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Wes Streeting is busy polishing the headlines.
… and to be honest, compared to what is in Downing Street right now, his performance on the media rounds last week was impressive.
Having a husband that is a PR guru is a bonus, but…
… being good on the telly, on a single, well rehearsed issue, for me, doesn’t quite tick the nuclear-button box, fixing the small-boats box, nor the economy, neither the NHS box nor... waiting lists.
If he wants to run the country, let’s see how well he is doing, running the NHS.
The last round of strikes were settled when he, effectively, bought-them-off. An expensive deal that gained nothing for the long-term and guess what…
... here we are again. Apart from turning into Steve Barclay, this time he hasn’t a clue where to turn to fix them.
We know the nation is skint so, Streeting can’t throw money at the problem. This time it will need skill, diplomacy and experience.
All of which strike me as missing and... inexplicably, he refuses to go to ACAS.
His policies got us into this and the NHS have to deal with the fall out. The NHSE Board should have an urgent come-to-Jesus meeting with him… before his hubris does more damage and...
… jeopardises efforts to reduce the backlog in elective care. Streeting's forgotten; one of the three principal reasons Labour was elected… fix;
- the economy,
- boats and
- waiting lists.
Machiavelli whispers in my ear; these are Starmer's failings and if he gets the heave-ho, we know who benefits.
Despite Streeting's claims to the contrary, nearly 3 million people on the +7m waiting list haven’t seen a clinician or had a test. Stuck in limbo, which raises serious questions about access, equity and what waiting-list numbers actually mean.
The brutal fact is each month, roughly 1.5m people join the NHS waiting list and a similar number complete treatment and leave.
NHSE managers are faced with improving hospital performance and at the same time shifting care out of hospitals, into the community. With no budget, no plan, and...
... some hospitals will be running the local health economy... make sense of that!
Streeting has no idea.
History tells us, pushing for faster elective care will entrench hospital power and resources.
The abolition of NHS England was poorly handled and risky. Rushed and chaotic.
Announced without adequate preparation and has created major uncertainty.
Streeting does not appear to understand...
...his reorganisation will consume huge focus and resources over the next few years… just when he needs to deliver performance improvements.
There’s no proof, in fact privately senior NHS people say; ‘real doubt’ that the structural change will necessarily lead to better performance. Especially in the short-to-medium term, before the election.
Streeting has undermined non-clinical and management staff, which is counterproductive.
The Darzi report (which Streeting deified) spelled out (page ten) the NHS was under managed. International comparisons tell us the same.
There are fewer managers per clinical staff now than in 2010.
Despite this, ICBs must cut staffing spend by 50%, by Christmas. NHSE are turfing people out... but they don't know who.
Without sufficient administrative and analytical capability, trusts lack the capacity to track, plan and improve performance.
Streeting has put morale at risk… managers feel undervalued and insecure in their jobs… in the midst of reorganisation.
10-Year Health Plan has big ambitions with no plan for implementation. NHSE is scrambling to make sense of it… on top of being reorganised.
The plan is a brochure of nice-to-have… prevention, remote care, non-existent technology, a virtual concoction of neighbourhood health centres and multi-year budgeting.
Streeting is depending on technological promises that will make little difference.
For instance, claims that voice-capture tech will generate more GP capacity, are wildly optimistic. It will simply make the day job a bit easier and is unlikely to create real headroom for increased throughput.
Nothing that Streeting has instructed for comes with a plan, money or insight.
There is no coherent, roadmap. He has surrounded himself with people who cannot, or will not tell him he is a dangerous fool.
It gets worse; contradictory forces now mean, to save money, NHS treatment capacity that could be used to deal with waiting lists, will stand idle, for fear of overspending.
These are not just technical issues or ethereal management thinking...
... they strike at the core of whether Streeting’s reforms can deliver real
improvements or whether they’ll be derailed by poor planning, under-resourcing or misaligned incentives…
... all of which is highlighted in this excellent report from the highly respected, independent, Institute of Government. It's a cuppa builder's read.
The tension between short-term performance targets and long-term system reform is a central, contradictory risk.
The institutional shake-up a further risk, that will absorb political and managerial energy and a distraction from core service delivery.
Streeting is grandstanding, creating rows with key staff, anxiety, chaos ... with no delivery architecture. The NHSE board must rein him in.
Streeting in Number 10… yer ‘avin a larf!
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