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18th July 2016

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Sir Andrew Dillon

Boss of NICE, in conversation with Roy Lilley

SOLD OUT - See you tonight

Details here

What comes next

News and Comment from Roy Lilley

Events in Nice have a particular resonance for me. Some years ago, on and off, I lived there.

I'm very familiar with the Promenade des Anglaise and Bastille Day celebrations. The famous Hotel Negresco, a favourite lunch-time luxury, reception turned into a casualty station.

We can only imagine the gruesome pressure the paramedics and hospital services were put under.

Thank-you to them all.

This act of terrorism is the consequence of something analysts call 'push-back'.

When security on air-planes becomes too good for terrorists to breach, they are pushed back and move their murder to airports. When airports become impregnable they are pushed back to do murder on the concourse. When that becomes too difficult; trains are targeted.

When explosives become too difficult to access it is all too easy to turn a lorry into a weapon of mass destruction.

Regular visitors to London will have seen the appearance of tasteful bollards and balustrades on pavements outside prominent buildings in Whitehall and other places. Now you know why.

"Push-back". Logic must tell you, eventually you get pushed into a cul-de-sac. In the long run you have to deal with the causes of terrorism.

Building bollards, ramps, security screening, gates and closing roads is easier than building the sort of alliances and relationships that will bring the problems to a close.

Our experiences in Northern Ireland underline it isn't simple, not without controversy nor complexity.

With the best of intentions governments end up doing the tough easy things instead of the easy tough things.

Government is reactive. No more than in health.

Don't look for parallels between the catastrophe of Nice and the NHS, beyond the heroism of first responders. Look for how governments around the world end up simply can't get onto the front foot.

Forecasting, dealing with root causes and the nub of issues requires a reach beyond political cycles, short term electoral gains and the day to day work of government.

Where there is a battle of values it usually extends beyond government, its tenure and electoral cycles. They involve forces and trends so powerful they take us well beyond the reach of a parliament.

Think about the NHS for a moment. It's its own story of 'push-back'.

Hospitals fill up, run out of money and we push the patients back to primary care. Primary care can't cope and we push back to community and pharmacy and finally the push back drives patients to self-care and Babylon.

Maybe we should be spending more time and effort figuring out why people get ill and wondering what we can do to stop it?

The tough easy thing, diverting flow, instead of the easy tough thing, persuading people being healthy is a good idea.

Building alliances with schools and employers and relationships with the food and beverage industries that might bring the nation's health problems to a manageable rate?

Government is ineffective, isn't it? Not just this one, all of them. It is the nature of government. Almost always on the back foot. Reacting, recoiling, remembering and expressing regret. I fear it is beyond their scope to think long-term. Ending a period of office in one piece is about as good as it gets.

Scrambling to win the next election, often at the expense of the good intentions of the last.

Government is designed around the idea that it can be the master of events. Events tell us, it cannot be. I get the impression they feel they can bluff their way into the future.

Last week the childhood obesity strategy became the victim of a government shuffle. A generation or more, of youngsters Nelsoned by politicians with eyes fixed elsewhere.

Short-term-ism; the curse of government and a blight on public services.

Events seduce us into believing 'now' is all we must react to, when really, now is the time to push-on and plan our influence over what comes next.

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Contact Roy - please use this e-address

roy.lilley@nhsmanagers.net

Know something I don't - email me in confidence.

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News and Stuff

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>> The NHS is in a mess - The Jim Reaper speaks.

>> Safe Staffing - Not-Monitor trying to dig itself out of a hole! :-)))

>> Vulnerable GP practices - no longer have to match bail-out funding.

>> FGM report on NHS campaign on the Ghana Web - beware very disturbing picture.

>> Save our heart department - Leicester campaign. Here we go more money and time sucked out of the service by campaigns, consultants and lawyers. Of course it doesn't matter as we have so much money to throw around.

>> Hindu organ campaign - Leicester; contrast with the above.

>> Bournemouth - no action over deficit.

>> Zika - here for 3 years more.

>> Huge Vanguard procurement - to wrap services together; this worries me. Will they end up in the same fix as Cambridge? The VAT on these approaches can be a killer.

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HealthChat

26th Sept Kings Fund 5.30pm.

Ed Smith

Chair of Not-Monitor

(I must find out what they are called!)

Great evening in prospect. He has a huge experience and a raconteur

Plus the usual wine and networking.

Special ticket prices

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Gossip

This is what I'm hearing;

if you know different,

tell me here

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>> I'm hearing - gathering disquiet over the appointment of a GP as the National WB Guardian. No large organisation experience. No WB experience.

>> I'm hearing - Confed interim boss Stephen Dalton has given up his day job as boss of the Mental Health Network. I guess we know what he's going to do. I wonder if there will be an open interview process!

>> I'm hearing - the Lords will be taking evidence on the long-term sustainability of the NHS. They haven't asked me but if they did I'd say, get the funding back on track and there is no problem. Doing 2016 volumes on 2000 funding doesn't work, m'Lord.

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