Where we do things…

Where we do things... NHS_Training_in_Primary_Care_General_Practice

Bojo’s latest testosterone charged world-class-wheeze, is; build some world-class schools.

All very John Maynard Keynes. 

With apologies to any economists reading this, JMK means; 

‘… the government spends money it doesn’t have, on public projects, to save capitalism.’

It’s quicker than relying on markets to organise themselves.  Governments can make things happen.  Well, they can, if they are determined enough.

If they want to by-pass a clunky planning processes and forget about contracting and tendering.

All good stuff, but… who’s going to build the new, good-stuff?

Of the fifteen key-trades and occupations in the building industry, 40% have skills shortages.

Just like healthcare, the construction workforce is ageing.  Over 20% of tradespeople are 50+ and 15% in their 60’s… that’s why you can’t find a plumber.

A third of construction firms employ workers born outside the UK.  And, you know what’s coming next… Brexit has.. well you know.

The construction materials price-index has been rocketing.  It’s dropped because of CV-19 but will take-off again.  Two thirds of construction materials are imported directly from the EU.  We’re no longer in the EU and I have no idea if that’s significant or not.  

And, of course there’s the value of currencies.  What CV-19, borrowing and debt will do to the cost of currency is a guess for a bigger brain-box than mine. 

Oh, and construction-material importers will have to pay VAT upfront on anything they bring into the country… which may delay their supply chain.

The upshot; don’t expect a building boom.

What about the NHS?

Expect a re-heated, re-announcement of the last BoJo wheeze, the NHS capital programme.  In case you’ve forgotten… allow me;

Capital was to come in two, parts, plus a BoJo-Bonus.  

First; £2.7bn to begin 6-shovel-ready schemes, by 2025.  I’m not entirely convinced these’ll still be shovel-ready, some of them were not shovel ready, when we were told they were… shovel ready.

The second; 34 other schemes for which there was a promise of £100m to pay for plans, planning, architects, building consents and signed-off, full business-cases, all to be built by 2030… providing the economy isn’t in the pawn-shop.

The BoJo-Bonus?  An open competition for money to build new stuff.  Call me old fashioned but I prefer a plan, to a lottery.  If we need stuff built, we shouldn’t have to get-lucky to make it happen.

Before Covid there was a backlog of maintenance and repairs that amounted to more than £6bn and dozens of upgrade projects that have been delayed or cancelled.

Who knows what state the estate is in, after the hammering it’s taken.

Here’s a question… do we want to do all this?  Knowing what we know, now.  

The amount of engagement that can be done on video.  Discovering people can work from home, without time-wasting, carbon-producing, Covid-risk commuting.  Dragging patients in, charging a fortune for parking, keeping them hanging about.

... how much NHS do we want?  I’ve always had a secret desire to make the hospital history.  

There’s a lot of talk about ‘no turning back’, keeping the best innovations.  Is this the time to make a start?

I’m not sure.  

If covid is our stepping stone to new-ways, capital charges and tariffs will be the mill-stone that holds us back.  Building new buildings will add to capital charges and contracting costs.

All this says to me; time for an estates review, before we rush off and build more of the same.

In 2013 the King’s Fund estimated the NHS estate had a floor area that would cover the City of London ten-times over, 6.9 million hectares.  The total floor-space, estimated at 28.4 million square metres.

Do we make every square centimetre of these assets, sweat, to produce faster, safer, value for money healthcare?  Dunno…

Building out of Covid has given us a lot to think about; the quality of the environment, the benefits of adaptable buildings with alternative use values and to put it plainly, do we really need all these bricks when we’ve proved healthcare can be safely delivered with clicks? 

Covid has changed a lot of  how we do things.  I wonder if it might change where we do things.

News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.