28th January 2013 

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It will please  
Mrs Lilley
News and Comment from Roy Lilley
As you can see, Mrs Lilley has a new friend. Her companion arrived at Christmas, wrapped in a box with a crimson ribbon. Mrs Lilley has joined the iPad generation. And, at age 92 and 11/12th not a moment too soon. 


Mrs Lilley has mastered Skype, Face-Time and emails, downloads the newspapers, has found an App for crossword mum with ipad solving and has mastered BBC's iPlayer, TVCatchup and the News Channel. And, she is a dab-hand at taking photographs (Groan). Courtesy Mr Google she has visited the Sistine Chapel, Marks and Spencer's sale and WeightWatchers (Don't ask, she's as thin as a rake!).


We're thinking about the 'Big Red Button' App that will alert me by text and email if she has a problem. It can also connect her to the emergency services if required. I think the ice cream box, with the red-button, sitting on the sideboard may well go back to the call-centre, along with the annual subscription.


Mum can connect anywhere, find out anything from sponge baking to spondylitis. New shoes to nuclear fission. Alas, she cannot connect with the doctor's surgery and speak to the nurse, report her blood pressure and peak flow readings or talk to the doctor. She can't 'do' an outpatient's appointment or have a face to face with the pharmacy.  


It does seem rational, doesn't it? A reasonable thing to ask? In this day and age, e-mail, Face-Time or Skype, might be a reasonable choice for a patient to transact with the NHS?


The NHS delivers theoretical, academic, policy-wonk choice. Ministers think a competition between six providers means choice. It doesn't. Whoever wins is what we get. No choice for the patient. Ministers think of choice in terms of retail. Choose the wrong dress, holiday, evening meal; no harm done. Choose the wrong surgeon and the wrong procedure; catastrophe. That's why patients say; 'What would you do Doc?'


The whole broken business of 'choice' is the subject of one of the least heralded and best reports I have read for ages; 'The Barriers to Choice Review' commissioned by the Treasury and Cabinet Office. They won't like it. It underscores; funding public sector choices is a mug's game.


The key to the report's excellence is in its authorship. David Boyle; part writer, part journalist, part politico, part historian, part economist and mostly brains, intellect and common-sense. (More here). This is a joy; elegant, succinct, well researched and balanced. It slays myths, asks awkward questions and gives us ideas based on proper research and painstaking listening.


It moves at pace; an energising read, brave, demolishes many assumptions and contains surprises. It's quite unlike the drivel from the Carbuncle and the DH. This is very, very good.


For the healthcare section go to page 21; the Full Monty must-read section. The recommendations are astute, discriminating and savvy. This is two cups o'builder's and a couple of packets of Hobnobs.


Rather uncomfortably the report points out 'public support for choice of hospitals is ambiguous'. The report's Ipsos MORI survey awkwardly confirms what we all know; 'proximity to home is the most important factor for choosing a hospital... and... GP surgery'. Some professionals 'doubted... (choice) was important to patients (!)... most of the time patients seemed happy with less choice as long as the service they got was 'good enough'. Despite QoF, telephoning GP practices is, still, a major issue.


The report tells us 'the old financial architecture... of the NHS (means it) still operates beneath the mechanics of choice... '. In other words; how we pay for what we get means we have to put up with what we've got.


Of the recommendations I like this best:


Give patients a right under the NHS constitution to ask for consultations (with either GPs or consultants) using a range of means of communication such as telephone or Skype, where both sides agree it is appropriate.


Well, that will please Mrs Lilley.


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>Central Midlands Commissioning Support Unit - they are worried about their Logo.  Yes, I know.... it's cringe-making, horrible

>> Lewisham Hospital - the battle comes to an end when LaLte has to decide on 1st Feb.  Create collateral damage to Lewisham by taking their in-balance cash to keep broke PFI Trusts going?  I suspect he will and blame Labour for PFI excesses. Protest picture here.  

>>  PH - draft regulations.  

>>  Mid-Staffs - dummy taped to baby's face.

>London Ambulance Service - say they are coping with demand

>>  Exercise for Life - middle-class clap-trap from the RCP.  

>>  SERCO - this company can't seem to do anything right - this time the appear to be instructing call handlers not to call 999?  

>>  Draft PH regulations - if this is your 'thing' it is unmissable




This is what I'm hearing; unless you know different. 

Tell me.

>>  Growing skepticism that LaLite 'paperless' NHS by 2018 is either unachievable or not worth the money.  Ooh, ouch!   

>>  Pfizer have seconded a very senior manager to head up the Innovation work-stream at the DH.  The direction of travel is interesting; have a look at this.   


>>  Premisses assurance model - up-dated

>Russian drivers - not health but you have to dip into this! 

>GP data extraction service - what do we think about this? 

> Could NICE work better - interesting piece on the work of York Uni.

>>  Alzheimer's - can exercise slow onset?  

>>  Complaints - staff don't know how to deal with them.   



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