Not recommended reading
It is touching that in finally bowing to pressure to release its review of safe staffing of hospital wards, NICE is sticking to the fictitious line provided by the Department of Health.
This is that NICE did not want to queer NHS Improvement’s pitch, just in case the newly formed regulator had a better (and cheaper) set of recommendations up its sleeve.
We can mock, but the same department that commissioned the review decided to bury it. NICE was merely a victim of government safe-stifling guidelines.
Thanks to the persistence of the HSJ’s Shaun Lintern, NICE has now published the recommendations, but they are both too expensive and too risky to be widely adopted – risky in the sense of career-limiting.
The minister for transparency Jeremy Hunt has just issued a warning that he will suspend the board of any trust that fails to achieve financial balance and keep patients safe.
As he continues to insist that “quality” is both a cause and effect of well-run organisations, Mr Hunt is busy peddling two different and rarely compatible ideas of safety – the financial kind and the real kind.
Any trust that spends more money on quality – by employing more nurses, for example – is highly unlikely to see a sudden and dramatic improvement in its financial position. Mr Hunt knows this, but is compelled to push his logic to breaking point. He is no longer saying that more money won’t necessarily make things better but that less may have an invigorating effect, like a cold shower in the morning.
The formula for success is based not only on a healthy level of self-denial, but on a quasi-religious notion of virtue in which quality and efficiency are indivisible and complementary forces, the sort of thing you might learn if you went to a Jesuit-run business school.
Where a business might invest in quality, public sector finances allow no room for manoeuvre, which leaves us with magic or prayer to fall back on. There is no funny money here. We get what we’re given and when it runs out it’s gone. There are no hedge funds short-selling hospital stocks to offset any losses caused by a rapidly growing population, no rights issues to raise extra cash for social care and no investors queuing for a stake in dementia care, diabetes or emergency departments.
Even so, the minister still appears confused about the difference between funding the NHS and dabbling on the stock markets. “Patients and taxpayers rightly expect a return on this investment,” he says.
Do they? The only potential returns are more life-saving, life-extending and life-enhancing care for every pound spent. In all other senses, the notion of a return is nonsense, as is the idea that financial balance is always possible if we work a bit harder or smarter. The NHS is a money pit.
(Having said that, if any readers are considering investing in the NHS, we have a sub-prime mortgage deal on PFI hospitals you may be interested in.)
Mr Hunt is too clever to believe that berating trusts can possibly achieve the miraculous effect on their finances he demands, but not clever enough to stop.
So while trusts know it would be mad not to follow the newly liberated NICE guidance, they have had a clear signal that it would be madder to follow it.
Religious affairs editor: Julian Patterson