He is dangerously naive. Promise me you won’t let him near a medicine cabinet, never mind the NHS….


I use Apple. All Apple.

The iPhone, the Mac-book, iMac, iPad, iPods, the whole iShebang. I even press my socks with an iRon.

I do it because Apple stuff works; connects, stores and sorts itself out.

I used Microsoft… until Windows 10. I couldn’t get it to connect with an brand new HP printer. I tried downloading ‘drivers’, turning on and off. Hours with the help-line. I gave up.

I bough my first iMac.


It worked, right out of the box. Transferred my Windows stuff and asked me if I’d like to connect the printer that was sitting, sulking, on the corner of the desk.

I was hooked.

Microsoft was at a low point. I wasn’t the only person to switch.

They were struggling with launching Windows 10… a huge, technical step change, and at the same time to support Windows 7 and 8.

Trying to do two things at once. Cranking up dual running costs. Never works.

In the 2000s Coca-Cola had troubles trying to migrate an IT system and run the new one at the same time. They fixed it with a big investment.

It’s not just IT companies.

Walmart threw millions at trying to transition to an on-line business while still operating physical stores.

Skanska the construction company, got tangled up, trying to move from traditional building techniques and at the same time, transfer to modular.

Rolls Royce tried shifting from its traditional engine design technique to one based on digital technology and simulations. It drove them into a big headache and a bigger bill.

All of these case studies will be well known to MBA people and biz-qualified readers.

In plain English, you can’t ride two horses at once and you can’t spend the same pound twice.


It’s at the root of NHS’ change problems; shifting services from one setting to another. Coping with dual running costs.

For example…

Hip operations… we do just under 80,000 a year. If they are uncomplicated think in terms of ≈£10k each. If the patient is older, with co-morbidities and been lying on the floor for hours, the costs rack-up.

How many are preventable?

We could;

• Ask each surgery to compile a list of people in the at-risk group.
• Go and see them.
• Provide aids and adaptations,
• stair-lift,
• bathing aids and
• persuade them to take-up the carpets.
• We could improve diet and awareness.
• Fit alarm systems.
• Keep in regular contact,
• visit once a week,
• phone them,
• spot signs of deconditioning and act.

Could we avoid a third of operations? Dunno…

… it might save £240m. Why don’t we do that? The answer is Walmart, Rolls-Royce and Skanska.

Dual running costs and trying to do two things at once.

If we took the money hosptials spend on hips and gave it to the GPs and community teams it might work. But, in the meantime what are the Trusts going to do for money?

How do we fund dual running costs whilst we see if this works. And…

… by the way, where are the community granny-watchers going to come from?

Daft idea?

Well, it’s the latest policy concept from Silly-Boy Streeting.

He was speaking at the King’s Fund annual thrash. The think-tankers know all about the problems and in their post event press notice they tried to do a Kelvin Kiptum and put as much distance between them and Silly-Boy as they could.

King’s thinkers know; the NHS needs a period of stabilisation. Proper funding, workforce revitalisation and to become a reform-free-zone.

Silly-Boy actually said;

‘… [he]… plans to divert money from the hosptials, to GP surgeries and beef-up local clinics…’

I know, you couldn’t make it up.

He argues that preventing ill health will ease the pressure on emergency services. Of course… but Robin Hood is a fairy tale… not a policy.

The NHS is struggling from 10 years of flat line funding in the years running up to Covid and now faces three more years of drought.

A shortfall of £4.3 billion in its budget for the 2021-2022 financial year. Most ICBs are mired in legacy debt. Around £10bn in backlog maintenance…

… a workforce crisis that is likely to last ten years and will cost millions to fix.

Streeting said;

‘…reform rather than cash is the route out of its current crisis’.

He is dangerously naive. Promise me you won’t let him near a medicine cabinet, never mind the NHS….

… promise.

News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
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