Failure of consequential imagination is common amongst those of us who enjoy a second and then a third glass of wine…it is easy to enjoy the moment and forget about the headache that will follow.
Momentary disassociation from reality will affect your health if you have three glasses of wine every night – but it is not going to affect the nation’s health. However, if you are Jeremy Hunt, a collapse of consequential imagination will create serious problems. Hunt wants to control the escalating NHS budget, but as he tries to manage staffing costs the junior doctors are once again kicking off industrial action. The junior doctors will increase his stress levels and as dissociation is the way the mind copes with too much pressure, Hunt is in a vicious circle.
Hunt’s problem is that the area he needs to control in order to save our health service is not part of his remit. Last week NHS England revealed that more than 6,000 patients were well enough to leave hospital but could not be discharged as there was no one to look after them. Local authorities would prefer to keep the elderly and infirm in a hospital bed, where the money does not come out of their budgets, than to pay for a place in a care home.
Simon Stevens, CEO of NHS England, understands the consequences of this, he said: ‘I do not believe it would be prudent for us to assume any additional NHS funding over the next several years, not least because I think there is a strong argument that were extra funding to be available, frankly we should be arguing that it should be going to social care.’
But how can Stevens persuade the Jeremy Hunt that there is a fatal disjunction in NHS funding because the money he has for the NHS is in the wrong place? Hunt is under extreme stress. He needs to stop arguing with junior doctors, and put together a plan that is not based on imagination. Managing a service is about managing the inputs and outputs.
The inputs of the NHS are a complicated mix of scheduled operations and emergencies. At present it’s the emergencies that turn up willy nilly on a Saturday night in A&E that are creating stress for Hunt. We know that A&E wards are under pressure through lack of staff and that when demand outstrips supply there is nowhere to divert the ambulances. Some A&E’s like the one in Chorley are closing their service at night because they cannot fill the shift…Hunt needs more junior doctors in A&E to deal with the unexpected. It is a serious problem but it is straightforward compared to managing the outputs.
The outputs in the NHS are the people who leave the hospital when they no longer need medical care; but as Simon Stevens has pointed out, they do need care from social services and because it is not available, they remain in the hospital.
So Hunt needs to argue for an increased budget for social services in order to reduce the stress on NHS. He cannot control input but he can manage the outputs if the social services can provide care for people who are bed blocking.
The failure of consequential imagination could cause the collapse of the service. Hunt may be suffering from symptoms of dissociation such as problems with memory, but many people with mild symptoms find it comforting to ignore the real issues and don’t feel ready to stop dissociating completely. Poor man. Even if he can find an agreement with the junior doctors, if the social services do not pick up the baton of the bed blockers the NHS cannot survive.