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5th September 2016
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HealthChat
Ed Smith
Chair of NHSI in conversation with Roy Lilley.
This will be a full house. Ticket sales end this week.  A few left.
The future 
News and Comment from Roy Lilley
How long should it take to reconfigure services?  How long is a piece of string!
 
Of all public services, health is about as near to the public's heart as it gets.  Try and move a clinic from one side of the street to the other and wait for the roof to come in.
 
Stakeholder buy-in, cross service agreement, unions, health-watchers, councils, Royal Colleges, CCGs, MPs, the public, Uncle Tom Cobley can all stick their oar in.... and derail the best laid plans.
 
We have to accept we are in the game with public money, so the public should have a say.  We know changes in primary care are likely to impact GP's income and they have money invested in their practices.  We understand shifting services up-ends consultants and their private practice income.
 
Staff may not be able to fit in a new place of work with childcare, spouse's use of the car, public transport and time tables.
 
The public may have real travel concerns, the cost of car-parking and where to go in an emergency.
 
Those who don't have skin in the game, have money.
 
Change is slow, deliberate and ponderous.  That's why the NHS hasn't changed very much and why reconfiguration generally works... the result of consensus.
 
A straightforward consultation has to take 14 weeks and end2end, three months is the quickest I've seen and generally they can go on and on for years!
 
All of that's been fine for the last 68 years but it's not going to work for the next 168 weeks... that's about what's left of the 5 Year Forward View.
 
I spent a day with wonderful Worcester NHS Trust.  Battered by an overheating health economy, recruitment problems, CQC lunacy and years of indecision.  They know they have to get on; it's make yer mind up time.
 
The enthusiastic, loyal staff know what needs to be done.  Closing this, moving that and sorting stuff out.  The solutions are obvious, the benefits scream out.
 
So what's the problem? 
 
Like a lot of Trusts they are trapped in an out of date modernisation framework that will take them years to work their way through.  Each step of the way monitored by the naysayers waiting to trip them up with a judicial review because there is a spelling mistake on page 517 of their strategic plan.

Obstructionists exploiting delays and wrinkles to stave off the inevitable.
 
Worcester has to make changes... to circle the wagons.  They have three (and a half) CCGs pulling in different directions.  The CQC who have made it impossible to recruit and a paediatric service that has to be moved and refocused, to make it safer.  We all know specialists in the sector are becoming rarer than hen's teeth.
 
They have to concentrate the talent, coalesce excellence and be frank about why.
 
It's time for all the players to start with the patient and work backwards.  Selfless, courageous leadership that parks self-interest.
 
There is not the money, not enough staff and they are left, juggling a problem gifted to them by politicians; the chaos of the Lansley reforms and austerity funding.
 
Wonderful Worcester's predicament is replicated across England. 
 
The solution must be a new, fast-track consultation process.  Something like:
  • Seventy days max, starting with the presumption... change will happen. 
  • No consultation documents longer than two sides of A4.
  • No one may object unless they have actually been to a public board meeting and listened to the arguments. 
  • Social media the backbone communications route.
  • Paramedics have to give an opinion, in public.
  • All changes must be clinically led.
  • ... and, NHS managers have to talk plain English and stripped-pine truth about money and why they are doing, what they're doing.
The changes the NHS needs are urgent.  They should not defy the democratic process, they should dignify it with the speed and clarity it deserves.  

Transparent so that everyone can have a say, lawyers will not be able to order a new BMW on the proceeds and the political protagonists can throw bricks at Downing Street, but not down the street where we need to make changes happen.
 
I know of no health service worker, clinical or otherwise, who comes to work, intent on poorer services.  But, I know lots who are realists. 
 
Worcester are realists, we should listen to them and the others like them, wrestling with a bureaucracy rooted in the past, and help them plant the seeds of a new NHS for the future.  
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The Vanguard Method
Beyond Budgeting
One day learning conference that will be worth every penny, from the only consultancy that has fans!
Details 
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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 - the radiographers have failed to join the Academy of Royal Colleges condemnation of the JD strikes as they know their contracts will be next in line for 'modernisation'!
>>  I'm hearing - current boss of Dudley FT, Paula Clark, is moving to North Staffs.
>>  I'm hearing - GP numbers are set to fall by over 1/3 in 10 years, caused by transformation plans.
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Muir Gray's
Guide to Living Well for 
Septuagenarians
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