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Keys to the castle

What will happen when Gordon Brown gets his hands on the keys to Number 10?

In corporate Britain it is unusual, in fact probably rare, for a finance director (FD) to take over as CEO.

The finance people are a funny lot, they have the 'no' gene. Under all circumstances their first reaction, to anything, will be to say 'no'. They can't help it, bless 'em, it's the way they are.

They do numbers and calculations, and understand the dark arts of Excel spreadsheets. They can do risk modelling, forecasting and work out percentages. At conferences, in the wee-small-hours, when everyone is drunk, they tell jokes about auditors and can work out what five per cent of a squillion quid might be in Swedish Kroner.

They can think back to the third quarter of 10 years ago and tell you the cost of sale and RoI (whatever that is). They understand how much a Euro is worth. They are strange. Essential and valuable but strange. And, they don't make good CEOs. They are too cautious, risk averse and safety first.

One of the biggest Plcs in the world is about to be taken over and run by the former FD. In a smooth move he will step into the job. Succession planning at its best. Endorsed by the outgoing boss, the trades unions and the staff, he will step up to the plate and take on the job.

The shareholders are suspicious. Some have said they think they should have been presented with more than one candidate, called in headhunters and had a beauty parade. However, that is not to be.

Poison chalice?
Gordon Brown, the former finance director of Great Britain Plc, will take over from Tony Blair, the incumbent CEO and the shareholders will hold their collective breath, and see if he can do the job. There is a lot to play for.

The nation is at war. At war in Afghanistan and Iraq. At war with itself on the streets of Britain where drug-fuelled gun and knife crime are on the rise. At war with poverty and deprivation. In some parts of the country, life expectancy can vary by 10 years from one place to another, just 10 miles down the road. It is a nation ill at ease with itself.

Houses are too expensive for the families of tomorrow to buy. There are more people over 80 years old than there are under 16. There are more of our fellow citizens in jail than ever before. It is a hell of a time to be taking over.

On the other hand, there is a golden inheritance. The economy is stable. Pensioners no longer freeze to death in their homes in the winter. More kids are going to university than ever before. School roofs no longer leak. And the NHSÖ well, what about the NHS?

Since 1997 waiting lists have halved and the service is on course to deliver treatments, for everyone, within 18 weeks. A decade ago you could wait 18 months for an appointment.

Deaths from cancer have fallen by more than 15 per cent and you are now twice as likely to survive a heart attack.

Despite recent hiccoughs there are nearly a 330m more staff in the NHS than in 1997: staff number now total 1.3m including, 122,000 doctors and 404,000 nurses. Indeed, there is now a surplus of doctors and nurses which will drive down wage costs and limit the aspirations of some of the more avaricious, left-wing unions.

The budget has tripled to GBP 92bn and overspends have been contained at a piddling GBP 50m. There is a colossal, biggest-in-the-world-ever, IT roll out, which will revolutionise care, what we do and what we pay for.

That's the good news. The bad news is: we have spent the last 10 years dismantling the internal market only to travel in a costly circle to reinvent the internal market. We have paid hospital consultants more money for doing the same things and GPs are counting a pile of extra cash, while healthcare assistants, nurses and receptionists earn the points that produce more money for doctors to count. And nurses have done nicely, too. They earn more than they ever have.

Yet, binge drinking is on the up, teenage pregnancies are reaching all time highs, sexually transmitted diseases are at critical levels and obesity has reached epidemic proportions. Oh, and dentists are rarer than a married catholic priest.

Private finance initiatives have led to the biggest building programme in the history of the NHS and we now have some of the most expensive hospitals you can imagine, with services locked into payment and rent deals that they can't get out of. As technology and pharma reduces bed-stays, the NHS is locked into 300-400 bed configurations they will not need.

The private sector has made a fortune out of poorly negotiated contracts and out-of-hours firms can afford to fly doctors in from Germany for the weekend to do the work that GPs no longer want to do.

What next?
What will Gordon do? Well, it is the Treasury that has provided the cash for this spend-fest and Gordon ran the Treasury. Now the man who ran the Treasury will be running the country.

Gordon Brown is not like your average FD. He says 'yes'. He has said 'yes' to all the wrong things and has nothing to show for it.

He will move upstream; expect public health measures and community wellness to top the agenda. Gordon's Chancellor will have to have a better grip on the money than he has had. Expect an
eye-watering squeeze on budgets and little in the way of uplift.

Expect more of the same. More private sector involvement, more targets, assets that are sweated, and local government and the public to have more say in how the NHS does its business.

The Blair legacy? Just the smoking ban that comes into effect in July.

Now it's all down to the FD who likes to say 'yes'. Good luck Gordon.

The Author
Roy Lilley is a healthcare author and broadcaster

11th June 2007

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