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19th April 2016
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Niall Dickson Boss of the General Medical Council in conversation with Roy Lilley
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The Martians have landed; a little wobbly man shuffles down the ramp of his spaceship, pops-up an eye-on-a-stalk, gives you the once over and says; 'Take me to your leader...'   Err, who runs the NHS?  Simple enou
gh q
uestion. 
 
Where will you take him?
 
As The Tinkerman is finding out; no one runs the NHS.  Andrew Lansley's cockamamie has crippled management.
 
The Tories went into the last election with a manifesto promise to deliver a 7-day NHS.  We know the NHS is a different place on a Sunday to a Tuesday.  Let's leave it at that.
 
The Conservative Manifesto actually said (Page 38/9):
 
"... ensure you can see a GP and receive the hospital care you need, 7 days a week."
 
"...We want England to be the first nation... to provide a truly 7 day NHS... with hospitals properly staffed, so that the quality of care is the same every day of the week."
 
The Conservatives had an unexpected win and Jeremy Hunt set about delivering their promises.
 
On page 10 of the 2016/7 DH Mandate (2.10) it says;
 
'We expect NHS England to ensure everyone has easier and more convenient access to GP services, including appointments at evenings and weekends.... [and] effective access to urgent care 24 hours a day, seven days a week.'
 
Note the subtle difference between the Manifesto and the Mandate and 'properly staffed' is dropped...
 
NHSE have been having a stab at it since 2013 but the problem is, they have no power over Trusts, other than through the mechanism of commissioning. 
 
Commissioners can't commission services they don't have the money to pay for, or services that providers do not provide.
 
Let's try 'Not-Monitor'.  NHSI, as I must remember to call them.  They exist to regulate Trusts.  NHSI; Monitor and the TDA, re-badged.  Neither of their constitutions nor legal status has been changed to enable them to 'make' Trusts do 7-days.
 
The CQC?  They exist to hire charabancs and fill hotels with inspectors.  They are already on a different planet.  Although, if the new JD rotas turn out to be as bad as is claimed, they could close down dangerously understaffed departments.
 
There are other problems.  HR is stuck in the same no-man's land.  

As we have been saying for weeks; the Tinkerman has no power to impose a JD contract.  Now that's conceded; all he can do is 'introduce' one...  which Trusts do not have to accept.  And, notice, the narrative is no longer about a 'JD contract' but a 'Foundation Year 1 contract' (FY1).
 
So, let's have an up-sum.
 
The Tinkerman is 'responsible' to Parliament and the taxpayer, for staff working on contracts he has no power to vary, in pursuit of policies he has no direct powers to bring into play.
 
Our new friend the Martian might be perplexed and we might have a larf but I think it is serious.
 
The NHS' distributed leadership model is; an unworkable cat's cradle. 
 
For any Secretary of State (not just this one) to have no certainty of being able to deliver a simple manifesto promise, whatever we might think of it, is undemocratic, frustrating for everyone and consumes energy and resources in fruitless argy-bargy.
 
Serious, political direction and strategic management has been pushed beyond our reach.  In its place we have dangerous silos.  Self-contained organisations that have to expend enormous energy and effort to work-round, work out and work-up ways of working together.
 
The Lansley legacy is a tragedy.  Politicians would do well to remember, they and all of us, for the time we are here, are custodians of this great public service and we do it no service to render it, through wilfulness, thoughtlessness or carelessness... unworkable.
 
We are each given talents, skills and the chance to develop our philosophies.  It's up to us if we leave an inheritance of stumbling blocks or stepping stones.    
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