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Medway…
... the North Kent Marshes… a painter’s paradise. A unitary authority. Rochester, Chatham, Gillingham, and Rainham, and a history stretching back to the Romans. Charles Dickens lived there and boogie -woogie-man, Joules Holland, still does.
If you want to know what the future of funding hospitals might look like, take a trip to Medway.
Actually, you’ll have to hurry… there may not be much of it left.
Kent and Medway’s NHS finished last year with England’s largest system deficit… £190.2m with support funding… £259.3m without it.
Something ain’t right and plainly has to change.
The proposed answer is breathtaking.
Medway Foundation Trust is expected to save £143.8m by 30/31.
That is over a quarter of its cost base… in effect... the money runs out on the 22nd of every month, but... the patients don’t.
To do that, it’s expected;
Let’s be clear. This is not an efficiency programme. It’s a different hospital.
Medway has the highest proportional deficit in the system, is rated ‘red' for capability by NHS England and is already in the national turnaround programme.
There will be waste. Productivity must improve. Difficult decisions cannot be avoided, but…
… you cannot remove one person in seven and pretend no one will notice.
There'll be fewer people to answer phones, clean wards, take blood, read scans, run theatres, dispense medicines, prepare patients for discharge and provide bedside care.
The plan to dig their way out of all this talks about shared corporate services, redesigned pathways, technology and AI.
All sensible. Some may save money, but…£144m?
Even the benchmarking exercise identifies only £114.9m of possible savings. Around £30m remains beyond the supposed ‘opportunity’.
Efficiency has become the NHS’s most abused word. It now means setting a financial target, calling the difference an ‘opportunity’ ... leaving managers to discover which services, posts and patients must absorb it.
The ICB insists this is a ‘system-agreed’ plan… says it wants to invest more in prevention, primary care, community services and mental health, helping people receive care closer to home and blah… blah.
Where are these services?
Medway’s own board papers point to low GP numbers, underdeveloped community provision and recruitment difficulties affecting the very workforce upon which this great left shift depends.
Worse...
... the detailed commissioning intentions are unfinished. The evidence chain showing that community investment will reduce hospital demand is incomplete. The benefits are described as ‘indicative rather than committed’.
And look at...
Background health, population forecast, social care, and think what a brilliant idea it is to perform an orchiectomy on the hospital's finances.
Moreover, they’ve calculated the staff cuts before calculating where the work will go.
The right and safe sequence is obvious.
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Build the alternative services.
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Transfer the care.
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Measure the reduction in hospital demand, then, and only then…
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Remove hospital capacity and money.
This plan starts at the other end.
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Take away the money.
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Remove the staff.
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Assume the patients will disappear.
They won’t.
They’ll still arrive at A&E. GPs will still refer them. Ambulances will still queue. Cancer will still need diagnosing. Frail people will still fall. Babies will still be born.
Demand doesn't vanish because it's been deleted from a spreadsheet. Nor does this upheaval reliably balance the books.
Medway reaches balance only in the best-case scenario. (I'll wager now, they won't because the time-line it too far away to make a reliable forecast)). In the worst case, it could still be £98m in deficit by 2030/31.
That should stop everyone in their tracks. This Trust is a prisoner of their geography, history and economy.
The hospital is being asked to take enormous risks with access, staff morale and patient safety…
... for a financial plan that may not work.
Most worrying is the attitude behind it…
... that existing hospital funding is money waiting to be redistributed, rather than the cost of treating people already coming through the doors.
Medway is a dire warning.
If this is how the ‘left shift' will be financed, it is not transformation. It’s the withdrawal of hospital care dressed in the language of reform.
Moving money does not move patients.
Cutting staff does not cut demand.
It simply ensures that when patients arrive…
… there are fewer people there to care for them.
-oOo-
Have the best weekend you can.
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