Let's say you were running a business... just pretend. Imagine you are in your mahogany lined office on the 35th floor and you hear a timid knock on the door.
Enter the chief operating officer. Slightly stooped, he produces a spotless white handkerchief and nervously polishes his gold framed spectacles. He slides a spreadsheet across the desk, clears his throat and says, quietly; 'These are the branch numbers for the last quarter.....'
You discover none of the branches have hit their targets and 80% of them are running at a loss. The COO takes a pace back and waits for your reaction.
There are several things you could do. You could reach into the top right hand drawer and take out the Smith and Western, pearl handled .38 and shoot him. Shooting the messenger is a time honoured way of dealing with bad news.
You could dismiss the COO, open the cocktail cabinet and pour a glass of Macallan M, from its Constantine decanter and roll the buttery creamy gold around your tongue; take in the brown sugar, spiced custard, marzipan, butter icing and sultanas undertones. Relish the rich dried orange peel, fragrant sandalwood, spiced butter, riverbank earth, damson jam and tingly spice flavours; feel it slide effortlessly down your throat ... and shoot yourself.
Other options are to call a meeting of the branch managers and beat them up, plead with the bank for more time and money, embark on a programme of cuts, sell the loss makers for their asset value and escape with your shirt. Or, you could hire someone to do a root-cause analysis and see what needs to be done to save the business.
The business in question is the NHS and the numbers come from Monitor.
In summary: 86 FTs reported deficits totalling �227m; �391m is being spent on contract and agency staff; cost savings are �58m less than planned; 28 Trusts are subject to enforcement action; 9 FTs are in special measures; 29 have breached A&E targets and 27 missed cancer targets.
If this was a business it would be broke. It is over-trading; doing more work than it is funded for, keeping customers waiting, risking quality and complaints, damaging the brand and overheating its bank account. Solutions; trade less and at a premium if you can, refinance, buy time from creditors, reduce inventory and cut costs without impacting efficiency.
The NHS is trying to stop overheating by slowing patients through the system creating waiting times. It can't refinance because political hubris or political dogma gets in the way and they won't admit there isn't enough money despite the OBR forecast. Flogging off doesn't work because there's not enough money for companies to make a margin. The root-cause analysis is being done by Tarzan who, with Monitor and the TDA, is having a private meet with all the Trust bosses over the next few weeks. Beating up the branch managers, so to speak.
At the heart of the problems is the nurse/workforce issue and everyone ignores; when the current cadre of FTs were seeking FT status many of them balanced their forecasts by understating their staffing costs. Monitor didn't spot it. Consequently the Unis are not training enough nurses for today's demand and Trusts are spending fortunes on agency staff or overseas recruitment.
It's Monitor's job to sort this out. David Bennett, Monitor CEO, says trusts should 'get a grip' on their staff costs. That's rich coming from the man who hadn't noticed his chairman had run up fortunes in cab bills... riding a few hundred yards and paying a king's ransom for the privilege and himself, earns �230,000. How much grip would you like? Bennett is a busted flush.
We all speak of the NHS in poetry but when it comes to managing it... a lot talk rubbish.
There are three things we might do: the first is a cross party agreement to make the NHS 5 year forward cash-settlement know, now. It is not fair to make the NHS struggle-on in the dark. Managers can't do what we hire them to do; plan, strategize and design the future.
The second; accept a hypothecated health tax is the fairest, quickest way to give the NHS some immediate headroom, to carry out service redesign, but trade it off with nailed-on levels of efficiency gains through innovation.
Third; recognise central organisation is a bad idea and let people figure out locally what works for them. Forget FT status, dump the TDA, the market, snout-in-the-trough-Monitor and roll the Carbuncle back into the DH.
If we can't do that, reach for the Smith and Western and point it at Whitehall.
