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I confess it was not the birthday present I had expected.
What's next?
A cabinet re-shuffle, a Tory leadership election and a new prime minister with no electoral mandate.
Then, maybe, an election and certainly triggering Article 50 of the Lisbon Treaty and our exit from the EU perhaps as early as 2019.
The EU is unlikely to be sympathetic; leave means leave. Unpicking trade deals, dismantling the body of UK law, threaded with EU laws and regulations, fathoming the impact on international relations and global diplomacy... reach for the headache pills.
Plunge in the value of the pound, bank stocks down 35%, house builders valuations down by 30%, EU stock markets turning red... reach for the reserves.
A Scottish push for a break-up of the Union... reach for your passport?
If anyone can tell you what happens next they are a either a fool or a liar. There are plenty of candidates. One thing's for sure, don't expect an extra £100m a week for the NHS any time soon.
What is the future for us. The NHS. Do any of these momentous events have implications for us?
We are in 'if' territory.
'If' there is an impact on the economy, 'if' prices rise and 'if' squeezes on public sector wages continue then.... see what I mean.
'If' this, or a new chancellor, decides to steady the tiller on the economy with a post Brexit budget, they will have three choices. Raise taxes, borrow more or cut expenditure... see what I mean.
The referendum purdah has meant the NHS, along with other arms of Governement, has been silent for a few weeks. Expect the silence to end.
Had the vote been to remain, I would have backed the Tinkerman to stay in place. I would also have predicted Number 10 to get more involved with the NHS. Why?
>> Over trading (demand) is making NHS budgets impossible to deliver. The Treasury are pushing for 'grip' and there is no more money.
>> Almost every working day a GP practice is closing.
>> The junior doctor's dispute is far from over and nurses are threatening industrial action over the future of their training bursaries.
>> Operational targets have been missed for so long they have no currency.
>> Measurement of Trust performance, against the CQC's made-up standards, puts 60% of them in trouble.
>> Increasingly it is difficult to find quality candidates to run Trusts. The old guard is being recycled and joining chain-gangs.
Austerity has taken its toll. The NHS is in free fall.
The Tinkerman is a Cameron ally, can he survive a shuffle and a move to the right? What will he do? A new Health Secretary will have the same problems. What will they do? What would you do? What would I do?
>> Get an immediate grip on finances. Redesign them. Make them balance over the local health economy. That means new approaches to controls, targets and allocations.
>> Blaming Trusts for 'overspending' when they have no mechanism to control demand is plain stupid.
>> Recalibrate targets. Measuring time in A&E or ambulances, is pointless if patients are parked because social care is broken.
>> Primary care is fragile and needs urgent consolidation. The days of the corner shop GP, as much as there is an emotional attachment to them, are over. They are not big enough, premises often landlocked or incapable of expansion. The can't attract investment nor offer young doctors a career structure or future.
>> Vertical integration, based around hospitals. Just get on with it. Assimilate primary and community care. TUPE adult social care into Trusts.
>> CCGs contribute nothing. Not though lack of effort but there is just no role for them. Roughly 200 consume £millions in back office and running costs... to do what? There is no market, contracts are repetitions of what we did last year with less money.
>> The STPs have a strategic footprint. CCGs tiptoe around the problems. Kick-start the obvious.
>> Accelerate the Vanguard programme. Shove them forward. The ones that survive will be the ones we want to copy and promote. Make the default first contact with the NHS via telemedicine wherever possible.
Focus every ounce of effort and every penny we've got, on the front line of care, protect it and make it fun to work there. Leave no stone unturned to share the best we've got and the finest we can find, to improve, innovate and change gear.
In or out, whoever is the boss, life goes on and some things just have to be done.
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