Author: Warren Town, Director of Industrial Strategy
It’s like a merry-go-round; this constant circular motion of bust and bust in the NHS.
The latest grand plan is to use ‘strategic transformation plans’ (a grand title for re-organisation) to show that the government and ‘those in the know’ have not been idle and instead have been beavering away on another of Baldrick’s cunning plans.
The upshot of all this heavy thinking is;
- Move the emphasis away from hospital-based care and services and into the community.
- Cut ‘units’ (to you and me that is hospitals, services and beds) because when you have less you can be more efficient!
- By reducing the cost of care you do not need to go back to the government with a begging bowl and say ‘can I have some more, sir?’
- In some cases, pay big sums of money to others to do your bidding because this is easier than doing it yourself.
- Tell everyone how well you have done and hope that they will not ask you annoying things like, "will it work?" And, when it happens, how confident can I be that by transferring the service to the community I will receive better health care? Or better still, by closing a competent service or hospital, can I be assured of a better standard of care?
No matter how you cut the cake it is still the same size as when you started. Cutting bigger slices does not make for a bigger cake. Just as cutting it into smaller pieces does not change the flavour.
But with STP’s we want to do both. Amalgamate services at the same time as delivery is fragmented and hived off into the community.
One of the problems with this philosophy is that we already know that social care and public health lack investment and suffer from poor planning.
Whether the two are linked is a moot point, but whichever way you look at the problem you still come around to the same pot of money, with a marginal and wholly insufficient top up in the next few years to re-organise health care.
We could, of course, simply say that we have to do the best with what we have. The problem is that we are constantly told that the NHS is a world class service. So making the most of a bad lot is not good enough - there has to be more.
Leaving aside the lack of investment, poor planning, service cuts and rationing that will inevitably follow STPs, there is a more pressing concern.
To make STP’s work, the current Health and Social Care Act, issued in 2012 and seen as the re-organisation to end all re-organisation, will need to be amended to address future changes in structures for financial management.
No doubt the many that oppose changes advocated by an STP will use the need to update the Act as an opportunity to challenge or block plans.
It is easy to knock STPs and treat them as yet another re-organisation that has decided to join the merry-go-round. But like the curate’s egg, many of the proposed plans have substance and potential, but what they lack is financial and operational planning.
Whichever way you look at the proposals, to streamline healthcare or to promote community based services, the fact remains there is still insufficient investment to make any change meaningful, or to ensure longevity. It is easy to say there is only so much money in the pot and it is not possible to fully fund the NHS.
If this is true, and you believe it, then you must also support rationing, payment for services, longer waiting times and lower taxes.