There are 217 NHS organisations providing secondary and tertiary care; 147 foundation trusts and 70 NHS Trusts.
Together, give or take, they employ over 1.1 million people, including, 117,000 doctors and almost 300,000 nurses and health visitors.
Before Covid, between them, in 2019, Trusts managed to rack up a combined overspend of £850m.
I mention that, not because of profligacy. Hospitals could not keep to their budgets because of ten years of near-flat-line-funding, staff shortages and rising demand.
Lack of workforce meant Trusts spent £1.8bn on agency staff, about £140m more than planned.
They over-traded. Meaning, they were obliged to undertake more work than they were paid for.
Financial jiggery-pokery fudged the year-end and the DH+ said;
‘… all trusts’ deficits would [be] erased by 2023-24.’
Getting back into balance? After Covid? It’ll need a fudge factory.
To make things worse, the NHS, to cope with normal demand, ageing population, developments, kit and caboodle, needs around a 4% pa, uplift.
The latest settlement (excluding Covid) takes NHS funding to around £160bn. In real terms, that’s about 3.8%… inflation is set to run to 9%, perhaps higher.
‘nuff said…
Oh, and as waiting lists are going through the roof, long-covid might give us 4m more customers than we bargained for.
To manage all this mayhem, each organisation, by statute, has a Board, that includes five non-executives and a non-executive chair.
That means each organisation has to find six talented people within striking distance of the organisation.
In total, thirteen hundred people, across the NHS, who have;
the time,
commitment,
can manage strategy,
priorities,
complexity,
risk,
values,
standards,
constructive challenge,
understand finances,
quality control,
renumeration,
external relationships and...
...stay well informed and across policy, guidance and national objectives.
What are the chances of finding 1,300 people who, with virtually no support or training, can put their hand-on-their-heart and say;
‘I’ve got this.'
How many of these good people have career experiences that prepare them for responsibility for budgets of hundreds of millions, that are never enough.
How many of these lovely people have experience of workforce issues, over which they have next-to-no-say, as to supply, terms and conditions or pay.
How many of these brave people have run a business over which they have no control of demand and almost no say over their supply-chains.
How many have experiences of organisations where plans and strategies can be upended, overnight by external forces, a dodgy headline in a news paper or a panicking No19.
How many have experience that will have prepared them for managing clinical risk and quality, that may and sadly has, ended in death, injury and misery.
How many really understand the intricacies of public sector finance, that has almost nothing in common with a normal balance sheet. Realise what fiduciary responsibility and the management of risk, really, really means.
Am I critical of NEDs? No, I am not.
I’m simply pointing out the impossibility of the task and how little the NHS does to prepare Boards for their unique task.
How many will be on top of subtle metrics like;
discharge variation at weekends,
exit interviews,
staff up-skilling and...
...the key to it all, 90% occupancy just about maintains flow… 91% doesn’t.
Not to mention, the ruthless management of set discharge dates.
When the Thatcher reforms turned a DGH into a Trust and gave us ‘Boards’, the expectation was, an influx of business brains would come in and run Trusts, in a business like way, within the envelope of the public sector.
I know because I was one of them.
I can tell you, as someone who had run businesses pretty-much, since leaving school, here and in other countries, nothing prepared me for the chaos, the complexity and...
... the admiration I felt for the executives who, each year, provide more health-care for less money, in an environment over which they have very little control.
If NEDs struggled before Covid; ladies and gentlemen, you ain’t seen nothing yet…
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This Autumn the IHSCM will be running a series of NED-Bootcamps, to help inform non-execs and develop their expertise. If you or your Board are interested, drop me an email...
... and have the best Bank Holiday weekend you can. 'Here's a health unto Her Majesty.'
>> I'm hearing - Dr Gail Marzetti has been appointed as Director of Science, Research and Evidence at the National Institute for Health and Care Research.
>> I'm hearing - NHSE will miss the 24,000 virtual beds Target. Data suggests more likely to have created 18,500 beds by 2023 deadline. I'm not too worried about this because the VWards, unless they are staffed and funded properly, are a risk for yer granny.
>> I'm hearing - The number of people claiming NHS pensions for the first time hit a record level in April... with early retirements at an all-time high.
>> I'm hearing - School nurses are witnessing an “exponential rise” in the number of children and young people with eating disorders. Mental health trusts say they are treating more than double the number of urgent cases compared to before the Covid-19 pandemic.
