Ed Smith, NHSI

Just stepped down as Chair of NHSI – after a positive marriage guidance role betwixt Monitor and NHS Trust Development Authority.  And ex captain of the Titanic (no relation – but hey, we always get someone who asks about re-arranging deck chairs when Ed is on stage…he has the decency to smile still…).

Health Chat 51 (I only know it’s the 51st because the last one was the 50th.)

Did we get anywhere near finding the answers to Health Care in the UK? Well maybe not? We expected more from this health chat more than others? Just because he has left his role? Well, a lot of people had arrived in the hope…I think

I just loved some of the themes. I do find it difficult to keep up with Ed’s train of consciousness. So maybe I haven’t noted everything!  But I hope you get the overview. Biased by Phil, of course. If you want to see the whole, to make your own view, see here.

The great thing about all the people Ed encountered in his time was simply summarised. “Desperately committed”. And they were exhausted, in the main. And had never been thanked. Just so many great people. Daft. It didn’t help that we have had to endure the Lansley legacy. Reforms that were specifically not only left out of the 2010 Tory manifesto, but we were told there would be no change whatsoever in the NHS, as too much re-organisation had been frosted on it already.  You can always tell when a politician is lying, because you can see their lips move…

How would Ed fix the NHS?  Three phases, he started with. He and Roy Lilley kept going off at tangents (Roy said and interrupted more than Humphrys, so I got a bit lost. I think, like all of us, he got a little excited…and his respect shone through).

Immediate need? Emergency level of funding. If there is a Flu epidemic (it’s overdue, and is already happening in Australia) we are up that creek without a paddle. And the biggest problem? If 10 % of staff are laid low, when we have unfilled vacancies everywhere (which is why everyone is knackered and deserve even more thanks. Just remember, these are the guys who run towards the shit hitting the fan.). So the emergency money has to fund temps. Tough. But please, get someone to negotiate this well? And if someone takes the rise, stop them being used anywhere in the NHS. Or let’s simplify stuff? If most agency nurses (for example) are NHS staff, pay them sensible overtime. It’s a lot cheaper and safer from a continuity point of view…

Second? We do need to invest money, Keynsian style, to bring down waiting lists.  OK, you do need fiscal responsibility. I do think a lot of the Brown Blair money was wasted. Setting the target as spending up to the GDP average of the EC doesn’t mean you get value for money.  We need to get back to basics, I think. Ward level budgets, real time spend on dashboards on every ward (like they do in every manufacturing company I work with, who are successful). And a sister in charge of that budget,moraines and incentivised. (Sorry. Last 5 lines were my views…back to Ed and Roy…)

There’s a maintenance backlog as well as a workforce challenge.  The estate will not be fit for purpose if we don’t fix stuff and just let it decay.

Thirdly? A need for investment in transformation. Luckily, although ere is legislation to back the Lansley reforms, the people on the ground ignore it, and just get on with doing things properly. This will need 3 to 4 billion per year over 3 to 4 years.

There is no one magic bullet…no one size fits all. There are different needs in different communities.  There are different patients with different levels of confidence in their own input into their healthcare in all parts of the kingdom.  We really need to change the mentality.

How? Ask the citizens? That’s Ed’s view (- although there was some concern that Brexit result shows what happens if you ask…). But if we start with free to use at the point of care? My view is there will still need to be rationing, and we still have to think health improvement as well as sickness fixing.  We still have to make digital work for us, and keep it simple. Maybe we all have to hold our digital record, if we want to, on a phone or a memory stick or on a personal cloud?

Primary Care is just another provider, Ed said.  But we maybe need to change the way we think about how we fund the patient interaction across the whole of health and social care? Pay for inputs by the General Practice, not an annual fee per patient. (Sorry guys – I think we either have GPs as fully small business or we have all of them salaried. This in-between level just confuses funding.)

What is the plan? He talked about when he started at NHSI, that their main aim was jet to keep the lights on.  Have we moved on? It doesn’t feel like.  Workforce planning would be OK for unskilled jobs? But most of our NHS and Social Care gaps have a 5 year lead time to fill them.  That was one of Ed’s regrets, not adds sing that earlier.  Along with not convincing politicians of the need for collaboration. On the plus side? Very proud of working with the Grim Reaper (Jim Mackey).  And to be trusted by the people he worked with.

He talked with passion about about being involved in a good, positive regulator. And of a blended ‘bricks and clicks’ style of healthcare provision, tailored to each citizens need – which will vary by citizen of course, depending on each situation they are in.  He often described what he was saying as ” romanticised “. It maybe was.  I call it passion.

He did show that passion at the end, expressing his view that Roy should Keep Going. He loved him, for representing the citizen in those e letters we all read.  And I agree.

We may have lost him from the NHS at the moment.  Ed Smiths legacy though is that he hasn’t really left. His ripples keep expanding.

 

 

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