Yesterday I watched Health Secretary Jeremy Hunt doing his stuff in the House of Commons, announcing the Lewisham decision. If you read his early-career CV you'll see he didn't have much luck selling marmalade. This time he's hoping for better luck with fudge.
What can he do but fudge the whole issue? He's stuck with two disastrous PFI deals (Private Finance Initiative), too many patients and no money. Whatever he does people will still be out on the streets. He's stuffed. And so are the good people of Lewisham.
He knows there are probably as many as ten other places in England where he's going to be faced with similar problems. There's not enough money to shift around the system to keep services open. His only alternative is to close stuff and shift the patients around the system and get NHS Medical Director Bruce Keogh to say it's OK. He's stuffed. (And so is Keogh). He can't expect the Treasury to come up with any more money because the economy is stuffed.
Robert Francis reports next week; he's going to want to demolish just about everything and unpick chunks of Andrew Lansley's lunatic reforms. Hunt is going to have to juggle all that. Again he's stuffed.
Earlier in the day the King's Fund's John Appleby was unveiling his 68 page bodice-ripper; 'Spending on health and social care over the next 50 years'. Central message; we're stuffed.
"..... policy options should include the quantification of possible trade-offs with other government spending. They should also consider the scale of the possible impact on tax and borrowing. Analysis of the distributional, access and health consequences of any moves to change or supplement the current funding base of the NHS and long-term care need to be part of this debate".
.... Err, this is uncharacteristically opaque for Appleby but I think he means, act holistically and persuade other government departments to give us some money? Bad idea; they're stuffed, too.
Around the same time as all this, the London School of Economics Growth Commission report was published. It says:
...at the beginning of 2013, the outlook for the UK economy remains highly uncertain. Output has been depressed for a longer period than it was even in the Great Depression, with GDP still below the peak level of early 2008.
This means we're all double, triple stuffed.
I think Hunt needs to act and act fast. We need an NHS Emergency Powers Act with five sections.
Section one; PFI. It's only about 2% of NHS turnover but in some places it is totally unmanageable. The NHSEP Act would allow Hunt to leave the PFI debt with the Trusts but deal with the payments as interest bearing debt and as one global sum by adjusting the tariff. Effectively, sharing the pain across the NHS. This would provoke an outcry from non-PFI places but he'll have to ignore that and act in the national interest. If he doesn't more Trusts will close, run out of money or end up with useless blue-light-lite services and more disaffected voters.
Section two; dump the market. Everyone knows the costs-in-flow around Monitor, staff, overheads, advertising, tendering, procurement-specifications, pre-qualification, evaluation, conditions, performance bonds, lawyers and all the rest of the hoop-la will never deliver savings or efficiencies to match the costs. Go to Scotland and ask them to be kind enough to show us how to run and NHS without a market.
Section three; the quality crisis. Scrap the CQC (Care Quality Commission) use the money to reinvent Community Health Councils. They are cheaper, local, know the plot, the players, the issues and the patients. Give them draconian powers of access and make them handle all complaints in three months top-whack. Introduce a license to hold public office for Board members.
Section four; give the private sector a sensible exit route. Not because they can't do the job, or for ideological reasons. The simple truth is there is not enough money in the system to give them a profit without cutting corners, deskilling and slashing staff numbers. There will be insurmountable quality grief and damage to brands, not least the NHS. They'll have Hunt over a barrel, pester for more money or fiddle with contracts. In the end they'll walk and the NHS will be in the lurch. Encourage staff, now, to take over services as social enterprises and give them the money and management support to do it.
Section Five; dump the Carbuncle and its ludicrous wage bill. Its line of command is too remote and will only be fixed by evermore expensive and labyrinthine layers of bureaucracy. Take temporary responsibility back to the DH until finances and the future are more stable. Then decide.
Hunt knows, Appleby knows, the LSE knows, Francis knows and every front-line worker, nurse, doctor and NHS manager knows; if we carry on the way we are, we're all stuffed.
This article originally appeared at NHSManagers.net