Put up with it

primary care training bully

The last thing Custer needed was more Indians.  The last thing Noah needed was another species.

The last thing America needs is more guns.  

The last thing we need is more Brexit-Bull from Boris.

The last thing we all need is another upgrade from Windows and the blue screen of death.

The last thing you want is to bump into is your Ex, when you’re with you know who!  

When he says ‘the last thing I want to do is hurt you’, head for Tinder.  When the dentists says ‘the last thing I want to do is hurt you’, head for the door.

The last thing we need is more Trump, more fake news, more global warming.

The world… full of things we can do without.

And the NHS…  

The last thing we want is more patients…  the last thing you want to know; sorry, there’s no let-up in sight.

… and the last thing we want to do to the overstretched, over-used, over-their-heads Trusts, in debt, is to burden them with more debt.

It seems the last thing NHSI want to do is publish the debt position.  The publication of the three-quarter year position has been ‘delayed’.  Who knows why and frankly, who cares?  How many will end up with a year end deficit?  Ask Bet 365.


No need to place a bet; this just in, the 

deficit is nearly a £1bn….. HSJ report here.

Dozens have received loans just to keep the lights on, buy bandages and pay the staff.

Special measures… a particular predicament… need a lifeline.  Money.  Trusts borrow from DH+, who charge interest.  The rate is six per cent – up to four times higher than the rates offered to other Trusts in less dire straits.

The DH+ say the policy… is designed to ‘reflect the additional risk‘…  involved in a bail out.

There’s no additional risk.  That’s cobblers.  They’re not going anywhere. 

The policy is designed to make Trust boards think about their balances and to provide a disincentive to ask for a bail out.

Maybe… if you are dealing with a Carillion or your kids pocket money but, not if you are dealing with organisations who are forced into overtrading…

The last thing you want to do if you want to help Trusts climb out of the death-valley of geography, history and financial famine, is to make them pay-off artificial debt instead of paying the wages of real nurses. 

The last thing you’d do, if you were worried about Trust solvency, is to arrange the tariff in such a way that each patient treated loses money.

It’s the last thing you’d put up with if you’re non-executive on a board… or a chairman.  It puzzles me why they do?  If they all refused to play the payday lending game it would be the last thing the The Tinkerman would be able to cope with.  

Sack 150 chairs and over 700 NEDs?  I don’t think so. 

Trusts are not in debt, they’re pushed into providing more care than they are paid for.  Trusts don’t overspend, they don’t have enough money to spend in the first place.

In most organisations the culture of bullying starts at the top.  Do the job,  Don’t bring me bad news.  The NHS… no exception. 

“Balance the books, I don’t care how.  Bullying down; ‘just go do it!’  Managing up… ‘everything is ok here, boss’…”

Penal rates of interest, artificial balances, fiddles imposed for no real reason other than to intimidate. 

The last things we think about should be the first;

Trusts have no say over pay levels for most of their workforce, have to cope with labour shortages they have no control over, cope with regulation they play no part in shaping, reorganisations they don’t want and demand they have no influence over…

…and Trusts are dangerously short of 100,000 staff.  A predicament they are all but powerless to deal with.

The last thing we should do is to condemn an underfunded Trust for not fitting activity to their budget. 

The last thing we should do is put up with it.


Post Script: The news of the likely out-turn came after I wrote this article.  It’s clear NHS finances are out of control.  It is time to send a clear message to The Tinkerman… ‘you can use balances, reserves, convert capital to revenue, bully, bung, get the DH press office to say silly things and wriggle all you like, but the game’s up.  If you care about the NHS as much as you say… show us what you’re made of.’


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