Who is in charge?

There are things worth worrying about and things not worth worrying about.  The problem is we can't be sure which is which.

Is it worth worrying about GPs 'doing commissioning'?  No, because they won't.   They are re-recruiting ex-PCT people or doing deals with the private sector who are re-recruiting ex-PCT people.  Most Docs will just get on with the day job.  Consortia and federations are lining up alongside existing PCT clusters and boundaries.  It is all starting to look like more of the same.

Is it worth worrying about care pathways being radically different?  No, financial pressures, far from creating incentives to change will consolidate the same-old-same-old.  PFI debt will lock the landscape for 30 years.

Is it worth worrying about the Go-Johnnies who will set up diagnostics and treatment companies and get paid twice for seeing the same patient?  No, competition law will stop it and it is odds on the Bill will be amended.

Is it worth worrying about the outcome of the Listening Exercise?  Maybe.  Insiders tell me there is 'tension' between the genuine listeners, the hard of hearing and the deaf, dumb and blind.  Already, private emails are circulating, divisions emerging.

Is it worth worrying about Monitor?  Too bloody right it is!  Worry, be anxious and lose sleep.

Monitor is David 'Mad-Dog' Bennett, ex-McKinsey and, it appears, paid well on the way to �300,000 a year.  He told us in the FT and the Times it is his role in life to 'dismember' the NHS.  Damage to clinical linkages aside, I'm not sure anyone actually voted for NHS dismemberment?

In my view David Bennet is clumsy, ham-fisted and a klutz.  Whitehall insiders tell me his 'dismembering' remarks did not go down well, particularly whilst the La-lettes were trying to calm everyone down.

Well, he's done it again.  With all the sensitivity of Colonel Gaddafi turning up at the Royal Wedding, Mad-Dog-Monitor is now saying the NHS will have to find savings of nearer 7% and not the 4% ordered by Big-Beast Nicholson.  

A shell-shocked John Appleby, at the King's Fund, reported in the FT, said; 'over five years, this cuts the cost of a �6k hip operation by 37%'.  Appleby asks, 'How?'

I'll tell you; patients will buy their own plastic hip, on-line, from Hips-R-Us, take it, along with a surgeons-pack, (From Go-Johnny-Supplies) to the day case surgery unit where they will rent a trestle-table, by the half hour, from Easy-Cut; water, pain-killers and crutches extra.  The operation will be carried out, free, half by robot, Chinese surgeons, working from Motuo, and half by retired, ex-NHS staff, working for B&Q.  Suturing will be provided by volunteers from the Town's Womens' Guild, who won the contract for sewing as part of a Big Society initiative.  Souvenir photographs of the procedure, along with a fifteen minute DVD (just the thing to get dinner-party conversation going), will be available from Virgin Media.  Post operative care can be purchased from Tesco (you-drop-we-prop) Home delivery.

Mad-Dog Monitor is a menace.  He is a menace to the Big Beast, who has no power over him. One wonders; does he even have his phone number?  Mad-Dog is a menace to the morale of the NHS.  Mad-Dog is a menace to public confidence in the NHS.  He is a menace to LaLa, who is desperately trying to look like he is listening and an absolute nightmare for Cameron who is desperately trying not to look like he is selling the NHS.

In fact I cannot think of anything kind, warm or sympathetic to say about David Mad-Dog Bennet.  I cannot think there is anything he can do, or has done, or will do that makes him worth �300k to the public purse. 

Unless, of course, he is right and we do have to save 7%, and hospitals must close. 

The DH, who are supposed to be in charge, say that Mad-Dog is only 'scenario planning'.  What if the scenarios are right and the Big Best is wrong? We need to know what we are planning for. 

Changes to the Bill are likely to curtail Monitor's role.  Big Beast is past his retirement date and is hardly LaLa's Valentine.  Is Mad-Dog being lined up to replace him?  

Wanna-be FT's are crunching numbers, fiddling with their worry-beads and visiting fortune tellers.  They and their staff, patients and communities are entitled to know if their hospital is history, amalgamating or being sold on E-Bay.

At this desperate time the NHS needs some proper focus, leadership and direction.  LaLa needs to bang heads together.  We need to know what we need to worry about.  We need to know who is in charge?