21st 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 
News and Comment from Roy Lilley
I'm not mad keen on surveys.  You know; the kind of thing Ip-FlopMurray do...
Interview 800 people over the phone; ask them something they know nothing about, put results through the mangle, weight it, fiddle with it, stretch it, compress it, hammer it flat, jump up and down on it, roll it up, smoke it and pronounce they know the secrets of the Holy Grail.
The BMA have just done one with Populus.  It's a mash-up, 1,240 people;
"... online panel and data... weighted to reflect the English population in terms of age, gender, region and social class."
In other words, the views of a village boiled, stewed and baked to represent the opinions of 53 million. 
It looks like British Machiavellian Army are intent on rescuing their reputation over the Junior Doc's strike; egging on the Doc's to spin out the strike, revealed in the HSJ emails... not their finest hour.  So, making the NHS look bad, to embarrass the government, is their new best idea.
Here's the survey headline;
"... this research shows growing discontent with the way the NHS is being run. 37% are dissatisfied with the running of the NHS, compared with 21% this time last year."
Ignoring the fact that well over half the public are content with the way the NHS is being 'run', the implication is; managers are not doing the job well enough.
Managers have borne the brunt of the Junior Doctor's strike, keeping NHS services open whilst the Docs did their dandiest to close them.
What the BMA actually means is the public is malcontent with the way in which the NHS is being 'directed'.  An entirely different matter.  In which case, this is more relevant:
"...58% say they do not trust the government with the management of the NHS."
As usual, in the crossfire, the people working in the NHS.  The collateral victims of events like the strike and careless headlines generated by tricky surveys.
My take; the NHS is working better than it ever has.  Flat-out, fit to bust and bursting at the seams.
The elephant-issue is social care.  The inextricable link which the BMA survey ignores. 
Tarzan made it clear in his speech at the Conflab.  If there is any more money, give it to Social Care... we can't make progress with social care on its knees... he gets it.
The BMA and the CQC are a good double act.  The CQC, stomping across the landscape of healthcare, denouncing Trusts as 'inadequate' is just as damaging and just as ridiculous as spiteful surveys.
The CQC pulled a stunt in Portsmouth.  They looked at the Trust and three months later, hammered them for keeping patients waiting in A&E.  Like that's what they want to do.
Ted Baker of the CQC then smugly pointed out a hospital along the coast, the Western Sussex FT, was doing better.  In consequence the BBC jumped on the bandwagon and did a bit in the Today Programme. (about 1hr30min in)
The Western has changed internal flows and rebadged observation units but the real issue is they have only one local authority to deal with and social care is making assessment and discharge about as easy as I have seen.
Back in Plymouth they have three, skint local authorities to deal with and the interfaces make life much more difficult.
For the CQC to pronounce on the performance of A&E, with no regard to the rest of the system, is like an MOT looking at the lights but not the tyres.
We need to shift our thinking.   The majority of the NHS works well.  The bit that doesn't is usually the bit dealing with the frail elderly.  A group of patients the NHS, alone, is not designed to cope with.  When it grinds to a halt it screws up the NHS 'whole system' across the board.
In Australia responsibility for ageing and aged care has moved to the Department of Health from the Department of Social Services.
Picking-off the NHS, in suspect surveys and inspecting a tiny part of the system is as childish as it is ill-informed and does more to expose the shortcomings of Trades Unions and regulation than it does our-NHS.
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18th July - King;s Fund - 5.30pm
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