Let me introduce you to the French Drop. Members of the Magic Circle, fear not, I won't give away your secrets.
The French Drop, sleight-of-hand, is a way of taking a coin from one hand, into the other... making it disappear. You can also make it reappear. Done well, it's magic!
Done badly and it's like listening to No18 on the BBC Today Programme prestidigitating with twenty billion quid... the 'extra' to keep the NHS running for the next five years.
It's an illusion; it amounts to about 2.9% next year and well under the 4% historical average, for subsequent years.
Let's have a look at how this misdirection is to be performed. Without any apologies to The Magic Circle!
The trick is based on a version of the French Drop;
... take the money away from secondary care and give it to hybrid, teams of high-end professionals, who will keep people out of hospital and pretend what you've taken away is still there, to pay for the same professionals to do the day job.
Good luck with that.
£3.5bn spread over 5 years, across 200-odd, CCGs, working with a system wide shortage of nurses and community staff and social care on it's knees... do the maths.
As the Nuff's super-sharp Sally Gainsbury tells us;
"This additional money amounts to annual increases that are broadly in line with the 3.4% overall that the NHSE is getting over the next five years
.....far from representing a big shift in funding towards out-of-hospital services, this money will simply allow GPs and community services to keep up with demand over the next five years... [and] is not going to lead to a significant change in the way that people experience healthcare."
A major part of No18's magic is to make admissions from care homes disappear. He's right but this is the wrong way to go about it.
Is it an exaggeration to say; care homes are becoming unfit for purpose? Nearly
half deliver poor quality care
. The original concept of a care home was giving elegant, elderly people a soft landing into a full-board future of tea parties and the White Cliffs of Dover.
Instead, over time, they have become full with very frail people, many with more comorbidities than you can count, increasingly including dementia.
These residents are way beyond 'care'. They need nursing for which the establishments are neither prepared for, staffed, nor trained.
Hence, at the first sign of a UTI, the flu, or a virus, they look at their insurance risk and ring 999.
The same is true of domiciliary care, staffed with well intended people, with, often, inadequate training, poor languages and pitiful pay.
All this points to a catastrophic failure of the CQC. It is they who are responsible for inspecting and regulating this patchwork of services many of which, in their own admission, exist on the brink of failure.
Solution...
- No care-home provider should be licensed to operate unless they have 24-7 nursing cover, full prescribing skills, an on the spot phlebotomist and expertise in tissue viability, infection control and a geriatrician.
- No domiciliary provider should be allowed to take our money unless it provides a weekly call from a community matron.
- All providers should be required to post a performance bond realisable in the event of poor service delivery or failure.
The CQC may tell you they cannot insist on this level of care. I'm not sure that is right but if it is, their Chair and Board should go, immediately, to ministers and demand to be given the powers, otherwise their existence is futile.
The care home sector may lobby against it and it is at that point we will find out what No18 is made of.
The care sector is on the brink of collapse, over-borrowed, under skilled and in, over their heads.
Bail out their care standards this year and you'll need more cash to do it next year and escalate year after year. Inflation will spiral out of control.
To stop this; require care homes to have higher levels of professional staffing to meet tougher registration standards and up-skilling.
The money? Use the £3.5bn for obligatory training for care providers in advance of a new, rigorous licensing programme.
It's not magic.
