It looks to me that the NHS is on the verge of a collective nervous breakdown.
You can see it coming.
Potty plans to reduce the pressures of demand 2% by encouraging people to look after themselves are right out of the Walter Mitty book of management.
Two percent may be possible but it is a generation away and certainly not in the two hundred weeks left of the 5 year thingamabob.
The legacy of Lansley's reforms is a dysfunctional system, highlighted in the judge's summing up of last week's 'who pays for what' lawyer-fest, in the high court and backed up, in part by latest from the King's Fund.
A lack of a appetite for more law and the government's preoccupation with Brexit means we are stuck with a broken system, an elastic band and some sticky-back-plastic.
Then, there is the money. There isn't any. Austerity-economics has hobbled the system, another 5 years will knee-cap it.
I guess we just have to get on with it. Which brings me to the STPs. Why is everyone on their case?
Think about it. There is huge demand and virtually no way to do much about it, other than analyse flow and divert it. Segment the users, redefine what care looks like, who does it and where.
That's called having a plan. To give the plans traction we have to have an overarching group of people who can pull the plan together. That's what we used to call a strategic health authority. Before that, a Regional Health Authority.
LaLa scrapped them and we are paying the price for trying to work without them. Hence STPs. They are a cobbled together, make-do-and-mend, lashed up solutions.
A life raft, whilst the rest of us are clinging to the wreckage.
STPs give local people the opportunity to define their geography of influence, get interested parties around the table and plan a way out.
They are not an opportunity to settle old scores, or dust-off plans that didn't work then and aren't going to work now. They aren't the opportunity to form cliques, exclude people with different or difficult ideas or for elitism.
They are an opportunity for grown ups to do grown up things. Really important things.
A time for people to realise the precious gift, that is the NHS, has been handed down for 70 years and people like us solved problems and saw it through difficult times. Now it's our turn.
This is not the time for the naysayers, the negatives and 'it'll-never-workers', to sit on the sidelines and crow.
Neither for the King's Fund to get sniffy. They did next to nothing to stop the LaLa reforms and they should be grateful there are enough heroes left to try and work around the wreckage.
There are 44 STPs. Bet the farm half of them are struggling. Half might come up with something and half of the half will be great, stunning and ground breaking.
Most STPs plans are far from oven-ready and need the time and space to get heads around what happens next. Leaking half baked documents is childish and feeds the egos of the 'know-betters' and deceives the public who may not realise, by law, in the end, will always have to be consulted in the normal way.
MPs, nervous about keeping their seats, shouldn't start hares running; it invites questions about why they voted for austerity economics that's made all this dismantling necessary.
We have to allow the STPs to do their job. Some will fail and we will learn. Some will be stunning and we will learn.
STPs are not the new kids on the block. They are the only kids on the block; to see us though the life and death weeks that we have left.
STPs will not be perfect, right first time and will be an easy target for everyone who feels excluded or thinks they have a better idea.
The future of the STPs is vital but is in their own hands. They must be inclusive, all embracing, comprehensive, open and the broadest of broad churches.
They should remember the golden rule; people love change when they think they are in charge.
How difficult is that?
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