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6th December 2012 

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Not very well

News and Comment from Roy Lilley

I'm not sure I should be writing this.  My eyes are watery, my head is pounding and my nose could be used as a warning light in the Channel.  Made worse by an irritating, persistent dew-drop glistening at the end of it.  Yes, I have got a cold and I am very grumpy, irritable and grouchy.

 

I don't expect sympathy.  I'll get by; console myself with a cuppa-builder's and a Hobnob or two.

 

It's difficult to be cheerful.  The Chancellor's Autumn Statement is not much to smile about. One way or another it looks like the GPs will have to pay a few more quid tax on pensions, no one is getting a real pay rise and the economy is struggling.  As sympathetic as I am, the really important issue is the absence of economic growth; there will be less to spend on the NHS.

 

I'm wondering if we aren't entering an era where we can't expect growth.  There was a time, when we made things.  We created wealth.  Now we make cars and fridges and hope we can sell them to people who make their own cars and fridges.  The problem is; neither they, nor us, has any money.  We watch people get personally rich, but they don't create wealth.  Information technology adds value but not prosperity.  How will the the next era of national affluence will arrive.

 

If the 'post-growth era' is a reality, we have a problem.   

 

Up to 2015 the NHS is bouncing between flat-line funding and at least 4% growth in demand.  The gap, the so-called Nicholson Challenge, means 20bn of cost savings must be conjured to keep going.  I can't hear the money rattllng in the tin, can you?  The big question; what happens after 2015?

 

Nil, or poor economic growth means the certainty of more flat line funding for the NHS.  Against the inexorable background of compounding 4% growth in demand, the NHS is heading into unchartered territory.  Richard Douglas, DH Director of Policy, Strategy and Finance is talking about the possibility of 50bn savings being the reality.

 

If true it means redefining the NHS.  An NHS where expectant Mums pay for their maternity services because being pregnant is a condition and the NHS only does illness and accidents.  It means an NHS that only does B&B in hospital because that dumps the overhead costs of the catering staff and equipment.  It means an NHS where nurses pay for their own uniforms and an NHS where everyone pays for their prescriptions.  An NHS where a 20% pay cut through re-grading is put-up-with-it-or-go.

 

If you think I am exaggerating take a look at what is happening in France, Spain, Portugal, Italy, Greece and even Germany.  Systems under pressure; shrinking entitlements and access.

 

If you still think I'm joking have a look at the Nuff's numbers in their fabulous report about NHS austerity.  Austerity, savings, cut-backs, call it what you like.  I think 'redefining' is better.  It is the economy that will redefine how the NHS operates, what it does, who it does it for and where it gets done. 

 

More private sector?  I don't think so.  There is no margin to be made in healthcare; the tariff is too tight, deskilling too risky for cherished brand reputations.

 

Improvements in NHS productivity will never catch the line on the graph marked demand.  Reducing demand is a generation away.  We don't have the time and Public Health doesn't have the resource or clout.  Moving treatments out of hospital?  Shifting where patients are looked after is cost shifting; do a costs-in-flow calculation and discover the real costs of 'care close to home'.  Dumping the market, quangos, the Carbuncle and the detritus of the LaLa reforms still doesn't create the headroom we need.  

 

These are very tricky times for the NHS and I fear it may not recover.  Five years of flat-line funding has done irreparable damage, another five could finish it off.

 

Am I too pessimistic?  I told you I'm not very well but neither is the NHS.     

  ______________________

 

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