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Editorial Friday 20 June 2014: Byrne, baby, Byrne (disco inferno)

Among the stupidest jokes of recent times is the former Treasury secretary Liam Byrne's note to his successor in 2010 after the general election. It read 'there's no money left'.

There are deeply, hog-whimperingly stupid things to do, and then there's something like this.

The last government is of course always to blame for everything in politics: this is a given. Yet the narrative into which this played was not (at that time) set in stone: the tale that Labour had spent all the money and failed to fix the roof when the sun shone.

That narrative is balls, of course. (Ed Balls). The Conservative front bench in opposition was not calling for less spending before the financial crisis hit. Those with long memories will recall Fantastic Dr Fox's bid for a subsidy to people wishing to go private up to half the cost of an NHS procedure - the wonderful Patient's Passport.

Yet by message discipline and consistency, George Osborne forged a narrative of Labour profligacy. Never mind the fact that Labour fixed many a roof (unwisely using PFI): the Conservative  message consistency, allied to a combination of ideological bias and deep and opulent stupidity across most of the national media which understood the global banking crisis poorly, gained traction and ultimately made the weather.

That is where we are today. We are less than a third of the way through paying off a deficit caused by the unpalatable, essential baling out of a massively leveraged and profoundly short-termist and incompetent financial sector.

Big Finance can't believe its luck, and nor can anyone who's bothered to inform themselves about it. Hey-ho.

Read my lips: new taxes
The horizon for public spending cuts extends a long way still, as the IFS have shown.

The excellent Flip Chart Fairy Tales has a nice Venn diagram of the effect on public services, and former SpAd to financial crisis prophet Vince Cable Giles Wilkes, agreeing with this point, also has crunched the data on the main Westminster parties' spending plans. Not pretty reading.

This affects all of the public sector, of course. social care via local government has still got most of the cuts ahead of them, so we can expect the waterbed effect of demand popping up in the NHS, despite the un-ring-fenced £2bn Pothole Care Fund.

The Kings Fund and Nuffield Trust have crunched the numbers for the NHS: they are not pretty.

The Electoral Resilience Fund and the Prime Minister's Panic Fund may help 2014-15 finances to land in about the right place.

Thereafter, we're what the economists describe as 'fucked' (and not in a good, consensual sense).

That is, we're fucked unless a politician in one of the main parties finds their arse-elbow differentiation skills, and tells us the truth: we are going to pay more tax after the 2015 general election because we're not going to let the entire public sector fall over.

A Dutch auction of pre-election promises not to raise tax versus reality: which will win? Mmmmm.

Even if you raise taxes (and I'd do a penny on basic rate income tax in year one; another penny in year two, hold it in year three, cut a penny in year four and if economic recovery permits remove the first in year five, giving an extra £4bn in yr 1; £8 bn in yr 2; same in yr 3 and £4 bn in yr 4), there will also have to be serious reform of public sector delivery as well.

That extra money has to be seen as part of a transformation fund.

Localities will have to find ways to pool budgets, and target efforts to prevent avoidable need or waste. It won't be easy. It's also not impossible.

The bloody obvious
They will also have to do obvious, evidence-based things.

An example: primary care needs are turning up in A&E. Does every A&E have co-located primary care, with experienced triage staff filtering patients accordingly?

I suspect that the answer is a big no.

Another: we know that the poorest people have the worst access to health (and probably all public services), and the highest need and worst outcomes. Is every health economy - indeed every public sector economy - actively collaborating (in the way the Leeds health economy is doing) to address this stuff working with communities and involving them?

I again suspect that the answer is a big no.

Is there evidence-based workforce substitution under way at scale and pace in primary care, not only to address rising demand but to help case-manage patients with long-term conditions in collaboration with expert patient approaches? Are we getting serious about using activity and outcome data, putting it up on the wall of providers and commissioners as soon as it's roughly right to drive change? Have we even started to use the not-a-magic-bullet-but-a-vital-tool IT and online opportunities properly?

Can you guess what I suspect the answer is here? Oh, you can. Good.

And all of this is essential, even if politicians stop fibbing and admit we are going to have to pay more tax. Demand is unlikely to stop rising, unless a really harsh winter coincides with the rather overdue flu epidemic that'll be along soonish. And we probably don't want to plan on that basis.

This isn't a thing for next month or next year.

This is for next week. This is serious.

Doing it to ourselves
And it's possible, if difficult, to do.

We simply have to be locally-focused first and foremost: all politics is local. One size never did fit all - public policy and practice isn't a onesie.

Then, we have to steal good practice avariciously and quickly; experiment and make inevitable mistakes and share the learning from them ('fail fast and fail forwards' is one of my phrases of 2014); and not be afraid.

Oh, and we'll have to collaborate like never before, without professional or organisational chauvinism and with a steely focus on users. Which means telling anyone charged with policing anti-competitive behaviour a good story that what we're doing is perfectly in line with legislation and policy because it's in users' best interests. (If they then query that good story, they'll just have to whistle out of their arse.)

Because pretty much whatever happens, it's going to be messy.

So we can do messy to ourselves, and have some ownership, or we can feel like victims of messy, and be bystanders, and argue about who to blame. I know which option I prefer.