20th June 2016

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What is the future for Public Health and the Public's health?
Roy Lilley in conversation with PHE boss Duncan Sellby
King's Fund - June 21st, 5.30pm 
Work outwards 
News and Comment from Roy Lilley
Major Tim is back to earth.  What an astonishingly composed man he is.  Mr coooool!  
By now he will have received a gift he will treasure forever.  There is a custom that Russian cosmonauts respect; they are presented with a set of Matryoshka Dolls.
Dolls, one inside the other; in English 'little matron' dolls, first made in 1890, the skill is in the painting and the lacquered finish. 
I think there should be an NHS version.
Speaking at a conference last week Tarzan spoke of three little jobs we have to get on with: 
  • stabilising the finances; 
  • implementing all the reviews and the 5YFV and; 
  • 'landing' the STPs.

Let me elucidate.
The money-thing is a huge worry.  There isn't any.  But for the referendum purdah rules I would have expected Number 10 to have put the boot in by now.  No more over-runs.
The talk is of 're-set'.  Trusts, alone can't balance the books.  They are obliged to do more work than they are paid for.  Reducing demand seems the only possibility and by that I don't mean redistributing it. Whatever, I see a lot of pain on the way. 
Not-Monitor will have to get its big-brains around invigilating local health economies, (not just Trusts) recognising the inextricable interdependence of the component parts... including social care.
The 'reviews'?  In case you don't have a Scooby-Doo who and what is reviewing who and what; expect an avalanche of 'do-its' and read about them in the speech here.  
Landing the STPs?  In English that means get them up-and-running.
They have no legal status, no money and will only work by charm or beatings.  My guess; the service is aching for some sort of strategic over-view and they will be welcomed.  Expect Accountable Care Organisations and the demise of CCGs.
Will it all work?
I confess, over the years I have done my share of being in the situation-room, pushing the markers across the planning table.  I am the one who has stuck the pins in the map.
None of it worked.  That's why there have been so many reorganisations.  Each one a precursor for the next.  The NHS; a work in progress.  This time it's about working and making progress.
Back to the Russian dolls.
The first layer, the NHS, as seen and perceived from the outside. 
The next, politicians; with policies and this week's good idea.  
Inside that, regulators and rules.  
The next layer; the public, patients, residents and carers, the users of the system.  
Next; management, bureaucracy, administration, supervision, regulation and the usual cods-wallop.
Finally, right in the middle is you.
When all the layers are peeled away, there you are.  Doing the day job; looking for a more nimble and responsive NHS.  

Trying to find ways to keep people weller-4-longer and sicker-4-shorter.  

My guess is, if we started with you, you'll have some very good ideas.
It's an old adage; the closer you get to the problem the nearer you'll be to finding the answer.
June will mark the 1,000th share we have on the Academy of Fabulous Stuff. Please note our new look!  Good ideas and innovations as diverse as A&E flow to 'fiddle-muffs'.  Education, emergency care, discharge to assess, bed management, falls-prevention, palliative care, alcohol misuse, safeguarding, Vanguards, ECIST, social care and being smarter.
An amazing collection of working, hands on solutions that can be copied, cribbed, passed on and put into action.
Money-saving, idea-prompting, quicker-fixing, lip-smacking, super-fizzin' ideas, innovations and solutions in action.
Big strategic changes take too long.  Policy packing and unpacking, wastes time.  We need to get to a realisation we can better our best with what we've got... but the impossible, for less, will take a bit longer.
What do we really want? 
Easy ways to find out what good looks like and getting on with doing it, seems to me, the only practical, realistic, doable solution to austerity and the seriousness of the situation... and believe me, it is.
The undeniable relationship between the work within the work.  The outer shapes framing the one narrative that counts; what happens at the centre?
Start with the inside and work outwards.
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Writes Exclusivcely for us
RIP 18 Weeks
Sir Andrew Dillon
18th July - King;s Fund - 5.30pm
This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - RCGPs are having problems over what is a 'struggling' practice?  Some are only a 'one-doctor-away-from-retirement' step from disaster.
>>  I'm hearing - the Wachter IT/digital review won't be published until September?  Why the delay?  Purdah will be long gone by then?
Extract from an email from a doctor:
I have been told by guidelines, standard operating procedures, protocols, procedures, 'dead lines', four hour a and e imperatives, cancellation fines, Nicholson agenda, foundation trust status imperatives, 2 week cancer 'deadlines', 5 minutes to see a GP patient, revalidation, investigation, target target that I may be slightly inefficient and possibly under-performing. 

What is your opinion, please?

Am I any use as a doctor any more?
Need inspiration, a good idea or solve a problem
NHS Deficits
They are not what the seem
The NHS is is 
Absolute must read analysis from 
Roger Steer