27th July 2015

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Health Chat

Sir Robert Naylor

One of the longest serving leaders in the NHS, running one of the biggest Trusts.

What's life like at the top? Find out; in conversation with Roy Lilley; King's Fund 16th September 

WARNING 2/3rds of the Tickets were sold by Friday.  Book now. 

Tickets here.

News and Comment from Roy Lilley

Michael Gove is my local MP. Enough said. Students of the national press will be aware that he managed to break his foot. Some of his constituents were hoping for much more; but that's another story.


Managing to break your foot and having a Fleet Street photographer on hand, to record your discomfiture and embarrass your Cabinet colleague, says all there is to say about Michael Gove.


His wife aka Sarah Vine is a columnist with the Daily Mail where the story also appeared.  Mmmm....  Why would Gove agree to this?  Tensions in the Cabinet, perhaps?


Mrs Gove alleges her husband, who had hobbled manfully all week, was unable to get a foot X-ray on a Sunday.


As far as I know, the excellent St Thomas' Hospital, opposite the Palace of Westminster, still has an X-ray department? The hospital in his constituency, Fabulous Frimley Park is open 24-7, with a new A&E, plus 24-7 consultant cover and a 'copter-pad.


However, I don't think Mr Gove lives in his constituency? He somehow became embroiled in a 'flipper-mistake'. He repaid the money, apologised for the confusion and as far as I know, moved.


This latest episode, in the life of Michael, is equally confusing. Gove was weekending (living?) in Somerset. The Shepton Mallet; 'Walk-in', minor injuries, treatment centre (whatever it was) that Gove attended (it is alleged) was unable to offer him an X-ray to assess the state of his metatarsals.


A fracture at the base of the fifth metatarsal bone is often mistaken for an ankle sprain. A fracture of the first metatarsal bone can lead to later arthritis of the big toe joint... so it is important to find out what's what.


At the Shepton Mallet Centre for Confused Patients, part of the service is run by the NHS, part, under contract, by Care UK... all commissioned by the local CCG. Fragmentation, a legacy of the Lansley madness.  No one wants to own up to showing Mr Gove the door.  


Maybe the clue is in the title. If you've got a broken foot and are having trouble 'walking'; a 'walk-in' centre is not for you. If you have a broken foot, that is not a minor matter and a 'minor' injuries unit is not for you.


If you have had an 'accident' and think you have broken something; maybe an 'Accident' department might be the place? That's why they have X-ray machines.


To deal with Mr Gove's (and I suspect a lot of other people's) confusion the Carbuncle is reorganising urgent care. On Friday they launched the next phase of their Vanguard roll out.


The Carbuncle announced:


"Urgent care will be delivered, not just in hospitals but also by GPs, pharmacists, community teams, ambulance services, NHS 111, social care and others, and through patients being given support and education to manage their own conditions."


Err.... where will Mr&Mrs Gove go to play hunt the X-ray machine?  Where is it? 


NHSE's Chief executive, Simon Stevens, said:


"Starting today, the NHS will begin joining up the often confusing array of A&E, GP out of hours, minor injuries clinics, ambulance services and 111 so that patients know where they can get urgent help easily and effectively, 7 days a week."


I think Mr Gove will say; 'Not a moment, too soon, Tarzan. It's a jungle out there... but my wife is still not sure where she should tell the photographer to meet me?'


Someone called Keith Willett, NHSE director of acute confusion said:


 "... a modern NHS needs a very different approach... even in times of austerity, we can transform patient care. We cannot delay... (it is )... important... these networks support and improve... local urgent and emergency care services, such as A&E departments, urgent care centres, GPs, NHS 111 and community, social care and ambulance services... no one is working isolated from expert advice 24 hours a day."


Errr... I have no idea what he's talking about.  Where's the X-ray machine?  Where should Michael 'network' his broken foot?  Does anyone at the Carbuncle speak English?


Guess what, my local minor-urgent-walking thingumabob is actually in the hospital! Which door do I hobble through?


Here's what I'd do; sweep up the minor injuries, walk-in and other plastic bits of the NHS, gather together the flotsam and jetsam of out of hours services and all the rest. Close them. Give the money to the local hospital and let them get on with providing 24-7, in-and-out, or on-the phone care. Vertical integration, population based, capitated budgets.


Clear out the undergrowth. It costs more than you think, is confusing and irritating.


People know where hospitals are. They have 24-7 imaging, path-labs and diagnostics.  Sort the wheat from the chaff with red-hot triage at the front door and well designed flow management strategies.  That way, whatever is wrong with you, you can never be in the wrong place.


And the beauty of it is; it makes life so much simpler for the photographers.


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Sir Robert Naylor
One of the longest serving CEOs of one of the
 Biggest Trusts
At the heart of strategy and policy for over 25yrs.
What does the future hold for the Vanguards, strategy, regulation, funding.
Come and hear him in conversation with Roy Lilley 
King's Fund
16th September.
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