27th June 2016

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Sir Andrew Dillon - boss of NICE, in conversation with Roy Lilley
The 6th 'P'
News and Comment from Roy Lilley
OK, so what happens now?
Five 'P's are on my mind.
During the never-ending-referendum-electioneering Ministers are obliged to be silent and civil servants restricted.  The NHS has been in free fall. 
  • 75% of Trusts providing more healthcare than they are paid for - budgets busted.
  • 60% accused of quality problems measured against the CQC's made-up standards - morale busted.
  • Targets mostly... busted.
Grip is something of an antediluvian word these days.  Let's give it a makeover.
  • Grasp; get a real grasp and understanding of what is happening.  I don't think we do.  We've been too busy firefighting; too busy working to figure out what's working.  So busy learning the how and what of managing demand and flow we've not understood the why.
  • Recalibrate; use indicators and benchmarks that are realistic; important to us.  Targets have lost their currency.  We must be able to answer the question; 'How did we do today?' 
  • Investigate; what are the top 3 things we can do to give us a high-impact improvement?  Improve care home clinical support, vertical integration?  Maybe neither but figure out what they are and do them.
  • Scene; set the scene for the future?  What are we trying to achieve?  Does anyone know?  Refocus the whole NHS; get it marching in step.  'What did we do today, to deliver the future?'  If we don't know what the future looks like we can't deliver it. We are not marching in step; we can't even hear the tune.
  • Public; we must show the public we are on top of our problems.  Every Chair, every chief executive has a duty to connect with every member of staff, every patient and every relative, carer and by-stander to spell out what they are doing to deliver on-time services with safe, reliable outcomes.
In July we will expect the Prime Minister to launch the Childhood Obesity Strategy.  It is a far reaching ambitious programme that challenges education, manufacturing, retailing, the law, advertising, the media, parenting, social care and health care.
It is controversial and tricky.  He may see it as a legacy issue and crack-on with it or as he is exhausted and in no-man's land, lame-duck and kaput he may let it go.  Make him press-on with it for the sake of the kids.  Inundate him with emails and letters.
The Tinkerman, whether or not accounts are true and he really is busy planning a run for the top job, he is incumbent 'till October.  Let's hope so.  A change now would simply add ambiguity to uncertainty. 
His sole focus should be smiling and doing nothing. 
The Junior Doctors were at Glastonbury this weekend, stoking support for what, I guess, will translate into more strikes. I doubt they will accept the deal on the table.  Jeremy Hunt can't fix this, nor deliver 7 days services.  Politics and politicians are toxic. 
His greatest contribution will be to do nothing... and smiling.  

Keep out of it and let St David, the Jim Reaper and Tarzan get on with the job, they can do without the Tinkerman clod-hopping about.
The facts are 5% of NHS staff (10% Doctors and 4% nurses) are from the EU.  Nothing will prohibit them coming for the time being, other than the genuine concerns they will have about their long-term prospects. 
If an English speaking clinician is willing to uproot themselves and their family they can go to Australia, New Zealand, the US, SA.  Multi-linguists can go anywhere.  Why should they come here?  Amid the turmoil, who would?  We have to make a big effort.  Make them feel wanted and welcome.
We really must become an employer of first choice; people must want to come to work.
The pharmaceutical industry sees the UK as a location of choice.  Why?  Geography, language and R&D.  Straddling the world's time zones, a front door to the 500m market of the EU, English-spoken-here, open door access to the huge US market and access, for R&D, to some of the world's finest teaching hospitals, bolstered by EU research and development grants.  What's not to like?
... the outcome of the referendum is not binding.  Only Parliament is sovereign.
Brexit are rowing back on immigration and don't expect 350m for the NHS any time soon... ever.  Expect an election.  Expect the public to be given another crack at this.
The nation may be divided but the NHS is not.  We will be needed like never before. 
Right now we also need the 6th 'P'.   Perspicacity. 
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Sir Andrew Dillon
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Dr Rodney Jones
A presumed infectious event in England and Wales 2014-5 lead to higher deaths in those with neurological and other disorders.
Fascinating, journal must read as usual.
This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - the Tinkerman may run a leadership big.
>>  I'm hearing - GPs want to stop doing fit notes.
>>  I'm hearing - almost one practice a working day is closing down 201 last year.
>>  I'm hearing - NHSE will withhold details of Virgin APMS deal.
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