Thread by @goldstone_tony

1/ Pleasing to wake up this morning to news that - FINALLY - were hearing about the NHS in the leadership contest for our next PM. Similarly pleasing to see the word crisis. As for the NHS, crisis is very much where we are. Some tips @RishiSunak

Pls RT

bbc.co.uk/news/uk-politi…

2/ Lets look in a bit more detail. "From day one of being in office I'm going to put us on a crisis footing." - OK as above - this is a welcome step. Snr NHS leaders have been reluctant to use the word "crisis" when asked in recent weeks by @Jeremy_Hunt

https://twitter.com/goldstone_tony/status/1546896389787066371?s=20&t=vM1yzWNg-ftRcAFk8IpZeg

3/ Now onto the detail. @RishiSunak "promise to accelerate NHS targets to cut waiting lists". Great, but the problem is not a lack of targets. We have targets we are not acheiving. These are predicted to get *very* much worse, perhaps reaching 14.6m👇

https://twitter.com/goldstone_tony/status/1541310425782001664?s=20&t=NbMeu5K8VNz7jV0wgCKFzQ

4/ We need to acknowledge this is *not* a "covid backlog". Its been building for a decade, worsened by COVID. It was the main reason, for example, an AA compensation scheme was needed in 19/20.

england.nhs.uk/pensions/

as doctors were rightly worried about "paying to work"

5/ But rising waiting lists are in no small part due to workforce issues. We absolutely need to train more doctors (and keep them in the UK), but we can *only* solve waiting lists in the short & medium term by *RETAINING* the existing workforce.

6/ Biggest driver out of the workforce is ill conceived pension taxation. This *wasnt* solved by the "taper tweak" in March 20, & indeed is now very much worse since the freezing of lifetime allowance in March 21 (& high inflation). Key additional driver out of the workforce

7/ is the general "annual allowance". With rapidly rising inflation, it is now the case that this is a very urgent threat to there being a huge exodus in 22/23, as the Finance Act is longer operating as intended measuring growth *above* inflation 👇

https://twitter.com/goldstone_tony/status/1530483691960541191?s=20&t=kbq775Yfy_SdlzCqOXf9fw

8/ Please urgently - take the time to review the debate brought by your colleague @DrDanPoulter 2 weeks ago & the suggested emergency solutions to Finance Act / Compensation Scheme, and also long term solutions fair to the taxpayer, like offered to judges

https://twitter.com/goldstone_tony/status/1548735054943330307?s=20&t=152lYP16GGWgvxD41vlOQg

9/ Returning to your suggestions- making it easier to get scans without going to the hospital. Increasing diagnostic capacity is of course paramount to helping the waiting lists, however it requires capital investment in kit & enough people to scan/report @RCRadiologists

10/ Despite proclamations from government that the pay award are "the highest uplifts in nearly 20 years" you will be well aware that the 1%,2% or up to 4.5% given to doctors, versus inflation predicted at 11%, are in fact the biggest pay cuts on record.

11/ Whats more, disgracefully, is that departments are expected to fund these pay awards (aka huge pay cuts) from existing budgets awarded before the inflationary surge. This has led @NHSEngland to stating the very diagnostics you refer to being at risk

hsj.co.uk/finance-and-ef…

12/ Psl be aware of huge role of unprecedented pay cuts will have on workforce, specifically retention. Please be aware that subinflationary pay awards, combined with the Finance Act issue (CPI disconnect, negative PIAs) will hugely accelerate retirement

https://twitter.com/goldstone_tony/status/1549700813114773506?s=20&t=3zFOyeSEOHlcUtsKKXM_iQ

13/ The NHS is quite literally on the brink of collapse as reported in yesterday's @FT .
To fix this we must fix waiting lists, and do this we *must* fix retention. To fix retention we *must* fix punitive pension tax #taxunregistered #FixFinanceAct

ft.com/content/c333a6…

14/ Its great @RishiSunak wants to make waiting lists his "number one public service priority" and I hope @trussliz does too. Please listen to experts @TheBMA @bma_pensions to understand the root cause of problems. p.s its not lack of targets.

Pls share/RT if you agree