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30th August 2016
3

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HealthChat
Ed Smith
Chair of Not-Monitor, or whatever it's called.  In conversation with Roy L
Good conversation, networking and a glass of wine.  Lots to talk about now the STP s are ding their thing.
This will be a full house.  
If you are intending to come, get your tickets organised!.  A few left.
The right direction 
News and Comment from Roy Lilley
Former Tory cabinet minister, Steven Dorrell's Confed says the STP plans are about modernising the NHS and 'matching people's care needs'.
 
Yer avin a larf!
 
They are all about saving 22bn by 2020. 
 
It's a bit rich of the Confed when you realise a good chunk of the millions (Yes, millions!) they have in the bank has come, one way or another, via the tax-payer.
 
Let there be no mistake, the NHS footprint is set to shrink.
 
Lord Carter of Bog Roll tried to save the NHS with better procurement, the Jim Reaper by chiselling staff.  Everyone has turned off the lights and brought their own lavatory paper to work.
 
To save 22bn in the next 980 working days is impossible. 
 
Unless.....
 
... you stop doing things.  'Stopping doing' means closing stuff.  Closing stuff, on this scale means the mother-of-all rows!
 
The Confed and all the others can try to tell us everyone will be better off when their A&E is 30 miles away.
 
Think-tankers will pretend we can make do with one bunkbed for 30 patients, cardio-thoracic bypass surgery on the kitchen table and yer granny can enjoy living in her trip-free home with pit-stop visits from a Kazakhstan nursing agency.
 
Get real. 
 
The public might be ill informed but they are not stupid.  The message is simple. 
 
"We do not have enough money to run the NHS like we used to, so we're circling the wagons."
 
There's never been a proper rationale behind the location of services.  Tesco and their likes use isochrones.  A time over distance calculation to make sure stores are in the right place and convenient
 
The location of NHS services is largely an accident of history and lobbying.  It is possible that coalescing some services around isochrone calculations and concentrating skills could be better.  

But, don't pretend you are doing it for any other reason than the money isn't there.  And, don't pretend it's going to be anything like more convenient.
 
Ambulance men used to scoop and run.  Now, paramedic men and women stay-and-play, then drive you to a Tier 1 A&E.  Ask them how they would reconfigure and you'll get the best answer.
 
Ask a consultant who doesn't want to up-end their family and private practice and you'll get a different one.
 
The message to the public; 

'It is difficult enough to reorganise the NHS from a desk, please don't try and do it from an armchair.'
 
Politicians?
 
Tell them; don't try to run the NHS from the green-benches.
 
If they are Tories tell them to shut up and talk to their Chancellor; they have brought this on themselves by agreeing to austerity economics.  

If they say they've funded the NHS' own plan say; 'Yes, with, what will be, 10 years of flat line funding against 4%pa growth in demand and the 5YFV is about survival and that's all.'
 
If they are Labour, ask them how they plan to get elected to change anything.  Right now I doubt they could change a light bulb.
 
All 44 STP plans will have been finely crafted and for once, involved local authorities. That means local councilors are stymied. Cunning. 
 
Recognise these are money saving exercises, making a pound do the job of two... out of which, at the margins, some good might come.
 
However, talk of bed reductions is barmy.  For primary care to share the heavy lifting with secondary care, consolidation of GP surgeries means closure of small practices.  Maybe one in three?  Some hospitals will become cold-cuts boutiques, for elective work, others 'fix-you-up factories' and a significant number could close.
 
The key to this upheaval will be how the public react.  Every presentation, every public statement, every press release you make, print and publish, should start with a Health Warning;
 
"... Present levels of NHS funding make it impossible to carry on with all of today's services.  Reconfiguration is the only practical option.  This may mean a concentration of services in unfamiliar places and some ending altogether.
 
No health service professional wants to shrink the NHS but we have no option. 
 
If you want to express an opinion on the changes... you can.  However, it's all about the money.  There simply isn't enough to keep going the way we are. 

Please take this up with your MP, who is..... [be sure to list them along with their contact details]."
 
This is not about the NHS.  It is about politics.  If, where you work, is impacted by STP changes and you don't like them, write to your MP.  Inundate them.  Forget counting the correspondence, make them weigh it.  Make the Tinkerman and the Chancellor's life in the lobbies unbearable.  

Make sure the guns are pointing in the right direction.
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Know something I don't - email me in confidence.
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Listen to today's eLetter
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Gooroo
The Gooroo writes exclusively for us
 ...and takes me to task about dropping targets and going back to clinical priorities.
He asks; 'which one is God?'
Excellent must read
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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. 
Tickets here
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Obsession with Activity must end
Report of conference speech from 
Hamish Dibley
Interesting take 
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Gossip
shh
This is what I'm hearing;
if you know different,
tell me here
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>>  I'm hearing - NHSE are all over Capita and the PCS contract.  Daily reporting... ouch.  Fingers crossed for some quick improvements.
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Need inspiration, a good idea or solve a problem
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