18th January 2016

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Former Secretary of State for Health and now Chair of the Confed
Stephen Dorrell

A place to hide 
News and Comment from Roy Lilley
No-Man Lamb (remember him?) and miscellaneous former health ministers from Labour and the Tories have combined to call for a commission on the future of the NHS.
In a carefully coordinated move, 40 charities and other health organisations have written to the PM asking for the same thing.
They're a bit late.  The King's Fund got Kate Barker to do one last year.  A very good analysis... it was ignored.  Two years ago I chaired and inquiry into healthcare in London; eighteen very doable recommendations (I think)... ignored.
None of these former ministers would have agreed to an inquiry whilst in office.  To understand why is to understand the political process.
If a politician concedes a scintilla of doubt that their policies may not be working it will be seized upon by other politicians and a row starts.  Numbers are lobbed over the battle lines; everyone loses the plot and eventually the press moves on to the next hot topic.
An inquiry into the NHS would require the government to admit that its commitment to the Five Year Forward View, the Osborne Recovery Plan and the Prime Minister's undying love for all things NHS, to say nothing of the Tinkerman's tinkering, ain't gonna work.
On the other hand; if there is a really tricky topic an inquiry is a good way to kick it into the long-grass.
Politicians aren't going to admit the damage done to the NHS by Lansley's madness or Osbourne's destructive, myopic fix on austerity.  The NHS is really tricky but do we want it parked in the long grass?  I don't think so.
So, as tempting as it is to support this endeavour, common-sense and experience tells me; give it a miss.
Anyway, what would an inquiry tell us we don't already know?  There is too much demand, not enough money and the gap between health and social care is not sustainable.  Thanks we've go that.
Demand going through the roof.  There are two things to do about that.  Tell people with self-inflicted conditions, illnesses and woes to clear off and sort themselves out.  That includes the over-weight, the drinkers, the smokers, the couch sitters and the runners with sports injuries.
The alternative; put a bomb under Public Health England, sort out school curricula to include healthy lifestyle and what-to-eat lessons.  A sugar tax and avoid eating anything that comes in a box.  Start using the plethora of data the NHS has collected since 1948, to find out why people get ill, what fixes them up, what does it cost, do we want to keep doing it and how can we avoid it next time.
The money?  Charge people for seeing a GP, missing appointments and being drunk in A&E?  Maybe, but the cost of collection outweighs the return on investment. 
Co-payments?  OK, take your taxes out of your right pocket and top-ups out of the left and remember; it's still your trousers.
Or, get NHS funding back in line with the EU average and make a law to keep it there.
The gap beween health and social care?  Be careful what you wish for.  Social care is means tested the NHS isn't.  Put the two together, and the NHS could become means tested.  Watch the Vanguards, for how to circumvent this problem.
How about we focus on the big issue.  Long-term care for the older citizen.  Let's encourage families, where they can, to do their bit; pay them and train them to be carers. 
How about we create 'Silver Bonds' for individuals and families to pay-in money and assets, tax free and make withdrawals, for the purposes of care, tax free.  Residual funds... also tax free.
All this could be in a manifesto at the next election.  An inquiry is likely to crash the buffers of that time-line.
If we want these things fixed the trick is; make the politicians fix them. 
An inquiry gives them a place to hide.
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>>  Strike - St David speaks; a lot of sense, too. Original story in the HSJ here.
>>  Regulators push to balance the books - headcount reductions to balance before the end of March.  More here.  If Bob Alexander's best idea to balance the books is to sack people, he might like to start with himself and the entirely superfluous TDA.
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Stephen Dorrell
Former Secretary of
State for Health
Chair of the Confed.
'the reforms were the biggest mistake of the Parliament'
This is what I'm hearing;
if you know different,
tell me here
>> I'm hearing - RCN is 100yrs old. 1916-2016.
>>  I'm hearing - Property services reorganisation will mean 250 jobs will go, 30% top teir managers and 8 new regions will be established.
>>  I'm hearing - Chris Wormald (formerly Dept Education) will take over from Una O'Brien as permanent secretary at the DH; I'd heard that the CQC's David Behan had thought he was in with a chance.
Need inspiration, a good idea or solve a problem
>>  Dame Sal (what a Gal) - thank to several readers, here she is again.  The Sunday Times this time.  She tell us; "I have a team of 14 staff, including a private secretary, three assistant private secretaries, a diary secretary and a number of other spare brains to help me stay organised".  She obviously has the gift of making her staff, including the 'spare brains' feel valued.  She enjoys "Ottolenghi-style salads" and "cavolo nero" and thinks she may be suffering from Imposter Syndrome.  Or, could that be Poseur Syndrome?