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30th October 2025

Exclusive; click here for podcast with Sir Jim Mackey CEO NHS England


News and comment from

Roy Lilley



I did...

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Short on time? Get yer ears-on and listen to Roy Lilley read this morning's eLetter... free!

I want to recommend a book…


… it’s a autobiography.


Well, actually, no. It isn’t a biography, it’s more a book of recollections.


Er, no… that’s not right. It’s not recollections, it’s a textbook.


Sorry, no. Let me start again. 


It’s not a textbook. It’s an information book… but not exclusively. It’s a book of opinions but with some forecasts thrown in.


It has to be said the book has one or two; ‘I-told-you-so moments’.  Even that doesn’t do it justice. It’s a book that lets you into some secrets and a peep behind the curtain.


In some respects its a travelog. At the heart of it is a treaties on the family and family life.


If you enjoy sailing... it's for you.


It's a thriller with shady characters and conmen. It’s a paean to the truth and a confessional.


Perhaps it’s a book of philosophy… but that’s too highbrow. It’s a book of common sense.


It is a big book, 474 pages and it weighs a tonne. It’s a stout and sturdy book… a bit like it’s author.


It’s the sort of book that if the upright piano in the pub developed a wobble, you could slide it underneath to shore it up, so the pints could be safely lined-up without fear of spillage.  


I guess it is a book of commentary. 

Picking up on the times... 


... it goes back to April 2012 and column by column, essay by essay, step by step it takes us through the life and times and thoughts and writings of Professor Joe MacDonald, the curator and creator, of this masterpiece.


MacDonald is the doyen of all things IT in the NHS. He dates back to the abacus (not quite) and takes us on a journey, via his regular columns, through the chequered history of an NHS, trying to drag itself out of the paper and pencil era.  


He is the guru's guru. The go-to. The sage. The Methuselah. A living lexicon of computing and software, how-to and most important... how-not.


He charts the disasters and the successes. In column after column of readable, fast paced writing which at times is as lyrical and romantic as a bunch of roses. On other occasions it's as brutal as a bunch of fives in yer face.


If IT isn’t your thing, read this book because it is about human nature and exotic places around the world. 


If IT is your thing, read this book because it will guide the decisions you will be asked to make tomorrow, next year and for the rest of your career. It’s a book that shouts; ‘don’t make the same mistakes twice’.


McDonald is generous with his praise, his thoughts, his failings and his wrath. 


If you are a boss of a company, the purveyor IT, software, hardware, vapourware, artificial intelligence, machine learning or flogging anything that plugs-in, you should buy a copy of this book for your entire sales force. 


You and they, will learn things… like the importance of making stuff that actually works and adds value… not pains in the derrière because you need a Phd to work it.


The book is called FHIR and Loathing in Las Vegas (if you know you now) and is available from Amazon, free as a Kindle download. 


It’s ideal for the journey to and from work because the book is a collection of over a hundred columns, none of which is longer than three or four pages…


… Prof Joe is the sushi-chef of reflection; slicing a dicing his thoughts and recollections. His advice, his successes, his failures, his humour and the sad times that are part of all our lives.


This book adds value. When you are done reading this opus you can use it to wedge the door open on a summer’s day...


… but really… this wonderful, insightful, thought provoking and funny book belongs on your desk, in arms reach, to delve into, to read again and to quote from… copiously.


If you are unsure if it's for you, I will leave you with the final words, on the final page. The Prof writes;


‘…all massively funded IT projects are doomed to failure… if you pay billions for clinical software, you’re a £^@%!”$ idiot.


Enjoy… I did.

EXCLUSIVE PODCAST

Sir Jim Mackey

Chief Executive NHS England

In conversation with

Niall Dickson & Roy Lilley

For all the previous

In the Loop

podcasts with

Dame Jennifer Dixon

Lord Darzi

Professor Tas Qureshi

Dr Penny Dash, chair NHSE

Richard Meddings,

former chair NHSE,

Sir Jeremy Hunt,

Sir Andrew Dilnot,

Paul Johnson IFS

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Dr Paul Lambden


Standards Under Threat


'... Twentieth century medicine is gradually being replaced by medicine-lite, with longer waits for appointments, more telephone consultations, cessation of home visits, fewer patients seen face-to-face each day and more delegation...' 


News and Other Stuff

---

>> GMC restrictions placed on surgeon suspended from Addenbrooke’s - after concerns over operations.

>> The financial sustainability - of England’s adult hospice sector.

>> Physiotherapy care in decline - because of poor NHS facilities.

>> An NHS trust has sold off its consultancy arm - as part of efforts to meet a demanding cost improvement target. 

>> Care England Publishes Two Papers Focused On Practical Cost Savings - For Care Providers

A comprehensive investigation of the nine 'never do this' catastrophic mistakes in paediatric capacity planning. 

John Lister’s excellent book delivers a searing examination of what happens to health care when power falls into the hands of a narcissistic, authoritarian leader intent on enriching a small elite of business allies across finance, technology, real estate, and fossil fuels. Using Donald Trump’s second presidential term as its main case study, the book exposes how self-interested governance and reactionary ideology can devastate public health systems, entrench inequality, and imperil millions of lives—not only in the United States but around the world.

EU flag

Alternative European Healthcare Perspectives 

November 2025

Roger Steer


Events are accelerating and taking unexpected turns.


'... featuring a discussion of what may be in the UK budget and what it may mean for healthcare in the UK with clues from East Germany and France (you will be shocked to discover how France finance their health system). As usual other issues gleaned from across Europe over the last month are reported.'







This is what I'm hearing, unless you know different. In which case, tell me, in confidence

__________


>> I'm hearing - Streeting is boasting the morning-after pill will be available free of charge on the NHS from pharmacies today!

He says; 'This is biggest change to sexual health services since the 1960s and a major advance for women’s reproductive health.' Afar as my recollection serves me the emergency contraceptive pill became an over the counter purchase in Jan 2001 and four years later included it as an enhanced service allowing it to be provided free under patient group directions. See here.

>> I'm hearing - There is a squeeze on nursing staff agencies' profits... a combination of increased operational costs and actions by the NHS and HMG to reduce reliance on temporary workers. These pressures are impacting the agencies' bottom line despite a continuing, and in some cases, growing demand for their services. 

More News

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>> Reform pledges £9bn - welfare savings .

>> The NHS’s shift to digital risks excluding vulnerable patients - widening existing health inequalities.

>> Cyclist gets 3D-printed face - after drunk driver left him with third-degree burns.

>> NHS migration to Microsoft Windows 11 is being stalled by medical device suppliers - which have not upgraded to the operating system.

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