I’m being honest…
… in the hope you can cut me some slack for that, surely.
I’m admitting, I have no idea where Patagonia is… somewhere in South America.
If I gave you a map of the world, could you put a pin in Bariloche? Probably not.
Patagonia’s famous for meteorologist Edward Lorenz, suggesting that tiny changes in initial conditions, like the flap of a butterfly’s wings, in Patagonia, could alter weather patterns drastically elsewhere, triggering a storm.
He wasn’t expecting to be taken literally.
He was pointing out the butterfly effect, a concept from chaos theory…
… illustrating how small actions or events in a complex system can lead to significant, unpredictable consequences, like chaos or a gathering storm.
We are, right now, heading for both.
Julian Kelly, NHSE finance director, appearing before the Public Accounts committee, denied [NHSE] influenced trusts and systems to sign up to ‘fantasy’ plans in order to paint the best possible picture of the service’s finances, at the start of the year.
It is, of course, nonsense but Kelly is to be pitied. The victim of waterboarding by the DH+, who are tortured by the Treasury. It’s the only logical explanation.
Last week, the HSJ reported on the South West Ambulance FT;
‘… whose seriously ill patients are typically waiting three times longer than they should for response… is reducing its planned ‘conveying resource’… due to its [financial] deficit.
Its original plan for 2024-25 was an average of 52,500 hours per week of ‘conveying resource’, [crewed ambulances to you and me]…
… but a board report released this week says it is now seeking to deliver 50,000 hours of ‘conveying resource’ a week, for the rest of the financial year…’
By April next year that’ll mean 50,000 hours. Over two thousand days of ‘conveying’ lost.
Its decision to reduce hours was;
‘… in response to the trust’s financial challenges and budget deficit position across the first half of the financial year…’
The Board report goes on to reveal…
… in October the average response time for category 2 calls, [including suspected stroke and heart attacks] … was around 1hr 40m in Cornwall.
Last month handover delays deteriorated to an average of +70 minutes.
The Trust said its activity was 7% above the level anticipated in contracts…
… numbers which would have been in their business plan for NHSE.
It’s a simple dodge. To make bottom lines add-up, underestimate demand. To make finances across ICB systems balance, everyone will do it.
Now SWAFT are faced with having to reduce their capacity (and costs), to balance their books. Balance-sheets put before yer granny, safely tucked up in hospital bed-sheets.
The most frequent users of the ambulance service are people with age-related health conditions.
At this point you need to know; about 22.4% of the South West’s population is +65, making it the region with the highest percentage of older residents in England… significantly above the national average of 18.6%.
In 2023, nationally, approximately 25% of emergency department attendances were aged +65. Nearly, 45% of ambulance attendances leading to hospital admission involved this age group. The figure increasing for the +80s.
There are probably over a million +65yrs people who once got social care help. Now because of upping eligibility-criteria by cash-strapped local authorities, no longer get it.
The butterfly effect.
Not in Patagonia. Lepidopterists will find our specimen sitting behind the desk in Whitehall… flapping about and creating a storm in Cornwall.
This is the Papilio-Streeting, distinctive with the red markings of Labour. Fluttering around, creating weather patterns in a complex system, he doesn’t understand, leading to significant consequences. A specimen known for indecision.
Which will create chaos in just about every part of the NHS because lack of elder care, creates a storm in the system:
- vulnerable people without routine care, decline and helpful neighbours ring 999;
- clogging up the flow through secondary care;
- filling up beds;
- over-spilling medical patients into surgical wards;
- delaying waiting list procedures;
- preventing discharges;
- filling A&E and its corridors;
- delaying ambulance handovers;
- creating demand across the system in community and primary care;
- busting budgets…
… there is no plan to fix this. Papilio-Streeting is cocooned-up until next spring, gestating plans, for ten years, that will be consulted on, legislated on and probably not implemented until 2026.
In the meantime, to meet finance restrictions, ambulance services will cut their capacity at the very time increased capacity is part of the answer.
Creating a case study in the chaos caused by a butterfly.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
