19th May 2016

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Duncan Selbie 
 in conversation with Roy Lilley
King's Fund 21st June 5.30pm
Drinks, networking details here.
Do a bit of good
News and Comment from Roy Lilley
I'm holed-up on the concourse at London's King's Cross railway station.  The one with the lilac, spider's web roof.  The spans diffuse into the afternoon sunlight.  It's ethereal, cathedral like. 
I'm hitching a ride on the WiFi, free, from Prezzo.  I've no idea where they are, or who they are but by way of thanks; have a mention.
The announcements drone on.  The security services will blow up my luggage if I'm careless.  I am forbidden to skateboard.  Welcome to London.
Lovers embrace.  A man eats a panini poking out of a paper bag.  I notice he takes a bite of the bread and the top of the bag.  He appears not to notice.  They must taste the same. 
A young girl in a vest and flowered pattern trousers, like a pair of my Mum's curtains, is hunched over her iPhone.  Both thumbs dance over the keyboard.  The software predicting her thoughts.  Messages at the speed of blur.
What shall I do to pass the time?
I could read the Big Issue.  The cheery vendor, in the red jacket and official badge, wished me a nice day.  His dog yawned at me.
I could reread the latest from the Nuff's about the future of the NHS workforce.  I had a look at it during the morning.  The media coverage told me nurses would be 'filling-in', 'plugging the gaps' for doctors.

The headline stems from some curiously,  injudicious language 
in the report.

"... advanced practice roles.... fill in gaps in the medical workforce..."  Ouch!
A Twitter storm followed.  Specialist nurses do not take lightly to the idea they are 'in-fill'.  
Publishing this report, hours before the junior doctor's dispute talks conclude, takes a special kind of Doc Martin sensitivity! Especially as the work was done at the behest of NHS Employers.  Careless headlines got everyone riled up.
Zero marks for whoever managed the Press, PR and communications. 
The grumpy BMA don't like it.  The BMA don't like anything. The RCN are in a bit of a fix as their members are the nurse specialists.  The Patients Association, with a hierarchy of doctors, said they wanted more doctors. 
If you read the press and not the report, you'd think the future of healthcare depended on hospital porters carrying out cardio-thoracic bypass surgery in the car park.
For all the brouhaha it caused, I'm sorry to say it's not a great report.  The best bit is the Appendix.  A set of case studies where hospitals and others have reshaped the workforce to do the same things differently and different things with the same workforce.  Practical stuff to copy.
Don't bother with the report.  Read the appendix and you'll get the idea.  That's about it...
The authors plod across a familiar landscape; why we are where we are.  We know... thank you.  Health Education England were dealt a bad hand and played it badly.  We don't have enough of anyone and there is nothing HEE, Trust Boards, the Royal Colleges, politicians or the tooth-fairy are going to be able to do to fix it, any-time soon.
The central thesis of the report is about up-skilling.  In industry we'd call it down-skilling.
It started in the Fundholding days when GPs showed receptionists how to be phlebotomists.  As far back as 1930 specialist nurses trained in the dark arts of diabetes.  Nurse practitioners arrived, with a vengeance, in the '60's and nurse prescribing changes mean about one in12 can write an Rx. 
It's hard to find anything inspiring or interesting in the report.  It's a catalogue of what we are doing now, a call to HEE to pull their finger out, the DH to get stuck into workforce planning and Trusts to do more training.

Indeed there is a foot shooting moment on page 4, para 4 warning against doing any of this. 
A Tsunami of frail elderly will force changes in training and skills. Look at the Buurtzorg website for the rest.
Passing the bandages up and down the food chain is no substitute for a good supply of well-trained professionals, properly resourced and happy where they work.
There's talk of 'ring-fencing' and to take it all more seriously.  It is:
"... urgent and essential if the NHS is to find a sustainable balance between available funding and patient and staff needs...."
You will be pleased to know, no rocket scientists were injured in the production of this report.
That's about it.  

My tip; buy this week's Big Issue,
it's a good read about the doctor's strike and buying it will probably do a bit of good.
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Health Chat
Duncan Selbie
Chief Executive Public Health England
In conversation with Roy Lilley
21st June - King's Fund 5.30pm
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Sir Andrew Dillon
18th July - King;s Fund - 5.30pm
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