I tried to work out how to summarise Roy Lilley's morning email this morning on the madness that Wes Streeting is unleashing on the NHS, and failed. So I am copying it with a suggestion that this is well worth subscribing to:
When the prime minister and chancellor say the world has changed, mostly for the worse there's a certain type of person who takes that as permission to do the big and ugly things voters would never vote for a Labour government to do.
It's happening to the NHS, right now.
Who and how was it decided that NHSE would go, budgets would be cut by 50% and the upshot… thousands of people sacked?
Where is the strategic analysis? The Board decision? The Bill? The risk assessment? The analysis? The impact statement? The plan? The license from the voters to demolish parts of their NHS?
Capricious decisions, erratic, volatile and like a ticking time-bomb smuggled deep into the foundations of the service.
As Isabel Hardman comments in the iNewspaper; Wes Streeting has a chainsaw but no vision for the NHS. She is right about the vision and the chainsaw but not the person wielding it.
Tell me decisions weren't arrived at on the hoof over a weekend, by Alan Milburn egging on Silly Boy and announced the following Monday.
The cunning plan; slash the budgets, stand back and let the service fight itself for survival; forcing a reduction in headcount, without wasting time on analysis or permission.
You'll have to go some to tell me that the poor-man's Elon Musk, Alan Milburn doesn't own the chainsaw.
Some of the impact;
- Reduce corporate function costs by half. Between 41,100 and 150,700 people across 215 trusts, dumped.
- Halving NHSE's workforce, slashing 6,500 jobs.
- Redundancy costs around £1 billion.
- Northern Care Alliance to cut approximately 14% of its corporate workforce .
- Mid and South Essex Trust, cut 150 non-frontline, clinical posts.
- East Suffolk and North Essex FT, approximately 350 jobs to go to the private sector.
- Royal Derby Hospital, introduced Mutually Agreed Resignation Scheme (MARS) offers severance pay to non-clinical staff.
- Glenlyn Medical Centre (Surrey), salaried GPs were invited to apply for voluntary redundancy. Three doctors set to leave as a result.
- Nottingham University Trust, where 'staff can't sleep with worry', outsource parts of its finance department approximately 80 administrative staff at risk of redundancy. Plus, a MARS option.
- Southampton University Hospitals Trust, plans to make 100 job cuts; administrative, clerical, and management roles.
There'll be more this week.
If MARS is a personnel strategy it would have been cobbled together by Del-Boy, on the back of a fag packet, in the Nag's Head.
It's just a way to ‘get rid of people'.
More expensive than statutory redundancy, but the key benefit, it avoids consultation.
MARS is arbitrary and open to favouritism.
Recipients cannot receive unemployment benefits after leaving, as their dismissal is ‘agreed'.
It's bad management. Not a serious long-term solution.
People are just tipped-out with no thought other than to reduce headcount and cut spending. It does not address the harder decisions around tackling structural problems in service delivery;
- the future of work;
- how it will be done,
- who does it…
… neither, does it fix the root cause of the NHS doing more work than it's funded for.
Worse, it only appeals to people with long-service. Dump them and you dump, knowledge, legacy, skills and the organisation's memory.
MARS = Management that's Arbitrary and Really Stupid.
And, there's this…
- the Darzi Report, accepted and agreed by Charmer and Silly Boy as the new testament, which warns:
- management capability is still behind where it was in 2011' (Para 21)
- and emphasises the critical role of management in driving effective reform.
Analysis by the Chartered Management Institute and the Social Market Foundation agrees. Their research indicates;
'... management capability has regressed... primarily due to prolonged restructuring and austerity measures.'
Skilled managers are essential for implementing reforms and keeping the show on the road.
An organisation can only do a few things well, at once. ‘Try to do everything, and you'll end up achieving nothing'… so said the guru's guru, Sir John Harvey-Jones.
The NHS is trying to;
- Cut waiting lists, a political priority
- Reorganisation and restructuring
- ICBs slashed, smashed and crashed
- NHS England, dumped
- New Ten-Year Plan, any time soon.
- Workforce reform and redundancies.
- Savings programme and financial pressures to find £illions.
- Service consolidation.
- The potential for more strikes by junior doctors.
- Digital transformation, roll-out shared care records,
- Adopt AI in diagnostics and admin.
- Public health and prevention; obesity, smoking, alcohol, and mental health being targeted all at once.
- Primary care reform, fewer full-time doctors, rows about PAs, rising demand, new GP contract, expanding roles for pharmacists and other professionals.
… do all that with managers who have no idea if they will be in a job this time next year.
This is total, unadulterated, copper-bottom, 24ct gold, big-time, bigly bonkersness.
Milburn madness.
Everything the capricious, mercurial Milburn did for Blair, from markets and PCTs to Foundation Trusts was eventually dumped and disowned by the Labour Party.
Don't let him do it again.
With apologies, Roy, but it's really spot on.
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This is what happens when children (a child) is allowed to get its hands on a major state function. The child in question has no experience – but is “guided” (groomed?) by those that do and those with vested interests.
For LINO MPs reading this: another nail in LINO’s coffin, I suggest you find other employment asap, cos come 2029 you won’t be MPs & by that date, it might be unwise to show your faces on the campaign trail.
Thank you and well said, Mike.
I have not met the man child, but have met people who have. Streeting really is childish and gets excitable, if not worse, when pushed back.
There are stories about him at university, which may not surprise people who know about his ancestry, and the protection afforded to him. The late and great Dawn Foster crossed swords with him.
I think LINO know the game is up, not just for the party, but for the UK, too, and now is the time to sell what’s left of the British state and cash in.*
*This point is also made further to yesterday’s post about why Starmer won’t condemn Trump. Starmer is an empty suit and vessel for vested interests, just like Streeting. Both were groomed in the early noughties by Blair and Mandelson. Streeting at Cambridge (where he even got Zionists to help against opposition students) and Starmer in the legal profession, and the forces and donors behind them. Some, but not all, of these forces and donors are also behind Trump.
As I write this reply, I think of the Cambridge Five (and likely more) groomed to advanced the interests of the USSR and communism. Further to another of yesterday’s posts, Oxford and Cambridge have the late 20th and early 21st century versions, this time in the service of the US and capitalism.
I understand NHSE conduct inequality work, and since poverty causes poor mental and physical health (not correlational, causal) this is surely an important role and work, and you would think being causal this would be a main focus of NHSE?
In my experience little is said, and little presence of inequality public health officers, though when present raise interesting points, must be a thankless job.
Now I wonder if their roles are first in the queue to go, I don’t think Wes Streeting’s private health and pharma chums would like Health Inequality work, they wouldn’t be able to sell us so much, if inequality were profiled and addressed.
The only surprise is that Isabel Hardman is a assistant editor of the Spectator.
My God……………….
……….Streeting is indeed the grocery clerk, sent out to collect the bill.
This time, the rentier’s bill – their ‘service charge’ for offering Laboured ‘market solutions’ to our self created ‘health crises’ (the crises being that our fucking useless politicians can’t be bothered to manage theses things anymore on behalf of society).
The Trust I work for is not making redundancies (yet) but, instead, is holding consultations to create a subsidiary company within an NHS Trust for estates, facilities, inventory management, logistics teams, etc, to make savings. The NHS terms and conditions, AfC, and benefits for the existing staff transferred to the new company are promised to be protected. Is creating a company with separate governance that operates on more commercial principles, even if it’s technically owned by the Trust, some form of internal privatization? I’m not sure it is a good thing.
It’s a preparation for privatisation, undoubtedly
It is not.
They did the same to council housing services in the early 1990’s under CCT (compulsory competitive tendering) and all it did was make what were interdependent departments into independent ones obsessed with cost and making surpluses and reducing co-operation.
This ought to be horror/science fiction. That Labour can preside over/instigate all this is beyond belief. And the in your face corruption that is Alan Milburn’s ( and his ‘child’ Streeting’s) embroilment with private healthcare is evidence that we live in a country with a governing system that is corrupt from top to bottom, and feels no compunction to hide the fact.
That is partly because they have a hold over the media – the ‘public service broadcasters’ who will not ask them questions.
You have hard working young doctors – not getting training appointments this summer which they need to advance to be consultants, and would-be GP’s driving Ubers because short-handed GP practices cannot afford to employ them .
This seems like a Trumpian approach – disrupt the system, arbitrarily sack people, create chaos – presumably with the notion that it will focus minds on what has to be done.
It is all performative theatrics – anything but commit real resources and produce a cogent plan for NHS/care working together.
We have to invert the narrative – the plans , forecasts, targets should be about real things – people getting healthier, treated and diagnosed promptly – and then design the finances around them ‘anything we can actually do we can afford’.
Until we do that – fictitious financial constraints, ‘rules’ , targets will dominate all the public discussion , and allow the corruption to continue..
Don’t the LINO genius team realise that when you take back control then gut the health service that you get blamed for the “failings”.
Or are they expecting to skip into consultancies with the private health companies that it’s highly let will be let rip in the NHS as part of the trade deal with King Donald?
Eliminating management is always politically popular. Doctors and nurses and other front line health workers are popular. Managers are not. But someone needs to deal with premises and procurement. Medicines and dressings and other consumables. Laundry and cleaning. Food and drinks for staff and patients and waste disposal. Water and electricity and heating and ventilation. Human Resources and pay and rotas and holiday cover and maternity leave and performance assessment.
International comparisons indicate the NHS is under-managed compare to European peers (not compare to the US where administrative overhead related to billing and insurance are huge). That lack of NHS management capacity is itself a problem which leads to inefficiency and waste. Brittle services running “hot” at or over maximum sustainable capacity all the time, which are venerable to any small incidents snowballing into a major but avoidable problem.
The big win has to be integration of social care, which will free up acute capacity currently used to look after people who need care but not in a clinical setting. That won’t be cheap but the returns will be big.
A great deal to agree with
Clearly Labour is trying to sell off the NHS to the private sector. Their dishonesty about this is astounding, and counter to the majority of the British public who want it to stay public.
The Labour Front Bench has received nearly £1-million in “donations” from private healthcare companies, which to me, is no different from bribery.
See also:
“Labour call for greater ‘use of private sector’ in NHS care”, The National (Aug 2023)
https://tinyurl.com/upb25vsz
How to Dismantle the NHS in 10 Easy Steps by Dr Youssef El-Gingihy (2018)
https://www.amazon.co.uk/How-Dismantle-Easy-Steps-second/dp/1789041783/
The Great NHS Heist (2017)
https://www.youtube.com/watch?v=ro-oU0u8Jos
“Private Finance Initiative: hospitals will bring taxpayers 60 years of pain”, The Telegraph (2011)
https://www.telegraph.co.uk/news/politics/8279974/Private-Finance-Initiative-hospitals-will-bring-taxpayers-60-years-of-pain.html
Thanks
Every day I shake my head and wonder what possessed me to vote Labour again.
I knew it would be bad, but it is much worse than I anticipated.
They are to the right of any pre-Thatcher Tory government I can think of.
“Every day I shake my head and wonder what possessed me to vote Labour again.”
I’m in the same boat. But Labour gave us false promises, and Starmer was disingenuous. And it has become a lot worse than imagined.
My dilemma now, is who to vote for next. Reform and the Tories are also non-starters.
I didn’t vote Green because I didn’t think they stood a chance, and I’m not entirely happy with what they offer.
There is a gaping hole in politics on the “left”. I’m hoping that someone will fill the void.
We all make mistakes.
Then walk away from it Ian – lighten the load. Politely return your poll card. And get on with your life the best you can.
It’s absolutely frightening. It was obvious that Streeting had no idea about the NHS and healthcare before the election, but as with much of what has happened since Starmer got in power, it’s far worse then I imagined. I worked for NHS Digital during Covid. We were severely under resourced and I saw many brilliant people work crazy hours to do vital work. Most working on the frontline of the NHS would agree that the NHS requires more not less administrative and back office support. These job losses are utter madness and we will lose many highly trained staff who have worked above and beyond the pittance they have been paid. I have no words. How an earth will waiting lists be reduced without the staff booking appointments etc!
Reality check: there is no significant opposition to the ongoing dismantling of the NHS amongst the entire political class, whether Labour, Lib Dem, Tory etc – supported all the way by the neoliberal media (and that includes The Guardian). Successive governments have been able to facilitate ever more extensive and deeper privatisation, all the while running the rump NHS into the ground. Do we even deserve a NHS? The public are by and large indifferent, ignorant, misinformed or apathetic. They won’t appreciate what they have lost until it’s truly gone. Face it – Streeting and his predecessors have got away with it, and there is no sign that they will not continue to get away with it. This remainder of this decade will be the final few years that anyone will be able to pretend to themselves that we still have a national health service. Having worked in a clinical role in the NHS for over 20 years, I have experienced the decline first-hand. It’s sickening – both figuratively and literally.
Agreed, and thanks
For those interested in the NHS, Roy Lilley’s pithy blogs are a must-read. Roy really understands people, management and organisation and has experience in both health and business worlds. He passionately believes in the NHS and its people, and that a key is getting the best practice that the NHS is capable of to become standard practice everywhere.
As for that old idiocy of ‘its all about cutting back office and administration’, Streeting’s logic would have surgeons scheduling their own operations and ordering the medical supplies.
Agreed, entirely.
This is true.
Any service is a balance between process and outputs.
Under capacity in the process side leads to under performance on the output side – quality suffers.
Likewise, running services short of redundancy – spare people/resources to absorb spikes in demand – also affects outputs. It’s the same on the railways as much as the NHS and an inadequate way to manage a service. It is done in the name of efficiency of course, but the real aim is to undermine the service, to break it and achieve ‘channel shift’ in demand and attitudes which means that people go private or are accepting of a change in ownership.
Cunning, and we should be wise to it by now.
Roy who I know a bit, totally gets the process, people and skills bit.
Unlike the Blair gang and Silly Boy who are obsessed with technology. Happily supported by the tech and outsource mob. Having spent decades around business and IT, we learnt 40 years ago that you sort the process and people stuff first and then apply technology. Sadly that lesson has still not been learnt by many. Which explains so many failures of ‘technology’.
I know Roy, a bit. I agree.