26th February 2016

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Prof Sir Mike (Deep-Diver) Richards - CQC
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News and Comment from Roy Lilley
I know, it's Friday and we should be 'dressing-down' and buying doughnuts.
Friday in countries adopting the international standard (IOS 8601), is the fifth day of the week. 
As we head for the weekend (and a spot of rugby) we are supposed to cheer ourselves up.  Hence the doughnuts.  However, in maritime circles Friday is considered unlucky and not a day to set sail. 
You will know all about Friday the 13th.  The Hebrides think it is a lucky day and a good day for planting.
As you can see I am desperately trying to think of a way to link a Friday with an uplifting message to send you on your way to the supermarket, the match, the gym, the movies or the couch, whistling a happy tune.
All this week I have tried to avoid two topics.  Two killer topics but I can't really avoid them. 
First the strike.  Already a near-miss-strike and two days of action have probably put about 6,000 people to the back of the waiting list.  It's about 2,000 people for every day lost.
Junior doctors have said to me; operations and appointments get cancelled all the time, so a few more won't matter, as 'their cause is just'.
The next round of strikes are two days at a time; 4,000 people.  There are three planned; that's 12,000 + 6,000 = 18,000 operations and appointments.
Except it isn't.  It is 18k people, patients, families, travel plans, time off work and probably a good bit of pain, suffering, anxiety and worry.  But it's OK because the junior doctor's 'cause is just' and anyway 'it's all the Tinkerman's fault'.
The Tinkerman says it's all about making the NHS better for patients, it's 'all the junior doctors' fault'... and anyway, his 'cause is just'.
Now, if you think this is a million miles away from what the NHS is supposed to be all about, pass the doughnuts.
Pretty soon this pain and suffering that patients are stoically bearing because; the 'juniors doctors cause is just' and the Tinkerman's 'cause is just' , will, like an neap tide, creep in and unexpectedly engulf us all in almighty grief.
Whilst the bewildered, gutless leadership of the Patients Association are dancing around their handbag, forgetting they are there for patients and not the DH, or doctors, there will be a flash-point; an accident, the death of a deferred patient, something horrible that will turn a stupid row into a war.
I can't predict exactly what will happen but I can tell you with absolute confidence; it will be ruinous for the Tinkerman, devastating for the BMA, disastrous for the reputation of the NHS and catastrophic for a patient.

The Patient's Association will still be palavering about and probably not notice. 

More calamities will follow.  Social media will turn into a bush fire that will rage through MPs surgeries, in-boxes and turn PMQs into a rout.  Not from the flat-footed Labour lot.  The Tory back-benchers will riot and Cameron is fragile right now.
So, here's what we should do on Monday morning; both-sides should recognise the damage they are about to do. 
Call off the imposition of the new contract, call off the strikes and appoint an independent chair (Dame Janet Smith is presently unemployed and seems eminently sensible) and have a commission to look into the contract and its implications.  Give them six weeks to make recommendations, on the basis of pendulum arbitration.

Just do it.
Right, now that's that out of the way.  Pass me another doughnut.
The second issue; the money.
The iridescent big brain at the King's Fund, John Appleby, writes about the looming prospect of finishing the year with a 2.3bn overshoot:
"...national bodies (he means Not-Monitor and the Carbuncle) have increased pressure on trusts to reduce overspending and introduced more stringent financial controls in an effort to get the overall deficit down to 1.8 billion by the end of 2015/16. Despite this, there is evidence that many trusts will not be able to deliver the savings needed; making it unlikely this target can be achieved."
He is right.  And, frankly, who cares?  There is nothing anyone can do.  Trusts have done enough tightrope walking, now it's up to the jugglers.  

The NHS isn't over spending it is underfunded for the activity it is obliged to undertake.
The Treasury didn't give us enough money to start the year and now it will have to make up the difference at the end of the year. Get over it.
Are you overspending, throwing money about, having a party?  No you are going without pay rises, working with too few colleagues and being run ragged.
It's the Tinkerman's problem, not yours.  Do your best on Monday; turn the lights out and use both sides of the loo-roll.  It's all you can do..
Pass the doughnuts, I like Fridays.
Have a good weekend. 
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