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12th April 2016

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Niall Dickson Boss of the General Medical Council in conversation with Roy Lilley

Fascinating career as a BBC Journalist, the Kings Fund and now Chief Regulator.

Interesting night in prospect. Does the GMC really protect patients?

3rd May 5.30pm King's Fund - a chat and a glass of wine Details here.

Tell me I'm wrong

News and Comment from Roy Lilley

I'm not that bothered about the Prime Minister's tax affairs. His family have a few quid, they took advantage of the rules at the time, to make a few more quid. He went to a decent school and has never had to do a proper job. What's not to like!

In our quest for equality we should try and avoid idealising envy.

However, I am concerned about David Cameron. He looks stressed-to-hell. He is putting on weight, a sure sign something's wrong and his peripheral movements, hand gestures and so-on are becoming more emphatic.

Let's take stock...

The referendum could well turn against him. The NHS facing an unprecedented strike. The cabinet is split down the middle, the economy isn't getting any better, the Middle East is on fire.

Millions of luckless souls have stuffed their lives into a bin-liner and are marching across countries, drowning in treacherous seas, to get to safe haven in Europe and here. His heart and his head are at war with each other.

The steel industry is melting, the equality gap is widening, the pot-holes in the roads getting deeper.

I get a picture of a man who set out, in the context of his politics and background, in his terms, to do the right thing. Through poor choices, bad policies and happen-stance, he is grinding to a halt.

Global economic forces are buffeting our economy. Cameron has problems a plenty and no solutions. Envy a man? Be careful, behind it lays a living hell.

His saving grace; the present state of the Labour Party makes a car-boot-sale look organised.

I'm pretty sure the NHS is top of Dave's domestic worry list. No political party wants a failure of health services on their watch. If Osborne sticks to his austerity policies there is no more money for health. We have fallen way down the EU league table of %GDP into health and it looks like we will stay there.

The Prime Minister does not understand the NHS. He says he loves it and all the usual palaver, but he does not really understand it.

Using it, visiting it, does not mean you understand it, any more than listening to Beethoven's 5th in C minor and knowing it took 4 years to write and that it is sometimes referred to as the Victory Symphony means you understand Ludwig. Nor, how he wrote his best music whilst totally deaf.

My fear is a combination of ignorance, good intentions, anxiety, impatience, temper (Insiders tell me DC is increasingly quick to anger), annoyance, frustration and pique will drive him to the wrong conclusions.

The Tinkerman has lost the confidence of the troops and is of little use to the Prime Minister. Dave is on-his-own. Save for the whispering guidance of his health-policy team Oliver Letwin, Camilla Cavendish and Nick Seddon.

My fear; their collective analysis will be that the NHS needs to be put under more pressure to sort out its finances and get the targets back on track. Their only levers are more regulation, more sanctions, more aggression, more bullying and more casualties.

They will be looking for wheezes. For instance. The biggest slice of costs is wages. Mainly nurses. Abandoning safe-staffing for Lord Carter's care-hours-per-patient-day opens the way to a neat deception.

If nurse numbers are reported internally, to Boards, but publicly reported metrics were adjusted to take account of non-nursing disciplines and a ratio concocted to take into account productive and non-productive hours, with no reference to the acuity of patients... bingo, there is room to cut expensive nurses and have more healthcare assistants, look safe and balance the books. Clever, eh?

Who would gamble that a worried, vexed, confused Dave won't personally intervene in NHS problems? 'Reset' the NHS, as his policy wonks might call it. You could bank on it.

Get the comm's teams at Number 10 and the DH working on timing around Referendum issues. Get the speech writers busy. I could write it myself;

Love the NHS, been through a tough time, 7-days seamless and safe, JDs strike will harm patients who pay for the NHS and expect more, get back on track, hold the NHS to its plan, more integration, strong health services needs strong economy, they've had more money, cut bureaucracy, more sanctions.... Blah, blah.

Whipping the horses to make the cart travel further, before the wheels come off, will leave you with exhausted horses and the cart in a ditch.

Tell me I'm wrong Dave.

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Contact Roy - please use this e-address

roy.lilley@nhsmanagers.net

Know something I don't - email me in confidence.

Leaving the NHS, changing jobs - you don't have to say goodbye to us! You can update your Email Address from the link you'll find right at the bottom of the page, and we'll keep mailing.

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News and Stuff

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>> GMC - veiled threat (I think) from Chair questioning the ethics of striking. New guidance expected. I will be in conversation with ChEx of the GMC Details here.

>> Strike - JD's letter before action. They claim the Tinkerman cannot impose the contract. I don't know why they need a lawyer for this? They are right. Trusts are free to offer local terms if the wish.

>> Strike - plot to organise Tory letter.

>> Productivity in the acute sector - very good King's Fund analysis.

>> Variation in length of stay - this is from Australia but it could have been written here. Our problems are global problems.

>> Success regimes - not working? Interesting leaked letter casting doubt on their success in Essex and Devon. Concluding regulation is not the way to promote collaboration. That's why we set up the Academy....

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Unexpectged Deaths

Dr Rodney Jones

...analyses deaths from Alzheimer's Dementia and other Neurological Disorders

The nature and mode of action of a presumed infectious agent requires urgent research.

Read it here.

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Health Chat

Lord Carter of Coles

In discussion with Roy Lilley all about his report and the price of bog rolls!

Details here

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Gossip

This is what I'm hearing;

if you know different,

tell me here

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>> I'm hearing - the threatening letter from Ian Cumming, boss of HEE, to Trusts warning them off offering local pay terms was written at the behest of the DH?

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