Saturday, September 19, 2015

Say it loudly..part 2

Lets do some maths, shall we? We know the NHS needs about 30 billion £ by 2020- not my figures- but as per health economists, think tanks etc. To help, Mr Hunt promised 8 billion of that and in fairness, thats what Mr Stevens asked for in the 5 year forward View. So he got what he wanted- the idea being that the rest 22 billion would come via efficiency savings, working differently etc etc

You with me so far? Ok. Good.. so that brought forth the Vanguards- a bit of extra cash to help them develop- never mind it came from Public Health (a 200 million spreadsheet shift)- all for the greater good- and if the Vanguards fly, maybe those efficiency savings would come. No problems there- big picture and all that. So we on track for what we need. All good. Innovation needs headroom - as the think tanks always talk about the much needed transformation fund

Problem..ah well.. a few here and there. For starters, 7 day working wasn't quite in the 5 year forward view calculations and its inherent bill...especially when folks started talking about elective work on weekends, that calculation started looking seriously awry. Thankfully better sense has prevailed and we are talking about non-elective care which actually is about patient safety. Still, a bit of a calculation upsetting curveball indeed

Then came the issue of efficiency- asking the NHS to achieve what it has never done- a level of efficiency never before seen. Even the most optimists don't see that happening- and with all thats possible, reckon, we would, at best, achieve about 10-15 billion of that needed 22 billion - hey-whats 5 billion here and there between friends? That would leave the NHS  gap of 7-10 billion, come 2020- early signs are there..have a look- the NHS is likely to declare- how much- around a deficit of 2 billion come end of financial year. Election time come..I predict a bit more injection depending on whether we have an opposition or whether NHS is polling as a major issue...and we will limp on a bit more.

Depressing? Not really- as the optimist also knows that it is possible to get good efficiency savings but the realist knows we are a fair bit away from it.
Why? Well- for starters, lets talk efficiency. In an industry dependant on soft touch approach, good will...to get efficiency, you need the goodwill of the workforce. Due to some mysterious reason, powers that be are trying their best to break that down. Which is exactly why as a Consultant, I look at this whole junior doctor thing with dismay. Forget the efficiency bit..we are struggling to get doctors to continue their careers and we are trying our best to make it worse. Odd...I always take pride as to what we do as a team- and what our juniors contribute..bottom line? Morale. Piss on it..and you can surely piss away your efficiency. Innovation? Technology...try and find someone more committed to it..and I can tell you without the presence of the person or the good will, those machines or technology are as good as cold machines. Newsflash- we haven't arrived at a dystopian future where machines do it all (and then take the world over either)

So, whoever you are, think about the generation next and the impact on patients. Our evangelist safety leaders are a bit quiet on this- perhaps out of embarrassment and realisation that championing patient safety without the resource or indeed, without a motivated workforce runs the risk of making things worse. As a Consultant, I am very clear that imposition of contracts is wrong and must be challenged. Whoever you are, whatever your title...have a think about why, for the NHS and patients, you do need to stand y our generation next. Say it loudly.

Next week, some suggestions as to where we could get some of the efficiency savings Mr Stevens alludes to...but till then...think of those glossy powerpoint you have made or seen umpteen times...think what they say about morale.

Then say it loudly.

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