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No such person
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News and Comment from Roy Lilley
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Last Friday, when I wrote about MOTO-Man, I intended a tongue-in-cheek dig at our 'leaders' who are so good a describing the NHS's predicament but nowhere near good enough at describing the way out. Confed delegates wrote to me, by the bucket load and in no uncertain terms!
What I thought would be a bit of controversial, amuse-bouche, for a dull Friday turned into a full scale 'things could only get worse' and the NHS was looking down both barrels of a full scale denationalisation.
More than one thoughtful reader pointed out that my draconian predictions were aimed at NHS structures; what about the patients? Well, that's easy:
Being pregnant is not an illness, it is a condition; uncomplicated, maternity care will have to be paid for, by the father. Similarly IVF.
All prescriptions to be paid for at full price. The NHS is a diagnostic and treatment service and that's all.
GPs, may charge up to £55 a consultation - it is up to them whether they do or not. This will help to create a market. Like Specsavers who don't charge for a sight test.
One in three A&Es will close and all waiting targets abandoned. The queues will discourage time wasters and create a market for efficiency.
Patients will be charged mileage for the use of ambulance services. This would make houses near hospitals increase in value and help the economy.
Lifestyle related illnesses to be treated at the option of the NHS, based a test of the individual's 'economic usefulness' to the nation.
Admitted patients will get B&B only, all other meals to be provided by relatives or social services.
..... now, if you think this is farfetched, have a look at what is happening to the Greek NHS. More important, given our post 2015 financial predicament, who will stop it happening here?
Delegates at the Confed tell me, apart from a general 'shifting deck-chairs on the Titaninc' feel to the conference, they left not knowing who is in charge of the NHS? Monitor, the CQC or The Tash. None of them seemed to be able to decide who is in charge?
They talked about shared leadership and dual roles and all the other Mickey Mouse palaver, common among people unwilling to cede power by stepping back and say, 'you do it', or the courage to step forward and do it themselves. They danced around their handbags.
Is Monitor in charge? No, it performs a Tango with the CQC. Is the CQC in charge, no, they Paso-Doble with Monitor. Is the NHSCB in charge? No, the Carbuncle Waltzes the commissioners. FTs are beyond their reach, as are the majority of community services, locked in a Rumba with the private sector, adjudicated by Monitor and unbeholden to the Carbuncle. The leadership of the NHS is reduced to a game of pass the parcel.
Is LaLa in charge? No. He is limited to whatever he can choreograph in the Mandate. The Mandate is delivered by the Carbuncle and that partly depends on marching in step with Monitor and the CQC. The Mandate is an annual document and that puts us a year away from knowing if it has been delivered, two years away from a fix if it hasn't and three years from knowing if the fix has changed anything from year one.
So, who is in charge? Who will prevent patients being required to bring their own bed linen and bog-rolls to hospital? Who will say 'stop' when someone suggests end-of-life care is limited to 48hrs?
Can someone tell me - who is in charge? It's a simple enough question!
The NHS has no leader, no Mr NHS, no boss. People manage bits of it. Top management is often portrayed in the context of leadership. Wrong. Mangers have authority and take executive action, that's easy. Real leaders are people like Martin Luther King, or Ghandi, who had no power only influence through ideas and character. They were visible had a vision and shared it, often.
The NHS has no such person.
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roy.lilley@nhsmanagers.net
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