptials and services more efficiently than the NHS? It’s not impossible, There are certainly savings to be made from operational efficiencies, particularly with the use of technology for the management of information.

But, I’m left asking the question what level of investment would be required, for what level of return?

Virgin invested in tablet technology for community nurses. The Nurses loved it and it created efficiencies, but it doesn’t look like it will keep them in the game.

How efficient is the NHS? Is there much fat to trim?

The NHS is more productive that the UK economy as a whole.

Figures published by the ONS showed NHS productivity in England, in 2016/17, grew by 3% from the previous year, more than treble the 0.8% achieved by the whole economy.

Trump sees himself as a deal maker. In truth he’s had patchy success. Will he get his way?

As he says in his book, The Art of he Deal; “Leverage: don’t make deals without it…”

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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.