The NHS crisis: "Slow down! Diversion ahead - consultations underway"
As Marlborough.News has been reporting - at some length, we're afraid - the Sustainability and Transformation Plans (STPs) will almost certainly have to find savings not just in the 'back rooms' of hospitals and GPs' surgeries, but in front line service reductions that will affect patients - affect us all.
But of course the changes will not be hurtling anywhere. They will be held up by complex consultation processes and rows between councillors, local politicians and NHS managers and clinicians.
Councillors in Salisbury have already cried foul at changes made by Wiltshire Clinical Commissioning Group (CCG) to the opening times of the Salisbury Walk-In Centre. From August 1 the Centre's opening hours were changed from 8am-8pm x 365 days a year, to providing an out of hours service in the evenings and at weekends.
Councillors took the opportunity of an extraordinary meeting of the full City Council on August 8, to pass a resolution noting the lack of consultation on the changes:
"The council calls on NHS Wiltshire CCG to consult fully on the proposals to reduce opening hours of the Salisbury Walk-In Centre from 84 to 41.5 hours per week and reconsider these reductions in service."
During debate at the meeting - which the Chairman opened to 'members of the public gallery' - another sentence was added to the resolution: "If the evidence suggests there is a need for 84 hours for the CCG to make arrangements to increase them accordingly." The resolution was passed by 15 votes to one.
No change in the NHS can be taken on its own and councillors were worried this change would simply end up "...transferring costs to the Accident and Emergency Department at Salisbury District Hospital."
But perhaps the key statements came from local residents who "...voiced their concerns that money was being saved at the cost of local people..." and one of the residents commented "...on the short consultation period of 14 days."
There will obviously be a flourishing growth in NHS Nimbyism when all these changes are announced: how can they plan to save money "at the cost of local people"? On the other hand, how can NHS money ever be saved without being at the cost of local people?
And if money is not saved, and if the government fails to find the Gove-Boris Euro billions for the NHS, the cost to local people could soon be in collapsed services.
Like the proverbial super tanker, the NHS takes a good while to turn about. But there is no 'good while' available here for some services will almost certainly run short of cash to pay staff before the end of the year.
Into this argument - which is central to the STPs that are very soon (we hope) going to be published for all to see - steps Roy Lilley. He is a well known health service policy analyst, who runs the nhsManagers.network and writes entertaining and wise columns for them.
In a column this week he looked at the delays to change and savings that lengthy consultation periods bring - defying the urgency of the changes, in some cases obscuring their necessity and merely postponing savings that had to be made. He wrote:
"The solution must be a new, fast-track consultation process. Something like:
• Seventy days max, starting with the presumption... change will happen.
• No consultation documents longer than two sides of A4.
• No one may object unless they have actually been to a public board meeting and listened to the arguments.
• Social media [to be] the backbone communications route.
• Paramedics have to give an opinion, in public.
• All changes must be clinically led.
• ... and, NHS managers have to talk plain English and stripped-pine truth about money and why they are doing, what they're doing.
The changes the NHS needs are urgent. They should not defy the democratic process, they should dignify it with the speed and clarity it deserves."