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A curse on all their houses!      
News and Comment from Roy Lilley

Who said this; "There are huge pressures in the NHS (but)... according to the independent Commonwealth Fund the NHS was rated the best healthcare system in the world..."


And, who said; "Coasting culture (in hospitals) kills patients."


LaLite said them both. 


LaLite has a three way problem. Saying sensible things about the NHS to the 1.3m people who work in it, who know the score about the flat-line funding, the overshoots on targets and problems with staffing. At the same time he has to sound like he's tough, in charge and on top of things when responding to system and quality failures in the Daily Mail and his other fanzines. And, dealing with political criticism from the opposition and backbenchers. It's a difficult triangle to square.


Despite all the efforts of the Health&SCAct to distance the Secretary of State from NHS operational management LaLite is more hands-on than a Bangkok masseuse.


Andy Burnham's speech to the Labour conference gives LaLite a special headache. Burnham advanced some sensible sounding solutions. An assortment of 36k more staff, a Robin Hood tax on posh houses, fag-taxes and wicked hedge-fund spivs hammered, creating 2.5bn.


Ignore, for a moment, the practicalities of property re-valuations, the lead-time in training staff (and Burnham's numbers aren't far-off what is already planned)... oh, and ignore the fact that 2.5bn (now revealed as an annual increase) is enough to keep the NHS going for a week... it looks good enough to obscure the real problem, the 30bn funding black-hole.


Changing Monitor's role to oversee-er of financial stability and driving integration is a bar of Andy-Fudge.  If Burnham dumps the market in healthcare, dump Monitor, save a shed-load and underline the market in healthcare is really dead.  Show you mean it.  Much better idea. 


The technical stuff about vertical integration, merging health and social care and 'time to care' will have a mixed reception.  Most Trusts will like the idea of managing an integrated, population based, capitated budget and creating care-pathways that become end2end, care-super-highways.


GPs have priced themselves out of the market and the difficulties finding more GPs puts them out of the running. There's gonna-B-change whether they like it or not. Their future is salaried and working for FT's. I suspect.


Burnham says he won't mandate structural models and that aligns him exactly with Tarzan's view of the future - whatever works locally, works.


The NHS is the last remaining nationalised industry of its type anywhere in the world and creates the dividing line between politicians. Never was this made more clear than LaLite, this week, writing in Conservative Home; a blog read by fans, enthusiasts, journalists and UKIP. LaLite makes 6 knee-jerk points and gets them all wrong.


First you can't trust Labour not to screw up the economy. The implication Labour were solely responsible for the recession of 2007-8 conveniently ignores the initial sub-prime mortgage crisis and recession factors including international trade imbalances, lax lending standards contributing to high levels of developed-country household debt and property bubbles that have since burst but appear to be on their way back.


Next; where will Labour get 2.5bn from? Well, to be honest it is guesswork but the bigger question is where will LaLite get 30bn from?  And, a treat for the anoraks - here's a simple breakdown following the Twitter-spat over the 2.5bn. And, write this down and stick it on the fridge door:


'More money is not the same as enough money'. 


Third; Labour's 're-reorganisation' is uwanted. Burnham's plans mean more upheaval but I judge the NHS more than willing to find the energy to demolish the H&SCAct because, in plain English; it don't work. LaLite running the NHS from his Whitehall desk knows 'it don't work'.


Four; no apology for Mid-Staffs. Both Gordon Brown and then-health-secretary Alan Johnson apologised. It was Burnham who instigated the first Francis Inquiry that had 18 perfectly doable, sensible recommendations that the subsequent Public Inquiry delayed and obscured.  The relatives still have no closure and who knows where we are on the 250 recommendations! The root-causes; pressures to hit targets, financial balance and standards compliance are pretty much the same today. If they were bad then, why do we still have them now?


Five; lack of detail in Labour's plans to merge health and social care. Will social care means-testing be extended to health? Obviously it's a no but, hey, this is politics. I expect more detail to emerge... unlike the Conservative 'no more top down reorganisation' bombshell.


Six; Labour is wrong to say the NHS is on its knees. Ahem... targets missed, well over half of trusts in debt, scouring the world for staff, complaints up, hospitals closed for basic business... I could go on.


The wiff-waff of political squabbles over the NHS is an exhausting, time consuming, demoralising, distracting, draining waste of time effort, talent and good will.


I say; a curse on all their houses!


Have a good weekend.

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If you don't read anything else today have a look at this:
It is a list of all the documents practices have to have ready for a CQC inspection.
Why GPs, the BMA and the RCGP are putting up with this is beyond me.
To add insult to injury; apparently it is impossible to find out how much it costs to inspect an average size practice.
I'm guessing 50k+

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Making a difference.
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>>  Where's no-man - here he is! - at his safest, out of the office.  Be a sport and make a donation; keep him out of the office!  Latest picture. He is half way to his target of 500 - make a donation and get him to cover his legs up!
>> Cannibal-nurse - jailed.
>>  HS&DR - commissioned funding opportunities.
>>  GP OOH - surveillance bulletin.
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>>  Cancer patient experience - annual survey.
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>>  Birmingham have close for business from some CCGs (Here) - I'm hearing there are Trusts that will follow next week.  Where does this leave Monitor?
>>  Can anyone tell me how much it's going to cost for the chief-GP-flat-earther, Inspector Steve Field to inspect an average size practice.  Is it true he is refusing to tell?  He can't, can he?  It's public money.
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