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I’ve never really understood why Alan Milburn is regarded by some as the great doyen of everything NHS.
For me, he's less St Saviour and more Jumping-Jack-Flash.
He was secretary of state for health when we were driving a Vauxhall Vectra and Glenn Hoddle was England football manager.
Over last weekend he joined in with the… ‘we can’t keep giving the NHS more money’, schtick.
When in office, he saddled the NHS with billions of PFI debt and almost succeeded in turning FT hospital into not for profit businesses.
He's conveniently forgotten he was given ‘more money’… something which he now has the brass-neck to deride.
Blair gave it to him, shedloads, a whopping increase… and guess what… NHS performance perked-up and waiting-list come down.
He introduced a labyrinth of competitive tendering to underpin the concept of patient-choice. It turned into gold-plated bureaucracy, cost a fortune and delivered no discernible improvement in quality.
And, we learned an expensive truth, patients are not that keen to travel for treatment and if they do, it’s principally to where waiting lists are shorter… and we all know they’re long, everywhere.
Milburn tried to decentralise decision making with dinky primary care groups, some no bigger than a bridge-club. It took forever to transition them into something big enough to do enough. The up-shot was to reinforce inconsistent service-levels across regions.
The Milburn years… the muddle years with targets that missed the point and morale that plummeted.
Now, he’s back. Streeting is not old enough to have suffered Milburn’s jumble-sale of initiatives, neither to understand the difference between talking a good game and actually playing the game… and winning.
For some bonkers reason Silly Boy has appointed Milburn to the largely superfluous Department of Health Board but it does give Milburn license to tell us how stupid we all are.
Streeting, who himself asked for more money in the recent budget (please try and ignore the irony) squeezed £23bn out of the Treasury.
The NHS’s underlying financial pressures mean that a large portion of the £23bn will go towards closing the current funding-gap, covering the increase in staff salaries, managing escalating day-to-day costs and work flowing through the system.
Streeting’s talk of reform is a fog of meaninglessness.
Get run over by a bus; gangster or granny, millionaire or malingerer the NHS will pick-you-up, fix-you-up and get you up on your feet again. Which bit of that do you want to reform?
Talk is cheap.
What the NHS is in desperate need of is, modernisation.
Which is not cheap.
New IT, machine-learned diagnostic support, diagnostic equipment, IT interfaces that patients can use as easily as FaceTime, demand forecasting, admin systems that don’t create more admin and buildings that are safe and easy to maintain.
Labour was elected to reduce NHS waiting-lists. Streeting knows he can’t. Hence the distraction of consultations and ‘reform’.
No discussion required. Streeting’s life is full of ‘gets’;
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Get an ambulance at least as quick as a Deliveroo pizza.
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Get to talk to a doctor, not a pretend doctor.
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Get a diagnostic as fast as an MOT.
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Get fixed-up with an appointment at least as quick as you can book a cut-and-highlights.
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Get people back to work and on with their lives.
That’s what Streeting has to get on with. Get delivered. Get right, first time, all the time, but…
… we all know he won’t until he gets social care sorted out…
… vulnerable older people are disproportionately the highest cost and highest users of health and care systems. They are likely to have the longest length of stay and be the trickiest to discharge safely.
Look after them better and they’ll need less care and that means more domiciliary support and fixing social care…
... and…
…children, the second highest users, especially the under-fives... for preventive care, immunisations, treatment of common childhood illnesses, respiratory infections, injuries, fevers, acute illnesses, help for mums and dads and accidents…
… giving them a ‘Sure-Start’ will reduce demand.
Streeting has to learn he cannot define himself through other people. Wrap himself in consultation and committees. Hide behind has-beens.
He must step forward…
… NHS people have to know what he stands for, what he wants, how and when.
Streeting is not a natural leader. He uses authority instead of insight. The uses the power of his office, instead of capturing the power of his people.
This week, his upcoming speech must define him. Find a maturity that is missing. Create clarity out of his confusion. Blend reality with optimism. Hope, underpinned with helpfulness.
We’ll find out if he’s any ideas of his own. Any imagination.
We’ll find out what he’s made of.
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