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8th July 2013 

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Brave enough 
News and Comment from Roy Lilley
The Twitterati were all of a flutter on Friday.  The HSJ reported data Wallah Tim Kelsey let slip at a conference the NHS would have to save �30bn in the next spending round up to 2020. (Subsequently reported in the Guardian)

I've been saying this for ages!  Those of you who have been kind enough to turn-up and hear me speak will recognise this slide:
A Bigger problem 
The yellow triangle is the �20bn Nicholson Challenge we are struggling with now.  You will see the period 2015/6-20 creates a shape that swamps the Yellow Triangle of Death and creates 'the Big Blue Bit of Doom'?

Five years of flat-line funding has hobbled the NHS.  A further five years will cripple it.  You can see, even with heroic improvements in productivity, the damage is done.

Richard Douglas, DH boss of blah and Finance is quoted in the BMJ June 2012 by John Appleby; " ...the drive to find further efficiency savings in the NHS will continue after 2015, with the total savings rising from �20bn to a possible �50bn by 2019-20". This is a blunt admission of the long term impact on public services of the banks nicking all the money.  What do we do?

 

Here are some options you're gonna lurve:

 

The big costs are people.  Slash wages, salaries and fees.  Abandon national pay bargaining.  Leave it to employers.  The NHS is the principle employer of doctors, nurses and other professionals who have few alternative employment options.  A 15% cut across the board would send the Unions ballistic but if the Government was determined enough they might get away with it...   

 

Revolutionise primary care.  Turn the whole thing over to nurses with referral to a GP the last resort.  GPs cost a �gazillion, self-employed but treated like employees for pension and other rights are expensive managers of CCG budgets.  We simply cannot give them more money.  There would be an outcry but these days the BMA has very little influence and after Lady GaGa the RCGP will be a push over. 

 

Dump pharmacy do everything like Amazon - on-line.

 

Collapse primary and social care into secondary care.  Create vertically integrated Total Care Organisations, run by FTs with population based, capitated budgets, with local 'Wellness Targets'. 

 

Merge health and social care?  Might save 5% management costs but doesn't fill up the Big Blue Bit of Doom.  People still have to be looked after.  But, every mickle makes a muckle. 

 

Limit treatments such as IVF and what not?  This delivers azure when we are talking cobalt blue.  Ten quid to see a GP, everyone paying for prescriptions all that malarkey just about adds up to lapis lazuli...  but, every little helps.

 

Create a care base-line; charge for the rest.  There'll be a ten year row over what constitutes 'base-line'.  The Oregon experiment in the US ground to a halt.  And, think about it; take taxes out of the right hand pocket for healthcare and cash out of the left hand pocket for top-ups; it's still your trousers.

 

Dump the hangers-on.  There must be 50 organisations with NHS in their title.  Close Monitor, abandon the market, close the CQC and sprawling NICE.  Scrap the GMC, NMC and all the rest of the hoop-la and make the employer responsible for their staff and providers stand-by their services.

 

Insist on a 15% price-cut from pharma and every other supplier.  Some would go broke and others consolidate.

 

Greater use of the private sector?  No, the idea was banjaxed when the economy went down the toilet.  The private sector can't make a margin.  Anyone who cares about their brand-value will run a mile.

 

Halve the number of hospitals?  This diverts flow but doesn't do anything about demand.  Reorganise the estate around specialised care-flows; elderly, heart, orthopaedics, maternity to tailored units and you might have an efficiency gain.

 

Greater use of IT; dump bureaucracy?  Might shave 2% efficiency but we'll still need info and data.  Smarter to invest in making it easier to capture data.

 

Reduce the number of patients; make people more self-reliant - probably a generation away.  Not a goer now.  Make everyone between 25yrs and 45yrs pay for everything other than emergency care.  All maternity care to be paid for by the father?

 

Charge for ambulance services - insure for personal risk.

 

I expect you can think of a dozen more equally whacky ideas but at the end of the day, the Big Blue Bit of Doom is huge and getting bigger.  Whatever we decide has to be good for sixty years. More people are going to need more care.  Sustained improvements in NHS productivity, even at 5% don't deliver enough to fill the Big-Blue-Bit-of-Doom.

 

Here's an alternative thought.  A penny on income tax raises about �4.4bn.  How about a deal with the NHS?  A hypothecated NHS Tax-4-Savings deal?  The more efficient it gets the more money it gets.  It could be a good bet for the NHS.

 

Do we have a politician brave enough to suggest it?

 

Join in and comment on the Manager's Network Forum now.

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Lots of interesting comment from readers NHS@65, Bullying and entitlements.
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Up-Coming Conferences
>>  Productivity increases - story here; this will come as a bit of a blow for LaLite.  His policy is to make us all think the NHS is coasting.
>>  Le Tache - the man too posh to use the NHS tells the HSJ how he's going to fix it for the great unwashed.  Should we be grateful?  Touch your forelock as you read this.
>>  LaLite 'refreshes' the Mandate - I thought the idea was to keep him at arms length.  More targets that are not really relevant but play well with the Daily Mail and some more on Mental Health (over-due) but looks horribly bureaucratic. Full document here.
>>  Carbuncle managers and CCG bods - dodge fit and proper person test.  How can anyone justify this!  (HSJ Exclusive Shaun Lintern).
>>  NHS at 65 - Polly Toynbee.
>>  Heroic or what - 2 Doc's run 65 miles to cerebrate 65 years of the NHS.  They ran to Spit-Spot's constituency to 'highlight damage being done by LaLite's reforms'.
>>  Rally outside Downing Street - NHS reform protest; isn't it strange how none of this, about our-NHS gets onto our-BBC.  The BBC had no national coverage of the 65th Birthday Celebrations.
>>  Shirley Williams says - charge for visiting the GP.
>> IpsoMori - InfoGraphic on the NHS at 65; really good must look.
>>  Named GPs to have 24hr responsibility for elderly - LaLite's latest Daily Mail pleaser.
>>  King's Fund - fancy being a 'Fellow in Health Policy'; they have a vacancy.  Think I might apply!
>>  Monitor - Storify on national tariff proposals.  Neat, well done.
>>  MPs are revolting (!) - over A&E cuts.
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