When I was 11 years old my family had the unexpected opportunity to have a holiday of a lifetime. Friends of ours were living in The Bahamas at the time, and we were invited to stay with them. We arranged a 10 day break during the Easter holidays. The trip would be our first and last overseas holiday as a family, and involved our first journeys by aeroplane. You can’t fly direct to Marsh Harbour where our friends lived, so we had flights from Heathrow to Nassau, and a connecting flight onwards. All very exciting.
The outward journey went well, we arrived safely and had a wonderful time. Part way through the 10 days our hosts checked with my parents about our return flight time. My mum explained that she had been rather taken with their descriptions in the past of how people sometimes used the Post Boat to hop from island to island rather than flying. We had therefore got a flight arranged back from Nassau to Heathrow, but thought we would just jump on the Post Boat for the short trip from Abaco Island back to Nassau.
There was a stunned silence. “The post boat takes at least a week to make that journey,” we were informed. Ah. Our flight back to the UK was in less than a week. There was no way we could use the Post Boat, it was just going to take too long. To make matters worse, it soon became apparent that there were no available commercial flights either. We were stuck on the island, which me and my brother thought was great, but was somewhat stress-inducing for my parents!
It can be pretty stressful when plans fall apart. Sometimes it can be because planning has been poor, sometimes our planning was based on poor or inadequate information, and sometimes the planning might have been fine, but other circumstances beyond our control come into play.
We have known for a while that our local health economy was heading for financial difficulty. I recently blogged about that in a post I called Glass Half Empty. Our plan for some time has been to collaborate and work with local providers to integrate and transform our local system. We have known there wasn’t enough money. We have known we couldn’t carry on with the current levels of activity. We had a plan. It has become apparent that our plan is like the Post Boat – it is going to take time, and our flight is leaving now. The Post Boat still seems like the better way to do it. A better journey, a better or at least the same end point, cheaper and smoother. We’ve run out of time though.
In 1982 my parents had to charter a 6-seater plane to get us back to Nassau. The picture with this blog is of my family standing by the plane (I’m the older child). I dread to think how much that cost. It wasn’t what we wanted. It was stressful and expensive, but it was quick. There were longer-term implications I am sure in terms of our family finances.
Our CCGs need to find the equivalent of chartering a light aircraft. We have to save money now, and our integration programme is going to take too long. We have developed a Financial Recovery Plan. It has all kinds of things in it, some of which sound really good for both our CCG bank balance and for patients (I particularly like the idea of the Virtual Fracture Clinic), but many of the schemes are going to be about cutting or reducing services. We will have to look at how many cycles of IVF we can afford to fund. We will have to consider our prescribing, and are looking st promoting self care, and reducing prescriptions for Over The Counter medicines (in other words, please don’t ask for prescriptions for paracetamol or calpol from me, as refusal can often offend). We will have to consider referral thresholds for procedures like hip and knee replacement (so, for example, you might not be able to be referred unless your BMI is below a certain value and only if you are a non-smoker, and you might have to complete a 6 month lifestyle class first). We will have to consider all kinds of things that are unpalatable, unacceptable to some people, and certainly unpopular.
The Kings Fund recently published a blog from Ruth Robertson about public perceptions of NHS finances. It’s worth a read and gives us an idea of how the public are likely to react to these initiatives. The key message for me is that we need to very quickly present these plans and schemes to the people of the Central Cheshire area. I believe that an informed and engaged public will understand and be tolerant of our actions. What we need to try and avoid at all costs is just cutting services without explaining why. I am disappointed that there is not a higher profile national conversation going on about this, as we are not the only area to be struggling with money. I have said before, and will say again now that I think the government and NHS England have a responsibility to be informing the public of the implications of austerity on the NHS.
34 years ago, we missed the Post Boat. This year we are realising that the integration boat has already sailed. We still need to do the integration work but it is not going to solve our immediate financial problem.
This blog is a warning. A warning to fellow commissioners who might still be on the Post Boat – are you sure it’s going to get you there in time? A warning to providers that the money is running out, and that drastic commissioning actions are about to be taken. And most of all, a warning to the public that NHS services as you know them are about to change. You may not like that. You may well blame me for them, and I can understand that, but the most important thing is that you understand why we are taking the actions we are. We want to do this with you, not to you, and the first step in that is letting you know what’s going on.
We’ve missed the boat, let’s make sure we all get on the same plane.
Dr Jonathan is a GP at Swanlow Practice in Winsford, Cheshire, and Chair of NHS Vale Royal Clinical Commissioning Group.
Follow Jonathan on Twitter @DrJonGriffiths