"Ever tried. Ever failed. No matter. Try again. Fail again. Fail better." - Samuel Beckett, 'Worstward Ho'

The chat in NHSland is that 2013 is to be 'The Year Of Pain' - one long run of long-delayed closures. The hope seems to be that the political pain begins to subside in time for a 2015 general election.

Mmmm. And mmmm some more, I rather think.

......................................................................

Click here for details of BMA: “Resign, Lansley! But fix our pension deal first” - Is SOS Lansley a misunderstood genius channelling Schopenhauer?, the new issue of subscription-based Health Policy Intelligence.

......................................................................

As South London enters its failure regime, and the financial woes of Croydon and York become ever more apparent, the 'pass the parcel-bomb' game continues.

Its outcome - who ends up with the deficit - is becoming quite a disruptive means of innovation.

You mean we have to close things?
The non-health-policy-geek general public - and that is most people, including the pretty well-informed classes - have the strong impression that the NHS has received special treatment in the Comprehensive Spending Review. Broadly, they probably don't expect major changes in NHS services, which will of course be perceived as cuts.

They are going to be in for a bit of a shock.

It's more than slightly weak that it has in effect been left up to the NHS Confederation, led by Mike Farrar, to make the case for radical change in service delivery.

Oh, we have the 25% measurable four tests devised by Andrew Lansley (saviour, liberator). Which are lovely, if essentially ornamental.

In the beginning was the bung
The NHS has a long history of dealing with financial failure by throwing more money at the problem. The money was usually a fictional end-of-year 'loan' or brokerage to ensure that the health economy of the patch (RHA, SHA et al) was in financial 'balance'.

All and sundry in the know were well aware that local NHS financial documents were (to borrow Romano Prodi's line about Silvio Berlusconi) "using figures like a drunkard uses a streetlamp - not for illumination, but to keep standing up".

The arrival of foundation trust status changed this slightly, but provider bungs were still going on in many places. Even FTs could get them, in contravention of a key aim of FT status: hello, Heatherwood and Wrexham.

Latterly, it has been interesting to see policy develop a bungs formula for Monitor as well as an explicit fuck-up fund. These accompany a new provider failure regime, which will ensure the continuity of essential services.

Smarter providers are thinking hard about failure and the future, and I cannot recommend highly enough Dr Mark Newbold's blog - the latest instalment of which is stunningly candid about the degree of change the NHS needs.

But commissioner failure has never yet been addressed.

Some will argue that this is because of the Stephen Dorrell line that "commissioning sounds like a good idea that we should try some time". Sure, PCT chief executives lost their jobs (for better and worse reasons), but we are now relying on the NHS Commissioning Board, which as Chairman Mal told the NHS Confederation conference last month, aims to be an organisation that understands there will be mistakes.

That is a lot to ask a new organisation to do to other new organisations.

It's the end of the world as we know it
Into this oncoming mixture of closure and failure (are you sitting comfortably?), comes the NHS South consortium of provider trusts in the south-west who, as HSJ revealed, aim to negotiate non-AfC terms and conditions.

This week, the Sunday Times got a leak of some of the consortium's proposals.

Ideas reportedly considered include "the termination of all staff contracts and a reissue on different terms that could include:
■ Pay cuts of up to 5%
■ An end to overtime for nights, weekends and bank holidays
■ Reduced holiday leave
■ Forcing staff to work longer shifts
■ Slashing sick pay rates

" ... Acting in unison . . . in a way which has not been undertaken previously demonstrates both the seriousness of the situation and the collective resolve to achieve long-term change”.

Mmmm. I suspect that this is more about negotiating tactics than strategy.

The south-west is the adopted home turf of Sir Ian Carruthers, a tough negotiator and not an individual known to leak documents. He had his south-west moulded in pretty much his own image. It seems improbable that local providers went leak-happy.

As an operational strategy, this is the kind of set of moves that might have been open to discussion as the financial challenge was becoming clear. Pulling these moves now, at a time when the new system is not yet born and the old is not yet dead, seems difficult to rationalise.

This looks much more like the classic negotiating tactic of leaving a 'position paper' in a photocopier to be found outlining a deliberately extreme scenario, so that when the options are less radical and less bad, there is a sense of relief.

I've no doubt there was a leak, but it looks much more plausibly tactical than strategic.