Chris is Chief Exec of NHS Providers. This is their Influencing Strategy outline from their web site (see here for web link):
“NHS Providers’ policy development and influencing work is focused on promoting and protecting our members’ interests against a backdrop of a rapidly changing health and social care system, and an extremely challenging financial context.”
Their members include the vast majority of NHS Providers. It is the membership organisation and trade association for NHS acute, ambulance, community and mental health services that treat patients and service users in the NHS.
A health warning first. Roy Lilley’s Health chat at the Kings Fund with Chris Hopson had a health edge. Roy had managed to mangle an ankle by tripping out of a black cab in London. He crumpled in a heap. The taxi driver (“gawd bless ‘im”), said “how are you? (not good) “Would you like me to take you to a hospital?” (yes). But I don’t think Roy expected him to charge £15 for the lift! ( maybe we are not blessing him as much now…..)
This means Roy was in pain. And tie less for the first time I can remember (watch the whole event here, if you want to – see if you agree with my biases: see NHS Managers.net You Tube channel.) I expected him to be even harsher in the cat and mouse game of this cosy chat.. It was as eviscerating as normal. And as ever, if you know Roy, he gives people a harder time if he likes and respects them, I think.
But I have to say, the way they were chatting was quite depressing. This was a week before the amazing election result / the predictable election result ( did you like that?). We talked money, staff, STPs, CQC, CCGs, and the fact that it was all going to hell in a hand cart. There were lighter views. But, I remained depressed at the prospects for the NHS throughout the event. And honestly? I don’t think we should be that fearful. I will return, but just for once, I think I may have to give you far more of my ideas and views, if that’s OK, on top of the overview of the event.
We were in the midst of Election Purdah….which doesn’t really apply to the NHS itself, as Roy politely pointed out. We have become more and more fearful of these sort of suggested rules, I worry for democratic debate.
Let’s look at the highlights:
- STPs : are they damaged below the waterline already? There was a suggestion from Chris and Roy that the level of public connection and involvement was not at the right level to make it stick. My view? Get it on Facebook, and Twitter and have public presentations from the people involved, and present it on periscope or google live, and just get the ball out there, not in the long grass.
- Chris also talked about the fact that the NHS people themselves are doing a grand job. Roy interjected with Mid Staffs debacle having an long spectre hanging over everyone and everyone’s thinking still. Roy and Chris begged to differ over Foundation Trusts and runaway deficits in our NHS budgets. There feels like there may have been a lot of pressure to cook the books, prior to calling an election (surely not?). It does feel like there may have been ‘arms up backs’ to make things look OK. The first FTs seem to have been featherbeded with extra funding to make sure they worked. And that sort of actuarial massaging is still occurring. My view? It’s healthcare, not a market. And there really is no such thing as a free market. From banking to the media, from oil to internet based organisations, the big control the little. So let’s get the market out of healthcare in the UK. But let’s add in business strategic thinking, otherwise we will never get spend under control. And everyone has to be involved and empowered. Except the politicians. Set the budget yes, but get out of the way and let the people who do it, do it.
- Safe staffing. Chris talked about the 8:1 ratio, and argued, rationally, that this may not be sensible in every ward, every acute mental health trust, or wherever. He suggested that we should let the local experts sort it. That is the people on the wards, and all who are hands on with the patients. I agree. Matron led organisations need to be the norm! Sadly, we may not have enough nurses for the matrons to make sure they have enough people to cover patient needs adequately and safely. Chris said national framework staffing levels should be a guideline. Why is it legally set in California, said Roy….I’m unsure, personally…
- Health education England have written that we may have a shortfall of 60 000 nurses. We still have over subscription for nurse training places, even though there are no Nurse Bursaries any more? (It is now 3 applicants per place, not 6.) Depressing bit came when both participants talked about the prospect of many European workers leaving for home. I think this may change once Brexit gets less nebulous and we all know where we stand. Why should it be really different than before we were in the EC? I personally am very pro Europe, but anti EC…and I don’t think anyone knows what will happen. Uncertainty though really doesn’t help long term planning.
- Election Purdah raised its head again. Roy tried to get Chris to come down in favour of one side or the other. He played the ball straight back. He said the only way to be sensitively influencing all sides equally was to be even handed. So Jeremy Hunt, Jon Ashworth and Norman Lamb were all involved. As all could be involved post election…
- We often talked about pockets of the NHS at the forefront of positive thinking and actions (Salford, Northampton, Northumbria, Frimley, Devon, and many more). Maybe we do just need to let the guys do it themselves? Just let them go, and do it?
Politicians don’t want us to use real evidence based reality to inform. I would love PFI to be removed from all of Chris’s membership organisations day to day reality. I bet this 2% of the whole budget occupies 50 % of management time in some Trusts?
There were many other interesting stats chucked into the conversation – have a look here…but if you want my two favourites, here they are.
Once we are 70, we start having the potential of increasing our demand on the health service. We need to make sure the education on exercise and eating is inculcated from junior school. We are living longer, but maybe less well?
70% of our lifetime healthcare costs come in the last 6 months of our lives. Are we over medicalising death? Perhaps we need to start having the good death mentality, and let nature take its course – and save both dignity and money at the same time.
I think I still feel depressed at the negativity and extreme worry portrayed by both participants. But madly, as a very annoying optimist, I want to let our amazing NHS teams be just that. Teams. Powerfully excited. They need to be supported, thanked, enjoyed, celebrated and kept alive. I think maybe Roy and Chris both feel that can happen, but will it be allowed to happen?
Politicians? Just leave them alone to get on with it. I trust them rather more than I trust you. And the NHS may well be ‘running hot’, but it is still running despite partisan politicking tinkering at the edges.
Thanks Chris and Roy. You worried me. But made me think.