Section one; PFI. It’s only about 2% of NHS turnover but in some places it is totally unmanageable. The NHS Emergency Powers Act would allow LaLite to leave the PFI debt with the Trusts but deal with the payments as interest bearing debt and as one global sum by adjusting the tariff. Effectively, sharing the pain across the NHS. This would provoke an outcry from non-PFI places but he’ll have to ignore that and act in the national interest. If he doesn’t more Trusts will close, run out of money or end up with useless blue-light-lite services and more disaffected voters.
Section two; dump the market. Everyone knows the costs-in-flow around Monitor, staff, overheads, advertising, tendering, procurement-specifications, pre-qualification, evaluation, conditions, performance bonds, lawyers and all the rest of the hoop-la will never deliver savings or efficiencies to match the costs. Go to Scotland and ask them to be kind enough to show us how to run and NHS without a market.
Section three; the quality crisis. Scrap the Care Quality Commission use the money to reinvent Community Health Councils. They are cheaper, local, know the plot, the players, the issues and the patients. Give them draconian powers of access and make them handle all complaints in three months top-whack. Introduce a license to hold public office for Board members.
Section four; give the private sector a sensible exit route. Not because they can’t do the job, or for ideological reasons. The simple truth is there is not enough money in the system to give them a profit without cutting corners, deskilling and slashing staff numbers. There will be insurmountable quality grief and damage to brands, not least the NHS. They’ll have LaLite over a barrel, pester for more money or fiddle with contracts. In the end they’ll walk and the NHS will be in the lurch. Encourage staff, now, to take over services as social enterprises and give them the money and management support to do it.
Section Five; dump the NHS Commissioning Board and its ludicrous wage bill. Its line of command is too remote and will only be fixed by evermore expensive and labyrinthine layers of bureaucracy. Take temporary responsibility back to the DH until finances and the future are more stable.