The King’s Fund paper “How cold will it be?” published in July 2009, discussed three financial scenarios for the NHS. The toughest was a 2% reduction in funding for 3 consecutive years. Of course that hasn’t happened, has it? The comprehensive spending review protected the NHS with a 0.1% increase, an option described in the paper as “cold.”
Back in the real world we are grappling with the Local Operating Plan. The months between September through to March are intense for the teams who are weaving together a plan, making sense out of trends in activity, demographic changes, and new developments and treatments, which have emerged or are about to emerge. We are interpreting hints, rumours, and runes that have been cast, to try and predict what will be in the operating framework, due out late December. The PCT will be likely to get its financial settlement in February – just about the time we are supposed to have all our contracts signed.
On top of this we are predicating our planning around emerging GP consortia. From April 2011 we are confident, in our patch, that they will exist in shadow form. We feel we are building on some strong foundations. It is important that they have a really clear view of the challenge being laid at their door. We are holding meetings with the engaged and the curious, setting out the context and the process which we are using to give them the wherewithal to build and grow, whilst we shrink and devolve.
This brings me back to the “gap” – a euphemism we use for the difference between what we predict we will need, if nothing changes in the system, and the likely resources we anticipate we will get in February. We have three scenarios. The King’s Fund paper had three scenarios: tepid, cold, and arctic. The centre has made it clear it is going to top slice 2% from PCT budgets as a central reserve. We have no guarantee that we will see that money again. We have a demographic challenge that puts over 1.5% inflation, by our estimation, into the system. I could go on, about prescribing costs, social care costs, but you probably get the picture. None of our scenarios gets above freezing.
In the next two weeks we will be presenting the “gap” to our nascent GP consortia. We will show them the QIPP opportunity available if we (they) tackle variation with vigour, if they implement the most effective and efficient pathways of care evidence suggests they can buy and if they strip out every non-clinical service that is not lean, mean, and keen. Then we will show them the gap that still exists. Then we can head on, towards The Day after Tomorrow.
Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.