Last week; another week of unattended motorway road works, miles of cones, disgusting petrol station lavatories and hotel receptionist with no idea how to meet and greet knackered travellers.  Jack Kerouac would have trouble keeping up.  Five conferences and an awards ceremony.

I loved the conferences, adored the awards but hated the travel.  The people make each mile worth the effort, every bad cup of coffee worth the swallow and filthy bogs worth holding your nose.

GPs, clinical auditors, suppliers, CCGs, CSUs, nurses and finance people were all on the agenda... about as assorted as it gets.  Whilst they are all very different, common themes emerged.  They are all busting a gut but none of it is working. 

In every case I found great people and organisations struggling with the consequences of the H&SCAct.   I get no sense that LaLa's lunacy is settling in.  I see us heading for a poor service for poor people.

Everywhere, I hear: 'we can't do that anymore because of the Act'; or 'the problem is, no one knows who is supposed to be doing that'; and worst of all, 'I think we've just given up trying to sort it'.

I honestly, really, truly, stripped-pine-frankly believe the NHS is on the edge of a breakdown.   Almost nothing works as it should.  Where we once had clock-work we now have won't-work, doesn't-work, no one knows how it works.

I have heard a myriad of local stories where this doesn't work with that, Data Protection stops this, contracts stop that, the CCG can't make up its mind.  Everyone is terrified of competition rules, circling the wagons, protecting their budget and keeping their heads down. 

There is a widespread acceptance of austerity, a sort of understanding that wages are not going to rise, irritation about pension rights, but outright opposition to what is seen as the Machiavellian intent of the government; to highlight NHS failings and present the only solution as a wholesale selling-off to the private sector.  Thousands of staff have already, against their will, been dumped in the private sector and quite frankly - they hate it. 

Medical education is a mess; not enough of the right people in the right place.  Reconfigurations stuck, mergers stuck, the money always the sticking point.  Locum and agency costs going through the roof.  Pathology services in turmoil, A&Es choc-a-bloc.  Waiting times about to explode and no one wants the Big-Beast's job.

Complaints from care homes are on the rise and the best LaLite has got is; 'Do the NHS a favour and take care of your Mum'.  No one realises the majority of care in England is delivered by an unregulated, poorly trained workforce of HCAs.

Social services are on life-support, surviving on a drip-feed of NHS money.  The 2015-16 top-slice for social care will bankrupt CCGs.  Why?  Because PbR protects hospitals; by enabling social services to get more patients out the back door, more can come in the front.  CCGs have less money to foot the bill for the thro-put and budgets will melt trying to fund the concentric spiral of demand.  It is a hopeless, truly stupid policy designed to throw petrol on the fire.  How can CCGs keep people out of hospital when their money has been filched to fund a system that keeps people going into hospital?  Is there anyone at the DH or Carbuncle with half a brain?  This is supply-driven care at its worst. 

Off-Sick is in a turf-war with the competition authorities over snouts in the trough.  The CQC doesn't understand they can't fatten a pig by constantly weighing it.  The Carbuncle doesn't realise if you put lipstick on a pig it's still a pig.  The TDA is trying to make a silk purse out of a sow's ear.  This is a pig of a time. 

Can we keep the show on the road?  There are 6 things I have seen last week that need to be fixed this week.  They are obvious but will require politicians to say 'we got this wrong but we will act, now, to put it right'.