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Let me introduce you to Peter Glazebrook.
He holds the 2024, impressive world-record for the longest leek…
… a 5ft 2.3inch piece of horticultural exotica.
How is it possible to have .3 of an inch, which is a measurement of imperial not metric? Who am I to argue with the Guinness book of records.
Note the spelling. Not ‘longest leak’, which fellow prostate cancer people will know, a long leak is something our exclusive band are expert in… or not.
There's another world record attempt on those leaks… the modus-communicatio of the DH+.
Pay-walled in the Times on Saturday and last week the stellar HSJ, both had leaks about what’ll be in the delayed nine-and-half-year-plan...
.. now on its fourth author.
Can I say 9.5 year plan? (Impetric… hybrid measurement).
Now that Alan Milburn is running the NHS, FTs are back. He’s having another go, at giving them another go!
Twenty years back they were the future. Bold, radical, local. They could borrow money, plan services around local needs, make decisions, flog-off their buildings. Independent…
… and that was the problem.
Independent... ouch! Nooo!
They cost a fortune to set-up:
- Incorporate as a public benefit corporation;
- establish a board of governors;
- reporting systems;
- undergo independent assessments and
- legal restructuring.
All up, for 150 FTs, call it £60m…
Plus… oversight infrastructure;
- Monitor (long gone) to approve licenses and regulate.
- Annual budget peaking at £60m (2014).
- Over a decade of operations call it £600m… including staffing, IT and overheads…
Plus…
…national and local training for executives and governors; public membership recruitment drives; external consultancy… call it £40m…
… £770m, it was only taxpayers' money.
What happened?
The DH behaved like a cross between the Gestapo and the Avon Lady. FTs ended up with all the freedoms of a scrap-yard dog.
The Treasury pulled the plug on borrowing.
A few stood out. Northumberland and Frimley, Wolverhampton, the rest relaxed into being ‘just Trusts’.
It eventually dawned on Whitehall the NHS was a collegiate organisation. Not competitive. As much as Milburn wished it otherwise, competition did nothing for quality and put up costs.
Labour let them fizzle out. FTs now sit round the table and behave like partners.
Their unique selling point, autonomy, became a liability.
The capital regime is national. The workforce plan is national. Pay is national. Targets are national.
What a surprise… it’s a ‘national’ health service.
If yer brother gets a service in his home town… you’ll want to know why you can’t get it, down-your-way.
FTs were built for a world that no longer exists. Reintroducing them comes with a contradiction. Streeting is closing NHSE so that he can run the health service. You don’t seriously think he’s going to let hospitals run themselves.
I suspect the real plan...
... vertically integrate primary care into the purview of FTs… as they have in Wolverhampton and elsewhere. It cuts the back and middle office costs and smoothes the care interfaces. Nothing is primary nothing is secondary. It’s just ‘care’.
Milstreet, (hybrid leadership) will pretend GPs could run the whole system if they want to. History says they won’t.
The next big leak?
The realisation that about 60% of people on waiting lists are there for a diagnostic or an outpatient appointment…
... a chunk of whom are post-procedure follow ups.
Wave goodbye to all those patients. They’ll be given a list of sinister symptoms to look out for and a phone number if they feel poorly… no OP appointment.
Wave goodbye to a nice little earner for Trust’s. OP’s earn an average £120 a pop. There were 124.5m last year.
It’ll appear to have cut waiting numbers. Our Great Leader will look heroic, until somebody sensible starts counting the ‘invisibles’.
Post procedure discharge involves a huge amount of pathway analysis and tariff redesign. Plus, risk management; high variability, depending on the patient’s age, demographic, access to solid wifi, awareness and acuity.
It’s already a thing and Sir Jim’s former Trust, Northumbria are doing it now.
When governments want to sell us a policy, they do it by making sure it's the only thing on our agenda, the only thing everyone's talking about…
… that’s why there are leaks about the Plan… it's called motivation by the impending event.
They preload impressions with highly selected images of the future.
We know, the 9.5 year plan will be a mix of; charity shop, second-hand ideas, a catalogue of stuff some are already doing and a headache for risk managers. What's missing?
The how and the how much…
… and without that, it's not a leek, it's a pickled onion.
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