14th March 2016

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Jim Mackey boss of NHS Improvement Tickets here 
We have moved to a bigger room and have just released a further allocation of tickets
Nearly all gone.....

How difficult is that?
News and Comment from Roy Lilley
The NHS is a rumour mill.  There is always plenty of gossip, speculation and chit-chat.  It can be delicious, intriguing, embarrassing and a damned nuisance, in equal measure.
But, it lubricates the day to day, entertains us, makes some people feel powerful and others important.
Right now the NHS is facing one of its biggest challenges and there is no word.  No natter, no chatter.
The NHS is on strike and no one is saying anything. There are no talks, just the ritual abuse the Tinkerman suffers but nothing useful.
Patients are piling up on waiting lists and the Patients Association, with all its doctors as trophy presidents and advisers... struck dumb.
Hospitals are on the verge of collapse and the Confed, now lead by an ex-Tory cabinet minister, all but silent.
The Royal Colleges are busy polishing their chains of office; too posh to push into a 'workers strike'.
The BMA have got nowhere to go other than more strikes, longer strikes, a complete walk out, or capitulation and oblivion.  The tide may be turning against them.
The Trusts are overwhelmed with demand, over-regulated, underfunded and sinking fast.  And, if this is true, there will be even less money.  They are probably turning into dangerous places. 

CCGs are moribund, powerless and the ugly orphans of the Lansley reforms.  If they had an opinion, no one would be interested in hearing it.
The DH is the communications department for Tory Central office and pretty well anything they say can be regarded in the same light as sprinkling glitter on a cow-pat.
There is now only one person who matters.  The Prime Minister.
Does the Tinkerman have the full, unequivocal support of a united Cabinet?  I'm not talking Premier League football manager 'support'. 
I'm taking real unambiguous, explicit, categorical support; the Tinkerman is going nowhere (all the time he supports Cameron's EU ambitions), the doc's can strike until Doomsday, trust management can be exhausted, finances shredded and patients can pile up on waiting lists as high as the sky.  They are not going to be rolled by a union.
If that's right, Cameron should say so.  At least we would know where we are; the junior doctors could go to Australia, the nurses could go to Marks and Sparks for a job at and patients could go to the chemist for a cure.
We have to do something!
Here is the mad part; we have a strike over a contract that no one has seen.  There is a pay calculator that doesn't work and anyway, each Trust will rota staff unique to their own circumstances. 
This is a row over nothing and a row over everything.
On the basis no one else is saying anything and someone has to go first... here's what I would do.
Lift the threat of imposing a contract that no one has seen.  There are iterations of various drafts but no contract.  The 'contract' should be published, at least then we would know what the row is over.  If it is in draft, let's see it.  If it goes no further that the Dalton letter of 3rd February, let's say so.
Pause the strikes; they are causing untold harm to the Trusts who are not protagonists in this fight.  They can't get staff, they can't catch their breath and they can't reorganise in time.  Financial damage, loss of moral and it is only a matter of time before a patient 'dies waiting' and then there will be hell to pay.  The BMA will only be sucked, deeper into industrial action.
Monitor; the likelihood of getting anywhere near a civilized end-of-year is gone.  Targets... forget them.  Finances... busted.  Management... either interim, exhausted, hanging on or looking for retirement.  Boards... utterly bewildered or beaten up.  The one-time fissures in the landscape are turning into cracks and they are becoming yawing gaps.  The best Monitor can hope for is 'tidy'.  In the meantime, they have to help.
The CQC; they are generally destructive and that is exacerbated in the current climate.  They should simply suspend all inspection activity whilst the current crisis pertains.  When times are good they do no good.  When times are bad they make things worse.  Clear off.
On a practical level... we need a panel of wise men and women to look at the 'contract', take a view, make a binding recommendation and let all sides get back to putting the patient first.
Pause; an armistice, lifting threats on all sides.
Publish; what is in the contract that no one has seen.
Panel; of wise men and women to examine and make a binding recommendation for the future.  If the DH won't play; empty chair them.
Patients; Oh  yes. try and remember them....
Four 'P's... how difficult is that?
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Jim Mackey
Chief Executive
NHS Improvement
In conversation with Roy Lilley
King's Fund 
14th April
Buy your tickets this week.  It is close to a sell out..
Chief Executive and Registrar of the GMC
Niall Dickson
Hugely interesting career as a regulator, the King's Fund and the BBC.
A great night in prospect.
The Gooroo
Writes exclusively for us
More fabulous analysis
The NHS is getting closer and closer to the car in front...
This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - the National Guardian programme is slipping deeper into chaos.  It seems there is no plan on how national leads will work.  Is there anything that the CQC can do right?
>>  I'm hearing - avoidable mortality rates will be published this month.  There is no way to compare Trusts because methods will vary but I'm telling you now, the newspapers will find a way to bash the NHS... once again.  It's a pity because it could be the start of something very valuable.
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