I wasn’t going to write a blog. Poetry in the sun beckons. But I blame Ally for goading me on twitter.
It is always though a pleasant surprise to wake up to the latest nonsenses of Simon Stevens and his well-paid crew. Having seemingly had little success boshing the big boys in acute trusts through new care models, STPs, ACSs, ACOs and now commissioning alliances (not to mention the expense of all this rebranding and re-logoing)… he has pushed his new medical director to play bad cop.
The NHS is set to save £200m by banning useless, risky and unnecessary interventions. What could possibly be bad about that?
(Don’t get me wrong, a lot of that stuff is unnecessary, but it’s not quite so simple).
Well, for one thing it shows that NHS England has given up on trying to change systems, engage stakeholders and foster collaborative leadership, partnerships and transparency. In its increasing desperation it has adopted populist tactics that appeal to demagoguery.
Out has gone any pretence to involve communities, patients or citizens in discussions about rationing or prioritisation. Actually, money for that went a while back.
I get that as, to be honest, SS has never really understood how to do that listening and working together thing. To lampoon someone who has talked about harnessing the renewable energy of communities for co-production is too easy. The only renewable energy he could and should be harvesting is his own wind. Though I do have another option (see below).
What is a little more surprising is not his lack of integrity. That was always pretty obvious. But his boys thinking that a ‘just say no’ policy will work. Is he stupid as well as unethical? I could not possibly comment. All I know is his and NHS England’s leadership credentials are buggered.
As any good (or even bad) quality improvement acolyte appreciates, changes like this have unintended consequences. Firstly, all those hospital trusts who will potentially lose out on repeated income from, say costly orthopaedic interventions will cry foul and will begin again now to talk about ‘destabilising the health economy’. So, some of the big ticket items - the things he wants to happen - just won’t happen. Power is power – and that lies still largely with acute hospitals, medical professions and big pharma.
Secondly the temptation to blame those feckless patients for ‘demanding’ treatments will become irresistible. There is no money in the wider economy to pay for what people should have access to – support for well-being in the community, walking clubs, free gym prescriptions (let alone better housing). The money saved will not be spent elsewhere (it never has been) and people will be orphaned from any care and support whatsoever. But much easier to blame the victim and those who are powerless and in love with the NHS (and those who pay your salary, Mr Stevens). Loyalty and guilt are always a point of leverage for the privileged.
Thirdly, complaints will soar, frontline admin and non-clinical services will be flooded with complex conversations to be had. It will not be enough to print a few A5 leaflets saying in red bold 14 font that ‘you have a responsibility not to ask’ for unnecessary stuff. Comms campaigns will be rolled out (many comms leaders are on £100k plus) run by those friends of the NHS, like McKinseys. Money will be found, new branding imagined, infographics produced, breakfast seminars well-pastried.
Meanwhile, It has taken big pharma decades to build an industry that persuades docs to prescribe antibiotics to humans and your pet cat Tiddles. A few leaflets on ‘don’t ask for drugs’ has not stemmed the tide of a medico-institutional industry bringing a worldwide threat of antibiotic resistance to your child’s front door. Expectation and demand can only be solved by patients and citizens in dialogue and positions of decision making to bring about sensible upstream solutions. This is about power really.
But it is more convenient to be a dictator. This seems to be SS’s last stand. It has the hallmarks of a desperate man who has totally lost his rag.
But try not to feel sorry for him. He is on £200,000 and had a jolly period at the elitist end of the management consultancy market. His senior management team and many in regional offices and other outdated national and regional quangoes are not far short of that figure.
Add all those heads and transformers in national research bodies and the opaque world of AHSNs, Public Health England, CLAHRCs, Leadership Academies, Health Education Board, weird horizonal improvement agencies where infographically entitled instagrammers spout their absurdities... the loveliness goes round and round as they swap seats with each other.
Oh did I mention how much money the think tanks have? Sadly, that is not renewable, 'cos of no possible citizen say. However, one would like to imagine erstwhile philanthropists and royal endowment funders turning in their graves at the expense of raisin buns.
Meanwhile the benefactors of the policy and thought-leader (ha-ha-ha) industry continue their ghostly shift up and down glass lifts and continue to schmooze with Jeremy and Simon. And oh those reports repeating sad stats that fill shelves (just think of all the poetry that could sit there brimming with more insight).
All of which fantastical verbage reminds me of another potential route to help heal our (yes 'our') healthcare system. But that would mean also harnessing the renewable assets of that coasting under-performing workforce – national leaders.
The CQC costs me and you £200m a year. Coincidentally, that is precisely the amount that SS and his gang want to save with this ‘ban’ on treatments. There are 500 Trusts, CCGs, etc with each of their exec team earning around £100-£150k. 10% - 15% ‘leadership tax’ would save about £50 million.
Plug in the entire management team of the 50-100 quangos (including regional offices etc) and you could easily take that up to £100m.
So, a 10% salary cut for national leaders (allegedly) plus halving the budget of the CQC would save you and me the £200m touted this morning in the tabloids.
Theresa May, bless her, has chimed in that she wants to ‘listen to the people’ as to how these sorts of cuts can be made. Listening to the above? Mwahahahahahaha....
As I write this in my local café, the radio plays the Monkees' ‘Daydream Believer’.
Hey-ho. I’m off to write poetry in the sun. More effective. Certainly more fun.
© 2018 David Gilbert
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