There are clouds, seaweed and yer granny’s arthritis…

… to forecast the weather.

What’s happening in the NHS? All you need is my inbox.

I get predictions for the future, a litmus-test of opinion and a daily dose of common sense.

I also get a steady stream of insider opinion. People who are kind enough to confide in me; what’s happening and what’s going to happen.

I can tell you two things.

• The last thing anyone in the NHS wants is a reorganisation.
• The first thing Labour is planning is a decade of NHS change that staff are ‘crying out for’.

So, figure that out.

I suppose it is too much to ask that anyone in the Labour Party has read the existing Long-Term-Plan?

A pity, because it is sensible, pragmatic and deliverable. A quiet evolution in how the NHS works. How patients are looked after.

It is true, it’s been disrupted by Covid, strikes and Brexit and the promise of;

… [a] secure and improved funding path for the NHS, averaging 3.4% a year over the next five years, compared with 2% over the past five years…’

… has been interrupted by the shock to the economy by Truss&Co, but…

… the fundamentals of a digital first service… saving 30 million trips to hospital, consolidation of GP practices and expanded community health teams are still relevant.

The Plan lays out major reforms to the NHS’ financial architecture, payment systems and incentives and needs no legislation to implement.

There are seven chapters…. too long for Labour to labour over?

I fear I am wasting my time… new governments always tear-up the plants along the garden path, on the way through the front-door to power.

The question is, what exactly do they want to change? The ‘system’ works entirely satisfactorily but it simply doesn’t have the capacity and cash to cope with the numbers and too much of it still relies on pencil and paper.

The NHS is powerless to improve the wellness of the nation.

That’s the job of housing, employment, education, legislation, benefits and the environment. National motivation and leadership.

The NHS is there to fix the bad health of the nation and that’s the reason…

… to shift emphasis. To increase capacity. A lot will be said about productivity. Most of it a myth.

The productivity of nurse cannot be measured in the number of patients they care for. That measures knackered-ness.

Neither, the number of procedures. That measures the supply-chain.

It can only be measured by the quality of the outcome.

Making life easier for the nurse, enabling their work-flow, systems that are more silk than sandpaper, certainly helps.

That’s why more nurses will make a difference.

A scan for a ‘query-prostate-patient’ takes an hour. Shaving time off clerking and preparation won’t mean the gazillion £ machine could do 25 scans in a day… there are only 24hrs.

That’s why more scanners, the people to press the buttons and read the results, makes a difference.

Moving patients around the system quicker might improve throughput… but only if every contact is with professionals working at the top of their practice and skills. Otherwise ‘re-doing’ and duplication creates the cost and aggro of failure-demand.

That’s why investing in education and training makes a difference.

What are the Labour disciples trying to change?

Silly-Boy’s latest? He told doctors;

‘Instead of spending £440 on an A&E attendance, we’d spend £40 on a GP appointment…’


If Labour’s focus is to be on waiting, and it should be, that journey starts a long-way from hospital. Primary care ‘working-up’ patients to achieve optimal-health before a procedure, to ensure they recover quicker is a goer.

That’s why more community staff would make a difference.

Labour have to look further ahead. If you are old, the long-term outlook is grim.

Tightening, council eligibility criteria, means probably close on a million fragile people no longer get the social-care help they need. The refugees in our system.

Do Labour know what metrics, mindset and culture to change? Timing is important. Social care is urgent.

The NHS is not like Blockbuster… about to collapse under the pressure of Netflix, nor Kodak who invented digital-imaging and never invested in it.

It’s a lose federation of disparate parts that when they can hear the same tune, will march in-step. That’s why leadership and ownership matters.

Memo to Labour’s apparatchiks; ‘you can’t cut your way to better performance, only invest in it.’

In 2019 the NHS boosted productivity by 3% in a single year, more than treble the 0.8% achieved across the wider UK economy, in 2016/17.

The NHS is a star performer and it doesn’t need a new script.

News and Comment from Roy Lilley
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Reproduced at by kind permission of Roy Lilley.