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nhsManagers.net

18th June 2026

What you need to know and what you need to think about - all in one place - for free!


News and comment from

Roy Lilley



Storms...

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

I've discovered I have something in common with Jeremy Clarkson…


... beyond irascibility, blundering into things I don't really understand and generally screwing-up.


More than our mutual attachment to old Jaguars, we both drink Whispering Angel Rosé, and…


... we both have, or maybe still have, prostate cancer.


If you've ever had a dalliance with your prostate plumbing, make sure you watch the final two episodes of Clarkson's Farm, on Amazon Prime TV.


If you haven’t... watch anyway.


The moment Clarkson tells Kaleb and Charlie he has cancer is one of the most moving pieces of television I've seen in years.


Unscripted, shock, The look on their faces. The silence. One of them reduced to tears, and…


… captures one of the hardest things about cancer. Nobody knows what to say.


Cancer tiptoes, silently into your life. One minute things are moving along normally, the next it’s pushed everything else off the desk, off the agenda. Your diary, your plans, your work and your future are all rearranged around a single word.


Cancer.


Watching Clarkson, I was reminded how easily old blokes can suddenly get mugged by happenstance and plunged into the turmoil of cancer.


One day you're thinking about work, holidays and what needs doing next week. The next you're discussing biopsies, scans and treatment options.


Just like Clarkson, I was left wondering how to manage treatment around all the other things queueing-up in yer life.


The treatment itself is one thing. The consequences can be quite another.


Life, post-catheterisation, is not for the faint-hearted. Fortunately, I didn't have to drive a tractor. Clarkson does. Black humour at it’s best! Compelling belly-laugh, telly.


And then there is Poppy… the first cow born on Diddly Squat, and sent for slaughter after testing positive for bovine TB… that she didn’t have... dodgy test regime.


Clarkson is furious. He rails against a testing system that can have devastating consequences for farmers already battling the weather, rising costs and government policies that often seem designed by people who think food originates on supermarket shelves.


Watching the TB debacle, I found myself thinking about prostate cancer.


Not because the diseases are similar. Because the uncertainty is.


We don't test cows perfectly.

We don't test men perfectly.


Not because nobody cares. Not because nobody has failed to notice. Because biology is messy, science is imperfect and certainty remains stubbornly out of reach.


Farmers live with that uncertainty every day. So do some old geezers.


My cancer was discovered by luck.


There’s no perfect answer to bovine TB. The disease persists in cattle and wildlife. Every solution seems to create a fresh set of problems.


There’s no perfect answer to a national screening programme for prostate cancer. The tests available today create a fresh set of problems.


Screen everyone and some lives may be saved.


Screen everyone and many more men may undergo investigations and treatments they never needed… which you do not want.


Neither answer is satisfactory. Both leave people asking; ‘cows, blokes, surely we can do better? Perhaps we can? Dunno.


Science advances. Veterinary medicine advances. Medicine advances, but…


… for now, uncertainty remains.


That, for me, is the message from Clarkson's Farm.


Not farming. Not tractors. Not planning disputes. Not even cows.


It is about uncertainty.


Farming teaches a hard lesson. You can do everything right and still lose. The weather changes. Disease arrives. Markets collapse. Things beyond your control decide your future.


Cancer teaches the same hard lesson. It arrives silently and without invitation.

It doesn't care who you are, what you've achieved or what was in your diary for next week.


TV star, farmer, chief executive or old bloke with a fondness for Jaguars and Whispering Angel… none of us gets a guarantee.


The countryside looks beautiful on the telly: the birds with their chorus; deer bouncing through the cornfield; the tiny butterfly dancing in the sunshine; lofty, blue skies; and kestrels suspended over the fields.


The clatter of the combine harvester. The blistering sun. The gathering rain clouds. The scurrying field mice. The rush to gather-in the harvest.


Beneath all that beauty and majesty and wonder and endless days working dawn to dusk, lies uncertainty.


TB will strike where it wants and cancer will just, turn up...


... just like life... you can plan. You can prepare. You can do your best. Yet still, events will decide on your path, and fortune your destination.


The trick is making the most of the time between the droughts and the storms. 

What's Wrong

with A&E?

PODCAST

Dr Ian Higgison


If there is one clear sign that the NHS is not working, it is the state of its accident and emergency departments.


Across the UK, under all sorts of different political regimes, the story is the same...


...patients spend many hours even days, many waiting for a bed and incontrovertible evidence that thousands of lives are being lost as a result.


In their latest podcast Niall and Roy hear from

Ian Higginson

President of the Royal College of Emergency Medicine...


...who voices his anger and frustration as a system that is failing patients and staff. But, he argues strongly that this Gordian Knot will not be untangled by discouraging patients from turning up at A and E but by dealing with the ‘back door of the hospital, and...


.. on that, he clearly believes that while there is more that hospitals themselves can do to improve discharge procedures, more attention and resources need to be directed at social care and community health services.


As for the former Secretary of State in England, he is determined to make sure that Wes Streeting’s commitment is not forgotten! 

For all the previous

In the Loop

podcasts with

Prof Jim Blair

Learning Disability expert

Andy Burnham

Mayor of Greater Manchester

Nichola Ranger

ChEx Gen Sec RCN

Tom Dolphin

Chair BMA

David Gregson

founder of BeeWell

Dr Charlotte Refsum

Tony Blair Institute

Rob Webster

ICB CHEx

Sarah Woolnough

CEO of the King's Fund

Sir Jim Mackey

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

CLICK HERE


-oOo-


Probably, the most listened to

Podcast in the NHS!

FREE!

Want to contact Roy Lilley?

Please use this e-address

roy.lilley@nhsmanagers.net 

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Dr Paul Lambden


Respiratory Syncytial Virus


The seriousness of the infection is most associated with infection of the lower respiratory tract where the small airways become blocked with inflammation and infected fluid. 

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

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