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21st February 2013 

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Mean it           
News and Comment from Roy Lilley

The result of our poll will come as unwelcome news to the Big-Beast. 91% of you think he should step down. Is it fair to say he has lost the confidence of the work-a-day NHS?

 

I recognise him as the man who did his best to blunt the worst excesses of LaLa's stupid reforms. Nevertheless, the mess on the ground is unbelievable and a top-down empire is being rebuilt with the bricks from demolished PCTs. The Beast only knows top-down.

 

You could argue that he spotted the need for NHS austerity and the so-called Nicholson Challenge was an attempt to put some rationale behind the use of resources. The QIPP agenda an attempt to give savings some shape and purpose. The reality is the scramble to save money and the fear of not doing so, has descended into cuts, redundancies, damaged services and the NHS running on the vapour of vocation.

 

It is equally possible to say that the NHS is a loose federation of the awkward squad and managing it with anything other than an iron grip would be impossible. The problem is 'grip' has been translated into control and as the situation turns more desperate has become rule and command. Where inspiration and management talent runs out, force and bullying takes over.  Bullies always work for bullies.

 

I know the Big-Beast has been an unfortunate victim of circumstances; a busted economy and ham-fisted political meddling. What might he have done differently? Everything or perhaps nothing. He is what he is. His know-how comes from years, unchallenged, at the top. The Carbuncle won't challenge him. Too many owe their positions to him and the others know too little about running one of the world's largest healthcare systems.

 

Some say, in time, all NHS staff end up hating the boss. Wrong. Many NHS leaders have been held in high esteem and affection right to the end.

 

In Pulse Magazine, so-called, GP leaders backed the Beast; Laurence Buckman (BMA), said blaming Sir David was not 'useful'.  What would be? Mike Dixon, NHS Alliance, twaddled on, blaming 'the system'. Er, whose system if not the Big-Beasts?  RCGP chair Lady GaGa, confusingly said 'leaders should be held to account' ... but, 'Sir David should not resign'. Er?  

 

Maybe they all benefit from too close a relationship with the Carbuncle and DH and have more than a small interest in buttressing an establishment that they are part of.

 

The HSJ rushed to the Big-Beast's aid, commissioning an old-school opinion piece by another Knight of Healthcare John Oldham (Who?).  Normally a good guy but this is just hopeless; 'Leaders do shape the culture of the organisation,' he says.  Er, isn't that the problem; 'the culture of the organisation'?  He should have read another Knight's comments in the Telegraph!  Oldham seems to imply the NHS is too dislocated and big to manage.  Nevertheless, a good tactical move for the HSJ; if the Beast stays they remain his friend and stay in the tent.  If he goes, they were 'striking a balance', and stay in the tent.  

 

We are now left with the hope that the dark-art of changing 'culture' will save us. No one knows how.

 

Will whistle-blowing phone-lines, law and regulations encourage people to say the things that they have seen cost others their jobs, homes and families? Culture takes years to cultivate and grow. We have just months to change the working climate.  

 

The NHS needs an urgent fresh start. The Carbuncle won't do it, it is merely a branch of the DH; full of ex-DH staff who owe each other.  The sensible ones have jumped ship.  

 

The NHS is badly damaged. If LaLite had any sense he'd make a clean sweep at the Carbuncle.  If Malcolm Grant, chair of the Carbuncle, had any nous he'd do it first; before he is sucked into the vortex of yesterday's management proclivities.  The pressures of money, morale and muddle creates a toxic cocktail that will corrode the NHS and eat into the heart of the service.

 

I'm sure the Big-Beast thinks he alone can save the day and there is no one else.  Others take that view, too. Not true; were he to be run over by the apocryphal Number 9 bus, there are several who could step-in.  

 

David Nicholson is a good man but emblematic of a past the NHS needs to scrape from its boots. We cannot have a fresh start and mean it, without new leaders who mean it.

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Medicine for Managers
2012 compendium here
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Dr Paul Lambden
'On the tip of your tongue'
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change day
Make Your Pledge
Or support someone else.
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News and Stuff
News boy
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>>  Inquiry - this time Morecambe Bay; infant and maternal deaths.  HSJ story here.
>>  NICE - fertility free-for-all, guideline here.  At a time when the NHS is struggling to do everything now, donchathink there is a lunacy at large at NICE, piling on more stuff?  However desirable and lovely.  More here
>>  Pensions - if you've been dumped in the private sector, or about to be, this is important news about the future of your pension from the excellent Health Investor team
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> Virgin turn away cancer patients - local news story here, surprised it's not in the nationals?
>Help with health costs - really useful stuff from the excellent NHS Choices people. Here.
>>  Bionic Legs - for military amputees.  BBC story here.
>>  Strengthening the Constitution - DH report.
>>  This is how you do healthcare - really excellent Blog-piece from an American in London.  This is today's cuppa-builder's and Hobnob moment.  A cockle-warmer.  Read it here.
>>  Social media - how Leeds&York make it work.  Well done them.  Have a look hereAnd, if social media is your thing, you'll like this crib-sheet.
>>  Information service for patients - reaches 100k signups.  Wow!  excellent DH initiative.  See it here.
>>  No one wants to take over 'failing trusts' - good HSJ story from James Illman.
>>  The Doctors' Orchestra - 4th March London.  Get your ticket here.
>>  This is me - having a gossip with the with the very enterprising boss of Assista Consulting at the recent fabulous HFMA conference at Blackpool.
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Gossip
shh
This is what I'm hearing;
if you know different,
tell me here
>>  Eastleigh By-Election - Betfair assess the Doc's prospects, here.
>>  Why do I keep getting emails from Confed members complaining about appointments and the like, that they have had no say in?  I don't know!  Perhaps the Confed have lost their address book?  I also hear used-to-be communications bloke Matt Tee is in line for a job-share?
>>  Am I right, it is still the case, Trust payments of over �100k to leaving staff have to be signed off by the SHA?  If true LaLite could ask for a list and review them, couldn't he?
>>  The Carbuncle are looking for a private sector company to run Norfolk and Waveney CSU.
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>>  Paperless NHS - cheeky cartoon thing from the DH on YouTube.  No idea who it is for?  Most NHS people can't watch it coz IT Dept's have bandwidth restrictionsSuggest IT Tzar Kelsey fixes that first!
>>   RCS guidance on whistle blowing - totally useless, won't protect anyone, wont reassure anyone and wont get one more whistle peeping.  And prays-in-aid the PIDAct that recent events have demonstrated is useless, too!
>>  LaLite promising harsh consequences - over gagging. More here.
>>  Childhood mortality - the worst in Europe.  Can this be true?  Some data here and here and better here.  Worrying chart here.
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cartoon martin 
With Martin Shovel