Saturday, June 27, 2015

Nothing is sacred

Have you seen a movie called the Matrix? The original one that is? Pretty special..apart from the spectacular special effects in the movie, for the uninitiated,it depicted a dystopian future in which reality as perceived by most humans is actually a simulated reality called "the Matrix"...pretty good movie  and one in which, for once, Keanu Reeves managed to put more than 2 expressions together.

It's relevance to the NHS as it stands is simply stunning. Whichever way you turn, all data point to the money running dry, acute Trusts in quandary, revolts from provider organisations against central diktats. Then again, there is the unflinching believe (and perhaps rightly too) that the money is there- its just not in the right place. We talk about the Matrix- and never before has it been better encapsulated than in the debate about Public Health. However you want to couch it, type 2 diabetes is on the rise- at a pretty startling pace. Drugs aren't cheap, it costs 10% of the budget- so Simon Stevens quite rightly pushes forward the National Diabetes Prevention Programme..so far so good...thats the swish world where Keanu can dodge bullets. And then simultaneously, a 200 million pound axe falls on public health..evidently because they didn't spent it. Welcome to the other side. Let me take a pause and say that again. There was 200 million pound underspend in PH IN 2014...did we just discover that type 2 diabetes is increasing in prevalence? Cue bemusement 

Then comes the basic question- we need more money in primary care- lets not deny that fact- given that majority of work is there...the usual debate always surrounds why it can't come out of acute Trusts. All acute Trusts will also agree on paper, social media about the need for working differently - that's the glossy side of the Matrix. On the other hand, do look a bit deeper into the provider revolt and the MRET negotiations (Marginal Rate Emergency Tariff) negotiations. Do I blame them? Not a jot-as they have building to maintain, staff to pay for. Thats your other side of the Matrix. 

So as Roy Lilley has said, its time to look at all the bodies funded by taxpayers. There should be no sacred cows anymore. Review all, see what they have achieved, see what they can deliver.Because when it boils down to it, do you want enough money to fund safe staffing on the wards..or is it about a quango which may or may not have outcomes?

So let's start looking- let's ask for a public debate- let's ask what NICE contributes, what NHS IQ does, what NHS Leadership Academy does, CQC- everything - no sacred cows. Let me be clear- this does NOT start with the assumption they don't contribute- it must be a open process where the money invested from taxpayers is worth its value or not. Let me give you an example from NICE. An august body- well respected...recently tried looking at Type 2 diabetes guidelines. 1st draft got ripped to shreds, second draft looks like simply adapting what the American Diabetes Association/European Association for the Study of Diabetes published in 2015. Question..how much taxpayers money wasted behind a prolonged exercise when all that was needed was ratification of a guideline the world now accepts?

So no more sacred cows please...put those cards on the table. Lets see what NHS IQ has delivered- and please look at patient outcomes- not simplistic bits like "it made us feel all better". Going on a holiday does that too- but unlikely that would be funded by taxpayers money, right? So lets see the investments, lets see what they have achieved- if its all about transparency..lets do so properly - and let there be a decision as to whether to continue with those bodies- or whether we use it to fund primary care properly.

Nothing is sacred. Question for all..I know how much taxpayers money is invested in our services. I also have outcomes to show- including patient satisfaction. Do you?

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