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Streeting’s plans were blown apart last Friday when Sir Jim confirmed to an online meeting of staff, ‘a major delay in the restructure of the NHS’;
It will be 2027 before anyone moves and redundancies will take place over ‘a number of years’.
Reason? Regular readers won’t be surprised; the Treasury has refused to fund the £1.2bn, estimated costs of redundancies.
Without the concomitant savings in workforce costs, there’s no money to implement the Ten Year Plan…
… plunging our NHS and its people into uncertainty, insecurity and anxiety. Mackey is due to say more on the 8th October.
A policy without a plan is just a wish list…
...a plan without a pathway is just a brochure....
... a policy, a plan, a pathway without funding is, well…
… ridiculous.
Labour was elected against the background of nine, major global pressures;
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Covid and the backlog; capacity and workforce pressures.
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Russia’s invasion of Ukraine; energy price shocks, higher commodity costs, triggering a cost of living increases.
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Global and UK inflation; higher interest-rates and tighter public finances.
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Supply-chain; cost pressures.
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Ageing population and rising chronic disease burden; creating a steady growth in demand for complex services
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Social-care effectively collapsed; creating a multiplier effect.
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Climate change and extreme weather; increasing unseasonal demand on NHS services.
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Geopolitical and macroeconomic uncertainty; trade tensions, migration flows affecting access to labour markets for all public services.
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Internal workforce discontentment; unprecedented doctor and nurse strikes.
All this was known in July 2024 when Labour won a landslide victory and they...
... promised to guide the nation through the nine perils... be a safe pair of hands.
A thin set of NHS manifesto promises, the principle of which, to ‘reduce waiting lists’… and eight months later;
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12 March; not in the manifesto, ICBs and parts of the system were instructed to ‘halve running costs’. Major corporate cost reductions to be delivered from October.
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13 March; out of the blue, the Prime Minister announce; abolition of NHSE, merging its functions into DHSC.
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3 July; Streeting published, late… the ‘Fit for the future, 10 Year Health Plan’, with no implementation details, risk register or funding.
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September; news and other reports indicated the Treasury signalling its refusal to underwrite the full one-off redundancy bill for the rapid job cuts…
… all of this has got us to where we are this sad, Monday morning.
We know that Streeting will claim financial black-holes, Uncle Tom Cobley, Rasputin and the kitchen sink, but…
... all of this was known before he embarked on his reckless, unfunded, unthought-through, nincompoop stupidity.
'A Stupid person is a person who causes losses to another person or to a group of persons while himself deriving no gain and even possibly incurring losses. Such people are difficult to deal with as they are not rational...'
(Carlo Cipolla, borrowed from this month's, Roger Steer's, excellent European Digest)
The financial instruction to deliver very rapid, deep, running-cost cuts in ICBS and NHSE, plus the pressure on Trusts to plug holes in NHSE’s finances, was known to be in the system by spring 2025.
Redundancy costs are a one-off hit. The plan to turn them into recurring savings, cut no ice with the Treasury.
They knew, in an NHS where demand is growing, years of neglect in modernisation and maintenance and struggles with productivity means…
... workloads will increase and the voids created by redundancies will be filled with expensive, temporary workers and consultants.
By mid-2025, the macro picture was known to be grim. Weak growth, sticky inflation, global instability.
Treasury orthodoxy is to avoid large up-front spending that increases borrowing in the short term and...
... we are already borrowing to pay back the interest on our borrowing.
Global shocks, the increases in the defence budget, the inability to create savings through welfare reform and little room for tax-rises... is Labour's self inflicted, doom-loop.
Charmer and Silly Boy's NHS reforms were launched into an environment where cost pressures and demand, pull in opposite directions.
They can’t say ‘we didn’t know’. Nothing has changed. Actually, it’s got worse.
Ministers and DH+ knew the scale of severance costs and if they weren’t sure… I remember calculating the total for them!
Without a guaranteed funding stream from the Treasury this was a colossal error. An act of self harm.
The true art of management always comes down to ‘the best attainable in the circumstances’.
These are criminally, stupid and wholly unnecessary circumstances.
The future now depends on skilful, masterly, deft, nimble and agile management and somehow raising the moral of thousands and tapping into their good will... if there is any left.
As the Labour faithful gather in Liverpool, they have no need to ask why Streeting appears not to have a speaking-slot in the main hall. There is nothing for him to say, but...
... they have every reason to ask why the Prime Minister has buried the NHS in undeliverable policies, demolished any prospect of his 10YP and pushed waiting-list recovery...
... further out of reach.
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