13th 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.

It's in your gift
News and Comment from Roy Lilley
I'm reminded about the old joke. 
A motorist asks a pedestrian, How do I get to Nether Wapping?  The answer.... I wouldn't start from here....
My in-box continues to flood with worried correspondents asking; 'What are you going to do about the strike?'  

I guess, 'I wouldn't start from here', isn't a good enough answer.
It is pretty clear that the Number 10 policy wonks, Cavendish, Seddon and Letwin are content to let the NHS go to hell in a hand cart.
It is hard to conclude anything other than 'they' want a strike but haven't we moved beyond the rights and wrongs of a strike.  The issues do not matter any more.  The principles have become more important. 
Who runs the NHS?  How do we get out of this mess? 
I can confide in you; there have been a number of 'behind the scenes' efforts to end the deadlock.  'Wise-man' panels proposed, personal approaches, letters, petitions... to no avail. 

Wake up folks, 'they' want a strike.  'They' think they can tough it out until the papers turn their fire on the JDs.  Is it too Machiavelli to think they will break the BMA, sort the waiting lists and collateral damage and it will all be forgotten by the 2020 election.  

The BMA is a big bastion.  Part establishment part good old fashioned union.  Taking them on and winning the Battle of Tavistock Square, carves your name in the NHS history book. 
To deduce, a catastrophe would suit 'their' purpose, is too awful to contemplate, isn't it?  High level policy calculations the pursuit of power and ruthlessness are tell-tale signs of dislocation with the front-line and reveal a true purpose.  

In fairness, it was St David, a trusted chief executive, who told the Tinkerman a deal could not be done.   
A death attributable to 'feckless junior doctors' walking away as the ambulances arrive... that will capture the front pages.  Some of the red-tops are tuning up.
It is a high risk strategy.  
A solution? Easier than you might think.

Uncomfortable and bumpy, it'll take some courage but we'll find out who the Trust leaders are.

Some people hear a bang and run, a few hear the bang and step forward to find out what it was.  The exceptions run to the bang, to stop the next one.    
The talks have been undertaken in the name of the Trusts but they have had little say.  They've just soaked up the collateral damage.
If Trusts really do believe they exist to serve their patients and not feed the beast of Whitehall, they would be talking to junior doctors, locally, about using their legal powers under the NHS and Community Care Act 1990, (later embodied in FT enabling legislation) to employ staff on local pay and conditions.
Page 101;
General Powers

16 ... an NHS Trust shall have the power to do anything which appears to it necessary or expedient for the purpose .... [of discharging its functions] including in particular...
(d) to employ staff on such terms as the Trust thinks fit.
That's the legal power, the key and the get out of jail card.  The Tinkerman cannot impose a settlement the Trusts don't want to utilise.  They can make their own decisions.
The knobby Shelford Group, the sleeves rolled up Mulbery Group should be talking to junior doctors about taking the proposed contract as a template and shaping it to local needs.  They have the power to do this and the Tinkerman can do nothing about it.  A flexible arrangement to accommodate workplace requirements. 
No one believes the imperious UCLH will have employment needs and conditions identical to the impecunious, Downtown Other NHS Trust, out on the coast or country.
The Confed might have once led a solution but now they don't have a chief executive and the chairman is a former Tory Secretary of State for Health... they are impotent.
Only the Trusts themselves can settle this.  It will take an act of heroic leadership.  We will see what the likes of St David and Dame Julie are made of.  My guess is a brave backwoodswoman will step up and organise a response.

If the rota-against-schedule exercise that Trusts are currently undertaking shows gaps and back-to-back working, because there are not enough JDs... they should say so.  If seamless-7-day working has to be deferred until recruitment issues are resolved they should do it.
Trusts will come under huge pressure.  The bloke running HEE will have a hissy fit.  Who cares? I'm told the DH writes his letters, anyway.  Surely not!  He can threaten all he likes; he still has to find a place for his doctors to train.  Try being helpful Mr Cumming.

This solution allows the Tinkerman to claim he imposed the settlement, the Trusts to make it work for them and the JDs to claim they got their principle objective, a safe and fair contract.
Breaking up central pay bargaining will tip the BMA out of the picture and they will go berserk.  Who cares?  The DH will lose a grip they never really had.  Who cares?
This strike boils down to what do we care about the most?  If the junior doctors really care about patients, there is the solution.  If Trusts are brave enough to use their freedoms, there is a solution.  If 'they' want it resolved stand back and let the Trusts do the work.
Marooning +20k patients on the waiting list tells me no one cares.  

Watching ambulances stacked outside A&E, queues of sick people, tells me no one cares.
Trusts... fix it.  You can do this.  It is in your gift. 
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