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Thursday is likely to be D-day… Darzi-Day.
Lord Darzi, publishing a report on his cures for the state of the NHS.
By all accounts, leaks and whispers, there’s not much in it that the average front-line NHS worker couldn’t have told you over a Latte in a coffee shop and Streeting pretended he understood, to persuade us to vote Labour.
Darzi knew the answers before he started. He’s nobody's fool. Been around long enough to know what’s-what.
Charmer was on the telly on Sunday. Gave us a taster…
- the NHS had been structurally damaged by ten years of coalition, austerity funding,
- Lansley’s misbegotten reforms, wasted millions, were a huge distraction... and of course,
- Covid.
He also nuanced the ‘NHS is broken’ schtick.
Silly Boy has been stomping around like a sulking teenager… ‘it’s all broken’. His insinuation, the NHS was in someway the author of its predicament.
Charmer made it clear he was adding the NHS to the list of all the other things the Tories had ‘broke’.
Thus far Labour’s only NHS policy ideas are to ramp-up performance by creating 40,000 more appointments a week and use the private sector to clear backlogs.
As far as I know there’s been no new guidance on how or when they are likely to kick-off overtime. Neither how it’ll be funded.
By the way… what constitutes an appointment? An outpatient’s appointment or an appointment for heart-surgery?
It’s important.
A general estimate for a standard outpatient consultation is around £150. The average cost for an inpatient hospital appointment can range from £3,500 to £5,000 per stay. Depending on complexity, could be ten times that.
Averages are useless, too crude.
I’d expect DH+ to have proper numbers but for the back of an envelope, stab-at-it; say ‘appointments’ means a mix, the average might be £1,800… times 40,000…
… everyday the NHS would need an extra, £72m and in a week… £504m.
If I’m half wrong… it’s still a lot of cash and a big slug of it will be at premium overtime rates… paying more doesn’t necessarily get you more.
In case you’re wondering… it could be well over a quarter of a billion a year… over half of our defence spend.
I’ll leave you and Rachel Reeves to figure out what that means for her budget.
Streeting was also doing the Sunday rounds, telling Sky;
‘… NHS waiting lists will need to be millions lower by the end of this parliament.’
How many millions. Dunno.
He added;
‘… where there is spare capacity in the private sector the NHS should use that to get waiting lists down.’
It’s worth having a look at that.
The total private sector capacity for in-hospital stays might be about 11,000 beds. Numbers are hard to get as they’re not obliged to report capacity, centrally.
We have no idea as to their actual capacity. Neither does Streeting.
A further worry is that few private facilities have ITU. Estimates say, 6,000 patients a year are transferred from the private sector to the NHS when ‘things go wrong’.
Meaning, they’re limited to the simple stuff. Which has a tricky impact on Trust's revenues and their ability to cross subsidise.
Most doctors working in the private sector are NHS and do private work part-time. The constraint is consultant surgeons and anaesthetists.
They can’t work in two places at once. Handing patients into the private sector will have little impact on the overall waiting list… and..
… the distribution of private facilities is centred on London. No good if you live in Blackpool South.
So, the upshot of all this is that the ‘overtime thing’ and the ‘going private thing’ either hasn’t got going or is unlikely to make much of a dent in the 7m people waiting for NHS treatment and .…
… Charmer's problem; the absolute patient and political priority is waiting lists.
Not another distracting reorganisation.
Not the upheaval of moving care from here to there.
Not wacky ideas that artificial intelligence will make it all better.
Over time some of that might be true but right now…
… we need a sensible period of sustained investment, some good old-fashioned management of resources, taking better care of our people and some capital to stop hospitals from collapsing.
I’ve said, Darzi is no fool. I hope I’m right.
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