21st March 2016

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14th April King's Fund 5.30pm
Jim Mackey boss of NHS Improvement Tickets here 
Last few..... will be sold out this week.

What will he stand up for?
News and Comment from Roy Lilley
If the emotional interview on the Sunday Marr Show is anything to go by, when history speaks, my guess is, it will say Ian Duncan-Smith, who quit the Cabinet on Friday, was more sinned against than sinning.
In 2004, upon relinquishing the leadership of the Tory Party he formed the Centre for Social Justice and set about reforming a benefits and welfare system that looks like a wiring diagram for a moon rocket and makes a dog's breakfast look like nouvelle-cuisine. 
Over the weekend it emerged he has been on the brink of resigning on three previous occasions... frustrated by the Treasury seeing welfare payments as a soft target in hard times; derailing his attempts to reform the processes over a longer run.  Short termism is a curse.
IDS resignation letter is an illuminating read.  He says:
"Throughout these years, because of the perilous public finances... difficult cuts have been necessary. I have found some...easier to justify than others but aware of the economic situation and determined to be a team player I have accepted their necessity."
Good guy or bad guy, reform or re-disorganisation, Brexit-Brentry; take your pick.  You'll have your own view.  Not my point and not my argument.  What is interesting is
to read between the lines.  IDS is 
doubt over the need for the Chancellor's austerity, choices and policy.   

I wonder where the Tinkerman sits in all this?
The austerity policy is the Chancellor's choice.  Balancing the nations' books by 2020, his target.  Achieving a 10m surplus by 2020, his idea.  

Taking 20% out of local authority budgets, his choice.  

Does the Tinkerman agree? 

A further cut of 3.5bn across departmental budgets in 2019/20, his choice.  

Does the Tinkerman agree?

Forcing public sector employers to stump-up 2bn in increased pension contributions, his choice. 

Does the Tinkerman agree?

No proper pay-rises for nurses for (what will be) ten years... his choice.

Does the Tinkerman agree?
No one is forcing the Chancellor into these choices, neither the time frame.  They are his decisions.  I doubt the sky would fall in and the Bond Markets collapse if the time scale was less steep?  He has already missed several of his targets and we seem to be still standing.
We are all implicated in these choices.  When we stood at the ballot box at the last election we knew the Tories (and to some extent, Labour) had promised no increases in taxation, national insurance or VAT and they also told us they would balance the books.  Where did we think the money would come from?  The nation made a choice.  Now we have to deal with it.
IDS was part of that choice but this is what he now says:
"I am unable to watch passively whilst certain policies are enacted in order to meet the fiscal self-imposed restraints that I believe are more and more perceived as distinctly political rather than in the national economic interest."
He is attacking the Chancellor's choices.

Does the Tinkerman agree?
So, when your granny receives a 15 minute visit from a care assistant, working on a zero hours contract with no prospect of training or support... it is because of choices made by the Chancellor.  Does the Tinkerman agree?

When our hospitals are bursting at the seams because Social Care hasn't got the people, resource or capacity to deal with the tide of demand... it is because of choices made by the Chancellor.  Does the Tinkerman agree?
If A&Es grind to a halt because there are not enough doctors or nurses, an agency cap and gaps in the rotas... it is because of choices made by the Chancellor.   Does the Tinkerman agree?

When hospital estates and equipment crumble because the Chancellor has chosen to take a 1bn out of the capital budgets - does the Tinkerman agree?

When GPs surgeries are overwhelmed and others close... it is because of choices made by the Chancellor... does the Tinkerman agree? 
When the government says it has given the NHS 'extra money', it is true but it is only enough to keep the lights on... that is the choice of the Chancellor.   Does the Tinkerman agree?  
The Chancellor's choices control our fate and we, along with millions of the dispossessed, the luckless and the victims of happenstance have no choice but to get on with it.  Does the Tinkerman agree?

Our fate is out of our hands but it is our our destiny, best we can, to work in the wreckage and pick up the pieces.

The Tinkerman wears an NHS badge and professes a commitment to the health service.  The question is not what he stands for but what he will stand up for.
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Today marks the 200th Medicine for Managers written by 
Dr Paul Lambden
First we say 'thank you' Paul for your support over the years.  Second congratulations on being our most popular contributor.
Just on 500,000 page views of your work have entertained and enlightened managers with your insights and explanations.
Today is no exception and a bumper version... a must read.
'... and so are you Paul, thank you from us all...'
 The Academy of Fabulous NHS Stuff 

New ideas spring to mind
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Doing more with less
Calling on the Prime Minister to intervene in the Junior Doctors dispute.
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News and Stuff
News boy
>>  Simon Stevens - disputes being 'lent on' over NHS funding.  Bear in mind, chief protagonist Liberal David Laws has a book to sell and is the author of 'The Orange Book' in which (See 8th paragraph) he espouses the NHS should become an insurance based system.  The financial failure of the NHS would suit him very well. #spannerintheworks
Jim Mackey
Chief Executive
NHS Improvement
In conversation with Roy Lilley
King's Fund 
14th April
 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.
Coming Soon
New Health Chat
Lord Carter of Coles
In discussion with Roy Lilley all about his report and the price of bog rolls!
This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - Yeovil FT has had a 23m bung from the DH to keep going.
>> I'm hearing - Sunderland and South Tyneside FTs are going to circle the wagons to keep going.
Need inspiration, a good idea or solve a problem