28th March 2012 

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News and Comment from Roy Lilley

Well, it had to happen. Monday evening; a little bing-bong from my computer. I hardly bothered to look. Just back from holiday, copy for the next day all written and tidied away. With no fanfare, no warning; the Transitional Risk Register arrived. Sent to me and to our favourite medic; Dr Phil.  He was also able, later, to publish the Transition-Business Case.

Late evening on a Monday is not a good day to interest main stream journo's. I rang one at home but he was busy reading his daughter a bed-time story and couldn't come to the phone.....

So, it ended up on Twitter and proceeded to melt my TweetDeck. The Guardian picked it up overnight (Patrick Butler Tweeted) and the BBC's fabulous, omnipresent Norman Smith (Follow him) Tweeted from the crack of dawn. The rest, as they say, is history.

'History' is probably why there has been so little coverage of the story. The Register is 'history' because the Bill is 'history'.  Anyway the story was never what is in the Register but why LaLa was so furtive about it? 

Was it leaked on purpose? Drifting it into the public eye-line at dusk on a soulless Monday night; editors all preoccupied with the Cash4DinnerPl8 brouhaha, confounding all that FoI energy and with the NHS actually in a cash balance and doing well on waiting - good timing?

So, what's in it? 

A Transitional Risk Register is exactly what is says on the tin. It chronicles the risks of transition from one thing to another. Armageddon to Auntie's Birthday. Response; a �50m underground bunker or �1.50 in Clinton's card shop. I've seen a few in my time and this is a surprise. 


Most RRs will have a fair spread of green, amber and red. Immediately you will see; this is nearly all red.

Real concerns from experienced DH professionals saying, in private, what most of us have been saying in public; Line 4 'implementation begins before adequate planning' - It has. Line 6; 'management loses focus and grip on QIPP' - It's happening. Line 12; 'emergency preparedness' - just the job with the Olympics about to get on the starting blocks. Line 13; 'efficiencies cannot be driven through the system because there is no organisational plan to manage holistic efficiency' - Too right. Line 21; 'GPs not sufficiently developed' - That's why�7m is being spent on sorting that out, in London, alone.

Do I need to go on? Just one more. Line 34; 'staff moral' - on second thoughts, perhaps I don't need to add to that.

On balance it is workmanlike document that inexplicably misses the points on preventing cherry picking, doesn't go anywhere near enough to conflicts of interest and is naive in that it doesn't speak to a failure regime in the event of another Southern Cross.  It is not a good document.  It is vision-less on the broad spectrum of the perils ahead. This is a baseline document and over time strategic risk registers will have been developed, working to attenuate the base-line risks and deal with them. But and it is a huge BUT; so-far, they haven't. What has happened since the birth of the Bill, the Future Fandango and 1,000+ amendments to temper, off-set and mitigate the risks?  Nothing. 

Line 39; 'misalignment in design of commissioning and provision landscapes' - Not sorted. Line 43; 'Estates Strategy has a conflict of objectives' - It does. Line 3; 'The whole system is unaffordable' - at �25 a-head, right. Line 4; 'Who is in-charge?' - Tell me if you find out. Line 23; 'Loss of clinical time by GPs due to CCG responsibilities' - It's happening now and the locum cost is sky-rocketing. Oh, and in the same group 'post-code commissioning and GPs manufacture increases in their remuneration by playing the system' - That'll be the �500 for attending a meeting and a new iPad for each GP that a reader told me about!

The battered Bill is due to become an Act in April. What's in it? Line 2; 'Amendments to the Bill have unforeseen consequences' - probably. Will the GPs 'do it'? Line 14; 'negotiate changes to GP contract to incentivise and lock-in to consortia' - that'll be another bung, then?  

The risks are still overwhelming and mostly still un-fixed because they are un-fixable.  By the way, see line 3; 'CCGs make use of the private sector and costs will go up' - I'll let you fill in the blanks. 


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