The parlous state of NHS finances and getting change done

The parlous state of NHS finances and getting change done
The Kings Fund tell us we’re doomed etc


No news here.
Of note – lessons from history…….

Nearly 20 years ago, Wanless told us if we didn’t inject more money into the NHS we were doomed. To their credit, the govt of the time did so, but also introduced many policy innovations that you can directly trace to today.

We’re now back where we were 20 yrs ago?
Of note, Wanless also told us that unless we sort out social care and public health we’d also be doomed. I don’t know the extent to which social care was sorted – experts in such matters may comment. 
We pretty much ignored the public health recommendations tho, and continued to raid the PH budget to pay for hospital over spends

Plus ca change.
Back to now.

In the excellent KF block there is a powerful graph showing the rapid deterioration of finance situation


My quip (nb the word I’ve used) was that as its the whole of NHS that is increasingly in the red, this time round (unlike previous crises where there was some cash sloshing somewhere, and an SHA to broker it) it won’t be Monopoly money…. It will be real hard folding.
I suggested this was an opportunity to get big change done
Then was asked what change

It took me 7.2 minutes to come up with the list below. It’s only a start, but it’ll keep me busy for a while
1. kick pharma and device manufacturer influence out of policy making

Not just device manufacturers but also procedure. Eg variance in TAVI. 
2. fundamental change pact btwn citizen and state and pt expectation
3. tune down specialism tune up (with mega steroid dose) generalist

But need to be careful re the generalist, specialist pendulum

Partha Kar suggests that being overly aggressive here has nose dived Type 1 diabetes care in this country and that NHS really bad at tempering its swing..so we need to learn how far to go
4. vertical and horizontal integration. Population focused care

This is accountable care in another guise

It’s not a panacea

I’ll write more on this later
5. abandon NHS commissioning as currently incepted

Gulp

Tin hat on
6. shift from PRB to outcome modified capitation
7. Don’t over focus on one thing

Spread your bets

A single thing isn’t going to solve it.
8. Dont over focus on organisational form, org charts etc

Focus on CULTURE.

Doctor / patient

Citizen / NHS 

GP / consultant

Generalist / specialist

Clinician / manager 
Etc etc
9. Adopt an improvement methodology mindset.

Measure what matters

Act on your measurements

I could go on

And I know everyone else has their own ideas
Problem 

some powerful vested interests in the way here.

Someone lend me a steamroller
Thanks to 

@parthaskar  

@foxhedgehog

@ralanshirley 

For ideas 

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