Reality. In the world of public finances there is no reality. We are dealing with visions and ideas. Reality is distorted by evidence-less policy, fond hope, imagination and a lucky rabbit’s foot. Some might say deception and casuistry.
We can have whatever public services we want. We just have to pay for them.
Value for money? That takes us into different territory. Your idea of value may not be mine. For a childless couple a few rounds of IVF might be just what the doctor ordered. For others a childless couple might be a condition and not an illness.
Eldercare may not be something for the state to provide but for individuals to make life-long provision for.
The Chancellor’s prerogative is to make it as hard, or as easy as he wants, for public services to empty the bins or empty hospital beds. He has chosen to balance the books by 2020, with a little £10bn surplus on the side.
That makes it hard. Balancing the NHS’ books will be excruciatingly tricky. Except it won’t.
In a blinding act of Damascus Road proportions, the Jim Reaper has spoken. As in the miracle of Lanciano, flesh and blood have become a reality.
The HSJ, reporting an exclusive, tell us Jim Mackey admits Trust’s financial plans for 2016/17 do not add up and what is more; they never will.
National planning guidance says Trusts will balance or first born will be taken and sold, yer granny forced onto a treadmill and yer husband indentured to B&Q.
Mackey admits there are still dozens of Trusts that have not agreed their ‘control targets’ and some have no prospect of doing so. Finances are a moving feast and we still don’t know what the final position will be but the dose of reality Big Jim has brought to the table is a cold shower of truth.
Watch my lips; there ain’t enuff money in health or social care.
When the referendum has exhausted us all and somebody or other gets back to running the country, expect a set-piece of love for the NHS and a kicking. Expect the conference season to be peppered with daft initiatives and displays of ‘grip’.
Expect everything but reality. Expect everything but brass tacks and nuts and bolts.
Expect sophistry, evasion, denial and hanky-panky.
There is no disgrace in plans not adding up the disgrace is in pretending they ever will.