'Five years of flat line funding has hobbled the NHS. Another five years will cripple it'. Who said that? I did. Last year... pay attention!

Labour is now saying something similar; another five years will finish (the NHS) off, altogether. They have published 27 pages on the future of the NHS. For the bobble hats it is full of well researched, referenced data on NHS failings.

Labour plan loads more staff (a lot of which are already in training), more money but no explanation how they'll attack the �30bn gap (although more information is promised in a costed plan). Pretty much a Conservative blue-print turned into a red-print.  There is an argy-bargy over the accuracy of some of the data concerning the role of the private sector. However, the real differentiation is the Labour plan to repeal the Health & Social Care Act... something which will produce a collective hurrah from most of the 1.3m voices in the NHS.

Repealing the H&SCAct means the end to Monitor, CCGs, TDA, Clinical Senates and the troubled CQC whose demise will raise another collective hurrah. It looks like the Carbuncle will go, too. Chaos? Yes. What's going to replace it all? Dunno; it's a pig-in-a-poke policy.

The Tories have trashed Labour's plan in terms we will all become accustomed to; 'a strong economy means more money for public services etc., scaremongering and all the rest.'

The election result will be close, we know that. The smaller parties will make demands neither Labour nor the Tories will agree to; UKIP out of Europe, SNP another crack at breaking up the union, the rest won't have enough votes to matter and too difficult to corral. With no coalition doable I predict, pressure from the markets will result in, after the mother-of-all negotiations, the Tories and Labour will form a government of national unity. The next secretary of state for health will be Yvette Cooper.

This is what she needs to fix:

• A proper workforce review. Encourage Trusts to design and train new posts themselves, in-house; super HCAs, hospitalists, medical assistants, super-DNs.  Pharmacists retrained to diagnose and treat LTCs on their own. Forget clunky HEE, NMC, GMC and Uni's. They are all based on workforce models that are no longer sustainable. Stop thinking organisations start thinking organic workforce.
• Encourage FTs to start 24hr GP surgeries in A&E departments; sidestep primary care, it's too stuck in its ways, tied to buildings and in thrall to incentive structures to change.
• Virgin will contract their exposure and like Serco slowly withdraw from disastrously unprofitable healthcare contracts. Yvette will need a Plan B.
• 80% of Trusts will be in quality or finance problems; targets, finance and made-up quality thresholds will, increasingly, be breached and top managers will walk away. There is a need for recalibration. Decide just 'three things' we want Trusts to deliver what is properly measurable and comparable. Circle will hand back the Hinchinbrooke franchise as losses hit �5m; another Plan B will be required.
• Look at the solvency of health economies, not just organisations breaking even.
• A major shake-up on NHS complaints and whistleblowing is required; set up an independent body 'NHS-Listens' to manage and resolve them, follow through and interpret data for trend analysis.
• Follow Jersey's example and integrate the NHS with the paid-for Babylon App, allowing access to GP care 24-7 on a smart phone.
• Find a major call centre player to enter the health-telemedicine sector and set up regional call centres, managing patients with long-term conditions, lift them away from primary care.
• Impose a cost-cap on locum and agency staffing procurement costs.
• Side-line PHE and get moving on sugar, smoking, obesity and alcohol. Something ruthless will do; Draconian would be better.
• Have NICE lead an EU wide lobby for a longer pharma patents. Allow longer to amortise investment, in exchange for a deal bringing down retail costs of new drugs.
• Encourage Amazon to undercut the medical supply chain, driving price and convenience and get them to establish a home-delivery electronic prescription market.
• End national pay bargaining; leave it to employers to settle locally and use the freedoms to reshape the workforce.
• Work towards vertically integrated care financed by population based, capitated budgets.  Forget the tariff.
• Move social care for the elderly into healthcare; just do it.  End2End integration of care is the only solution.  Get on with it. 

That'll do for the first week. I'll have a think about week two. 

------------------------ 

What's the future for primary care?

If you want to know, too, join me, the NHSE Primary care Tsar and Deputy Medical Director Mike Bewick, leading GP Dr Clare Gerada and the president of the NAPC and former policy advisor Dr James Kingsland, at the Kings Fund for a night of

 The Big Conversation about Primary Care. 

  Details here. 

--------------

[email protected] 

Know something I don't - email me in confidence.

Leaving the NHS, changing jobs - you don't have to say goodbye to us! You can update your Email Address from the link you'll find right at the bottom of the page, and we'll keep mailing.