The Gettysburg Address is a speech by U.S. President Abraham Lincoln, one of the best-known in American history. It was delivered during the American Civil War, on the afternoon of Thursday, November 19, 1863, at the dedication of the Soldiers' National Cemetery in Gettysburg, Pennsylvania, four and a half months after the Union armies defeated those of the Confederacy at the Battle of Gettysburg.

The carefully crafted address was one of the greatest and most influential statements of national purpose. Just for the clinicians; Lincoln is thought to have been in the early stages of a mild bout of small pox when he delivered it... he looked ashen and grey.

Now, it might be a bit of a stretch to get from a speech delivered 150 years ago, on a windy, winter's afternoon and the NHS... but go with me.

The parallel, for me, is to be found in how huge steps in thinking and influence can be contained in brief documents. Twitter is a good example. The discipline that is required to condense and abbreviate, shorten and summarize, shrink and reduce thoughts to their absolute essence. It's a skill.

The NHS can't do 'brief'. Almost every document is too long, rambling and all too often, reports are a vanity publication to make the authors look good. Guidance will have its lack of evidence and research wrapped in pages of bunkum.

At least until a couple of days ago; a document has been published that could redefine healthcare, its purpose and place in the nation. Is it an exaggeration t claim it is a revolutionary document? In 1,500 words it maps out what the NHS could look like in the future. It is four pages that describe the next steps in the Vanguard Programme.

The language is extraordinary; tackle barriers, consider different options, franchise, ambitious vision, vertical integration, horizontal collaboration, new organisational forms, specialist services across providers, reducing avoidable variation, radical options, groups, chains, multiple organisations.

This document recognises and includes hospitals that, for years, have been marooned by their geography, prisoners of their local health economy and beaten to death by the regulators. The document sees the difference between urban and rural locations and recognises a one size fits all future would simply straitjacket the nimble and innovative and lock out talent and the triers.

Proposals include the delivery and management of elective services across different geographical sites by a single provider; share back office and clinical support functions and create multi-service chains or "foundation groups".

I don't think it is too much to ask you to find a moment to read these few, ground breaking pages.

Do the words leave Monitor running to catch up? No, they leave them behind. There is no room for their clunky market mythology when, by the leave of this document, people will roll up their sleeves and have permission to work together.

Does it leave the flat-earth brigade at the CQC scratching their heads about what they do with their coachloads of 'inspectors'?  It sure does.

If services are run horizontally, defying geography and management hierarchies, through franchises and service chains, collaboratively through entire care pathways, where will the CQC park their buses? Tarzan speaking of his document talks of; '... the first stages of a proposed "success regime", which aims to help struggling areas move towards the new care models...' Note the words 'help' and 'success'; not special measures nor stomping on.

I say again please read and reflect on what this document offers the brave and the bold and the people with ideas and ambition. This is a document to read and finish standing up, shouting; '... how do I join in?'

And, when you have finished reading it, think about the fact that the Health and Social Care Act has 12 parts, 309 sections, 23 schedules and enough words to exhaust your print cartridge and bust the stationery budget for paper.

If there isn't something in this for you, where you work, that can make you part of the mutiny against Lansley's legacy, you're working in the wrong place.  

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Academy of Fabulous Stuff;

Have you looked at the fabulous stuff?

New 'shares' every day.

Make a note; be a sharer this week. 

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