7th November 2016

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HealthChat - Xmas Special
Simon Stevens
In conversation with Roy Lilley
6th December - King's Fund - Details here.
Ask Teresa May
News and Comment from Roy Lilley
Ever moved house?

... ages to find a new place, get the money, the lawyers tee'd-up... surveys, removal company, chains, palaver and come the day...

... last minute panic over some legal nicety and the boundary fence... eventually, sitting, dazed, amongst a pile of boxes... eleven o'clock at night, wondering what happened.

... saved by the finest invention of the twentieth century.  An innovation that makes removals and most days bearable; the screw-top bottle of wine.  No hunting for the corkscrew!

Now the fun begins.  Tell everyone, redirect the post, remember a new phone number.  New neighbours to wine and dine...  

Got kids?  That means half the family wont want to move!  New schools and all the harrumph that comes with broken friendship circles... finding ways to create new ones.

Yer mum thinks a 10 mile move will put you on the outskirts of Kazabeutystan.

Utility suppliers, new tariffs, new meter readings.  Find a decorator, find a GP, find a new kitchen... find a landscape gardener.

I read somewhere, moving house is among the top three most stressful events in our lives.  Divorce and a new job the other two.

Brexit... like moving house... but more complicated.  This is not going to be easy.  By comparison Brexit will feel like an eviction.

For over 40 years the UK has become entwined with Europe.  Every part of our daily lives, in some way, influenced, made safer, made more frustrating by the benevolent, or malevolent (your call) influence of the European Union.

Half the family don't want to move, new neighbours to wine and dine, new tariffs, new everything and to make matters worse, the High Court have induced panic in the ranks with a legal nicety.

Take time to read the judgement; they are at pains to decouple the political decision to leave, from their opinion of constitutional law.  

Any schoolboy student of British Constitution will tell you; Parliamentary Sovereignty is supreme.  If the Brexiteers are so sure of their case and the Remainers respect the will of the people... what could possibly go wrong! 

The answer; everything.  The list of known unknowns is very long and the list of unknown unknowns, longer!

In the name of democracy the processes could stall the process... expect an election.

All this malarkey has a resonance for the STPs; the new landscape gardeners, trying to reshape a tapped-out NHS.  Change everything.

They're not messing about.  Crashing services together, circling the wagons, closing this, moving that.  Amalgamating, merging, mixing things up.  Getting on with the job.

There are only, about, 160 weeks of the Five Year Forward View left.

No matter how collaborative they try and be, (remember Brexit had a referendum) there will still be people who just don't want to change anything.  No matter how inclusive; the awkward-squad could use the processes to scupper the process.

The trick is to consult like crazy.  Here are my top nine tips for consultation: 
  1. have a clear transparent public schedule; 
  2. clarify the message, why no change is not an option and is going to happen, be honest.  If it is the money, say so; 
  3. be inclusive, not the usual suspects, go through schools, clubs, workplaces and social media; 
  4. don't front load with solutions, lay out the problems;
  5. don't say services will be better, say they will be different because they can be (safely) and have to be (financially);
  6. remember the ambulance service is your best ally when deciding safe relocations; 
  7. decide what you want, endorsement or acceptance, they are different; 
  8. question yourself, is this the way you'd want your family asked for their views;
  9. above all, be honest... 
... financial and demand pressures are obliging us to reshape parts of the NHS.  We will have to provide some services differently and some in unfamiliar places.  We will use technology and thorough planning to develop safe solutions to our huge problems as best we are able.  We don't like this anymore than you do.

Do all this and still, local councillors and MPs, worried more about reelection than relocation of services, will try to derail you.  

GPs will panic at the potential loss of income, Trusts Boards rage at being downsized and reputations undermined.

STPs are a neat invention.  With no laws nor budget, they offer a strategic over-view and done right, should be inclusive, consensual and have traction through buy-in.  

But... the bigger the changes, the trickier it becomes.  

Ask Teresa May.
  Contact Roy - plse use this e-address
Know something I don't - email me in confidence.
Leaving the NHS, changing jobs - you don't have to say goodbye to us! You can update your Email Address from the link you'll find right at the bottom of the page, and we'll keep mailing.
Medicine for Managers

Dr Paul Lambden
'...in a departure from his normal topics Dr Paul takes us on a journey though the history of GPs and primary care.  This is a tour-de-force and an absolute must read....'
Come and Join us
 at this Year's Academy of Fabulous Stuff Awards

24th November
The Indigo - O2
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News and Stuff
News boy
Dr Rodney Jones
The latest from our favourite analyst and data cruncher.
Using Social Groups to Locate Areas with High Emergency Department Attendance, Subsequent Inpatient Admission and Need for Critical Care 

Simon Stevens
6th December
This will be a sell-out.  Get your tickets organised today!
King's Fund
This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - St George's operating theatres have been causing problems for ages.  Temperature control being the favourite problem.  Some of the ventilation parts date back to the 80's and engineers have been searching for spares on E-Bay.  St George's apparently spent 3m with KPMG to help sort out their financial problems. The financial problems stem from flowing unprofitable patients.  The CQC are suggesting a larger department - to flow more unprofitable patients.  The former incumbents in the top jobs at the Trust; Miles Scott (CEO), Steve Bolam (CFO) and Jennie Hall (Chief Nurse) now work for NHS Improvement.  You couldn't make it up!
>>  I'm hearing - 14 practices in Suffolk are set to merge.  I think that makes them the largest in England?
>>  I'm hearing - a Canterbury, single handed, GP practice was inspected and the report took five months to appear and the practice given 5 days to reply.  And they wonder why everyone hates the CQC!
Need inspiration, a good idea or solve a problem
Dr Sir Sam Everington
Barrister, doctor, leader.
In conversation with 
Roy Lilley
King's Fund
9th November 
Tickets for IHM members half price.
New Award

'Are you using health technology that is making a significant difference to your patients?
Nominate it for a Health Tech and You Award!'
We thought this was a really good idea so we are partnering the Professional Choice category
Have a look, nominate someone and make their day!