Oxymorons and unintended consequences

I receive a daily digest of articles from the HSJ, or Health Service Journal in full. Today there are two headlines:

More trusts considered for ‘financial special measures’

All trusts given new targets to achieve provider sector surplus

Now Trusts considered for special measures are, basically, in financial trouble, in other words in deficit.  Many such Trusts have been unable to solve their deficit problem, and have had a succession of managers who have come and gone as the impossibility of balancing the books and maintaining safe clinical services becomes apparent.  As I have commented before, reducing deficits means cutting services, while maintaining these with adequate staff means increasing the deficits; there is a limit to how long the pips can squeak for.  The disastrous failure of clinical safety in Stafford will almost certainly be accepted to have been due to the cutting of corners, but the Care Quality Commission can put a Trust into special measures if its finances are wrong (even if its clinical services are fine) or if its clinical services are wrong (but its finances are fine). Heads I win, tails you lose.

To achieve a provider sector surplus requires Trusts to save more money still.  If they cannot do it now, how will they possible do it tomorrow? And what will be the effect on their clinical services if they succeed?

So these two juxtaposed headlines are, effectively, mutually exclusive.  The irony of the juxtaposition appears to have escaped the HSJ.  However there is another ingredient to this toxic mix. Jeremy Hunt,  the Rachman landlord of the NHS, has spoken at the Conservative party conference to announce that he intends to force trainees to stay in the country after qualification for four years, because too many are leaving and abandoning patients to foreign doctors who can’t speak good English.  He also intends to increase medical school entry to make it less necessary to recruit NHS medics from abroad, but also fill the unfilled posts currently washing around the system.

But herein lies a problem.  If Trusts are bust then how will they be able to employ more doctors?  It won’t help the provider sector surplus, will it? Cutting deficits means shedding staff, not employing more.

Of course what Mr head-in-the-sand Hunt has failed to realise, or chooses to ignore if he has realised, is that doctors are voting with their feet because life as an NHS doctor employee is becoming intolerable.  He won’t fill medical school places when all the prospective students are being put off by their medical friends, parents and relatives.  So before trying to induct more people into this uncomfortable and failing system he should first address the concerns of doctors over workloads, continuing education, regulation and bullying (viz the attempt to enforce a new contract).  Then we might get somewhere.  But he will never produce results from a sullen and rebellious workforce.

 

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