A little NHS story...

[Minty]

This is from an NHS mailing list I'm on...

 

(FT's are Foundation Trusts)

 

"You're going where?"

 

"I told you last night, Downing Street. The FT's have been summoned to be given a good listening to."

 

With; "Blimey, they must be in a mess if they've called you in" and "don't be late back, you've got to pick up the little one from ballet", ringing in his ears the FT Boss, who might be the Boss in the office but not in the leafy suburb called home, made for the station and a very early train.

 

No breakfast, the swish of the train and a warm carriage did the job. He was asleep in no time.

 

Downing Street; gates, security guards, Police, ID, search, sniffer machine and you're in. Ever wonder how the front door opens so magically? A bloke looks out of the window and sees you coming!

Inside; the distinctive black and white rectangle flooring and red carpet we sometimes glimpse on the evening news. To the left the travelling chest of the Duke of Wellington and a Benson and Whitehaven Grandfather Clock; its Chime turned off on the instructions of Winston Churchill. An ormolu mirror reflects the right of the room and a Chippendale designed hooded-chair with a drawer underneath for hot coals to keep attendants warm on chilly nights.

 

The PM was late. He's got a country to run as well as the messes in Libya and LaLa land to clear up. In a blitz of camera flashes he arrives. Apparently they follow him everywhere? Weird, or what?

 

"Why does everyone insist on calling it GP-Commissioning?" he demands to know. "It's primary care commissioning". Stunned silence. Who will say; "Prime Minister, in your Bill membership of Consortia is open to holders of a general medical services contract and that's a GP. So GP commissioning seems about right. Doesn't it?" No one does.

 

"Why can't we get the consultants on board?" Strange, still air hangs over the room. No one says there is nothing in the Bill to encourage it. Anyway, why would they? They are left out of commissioning and the Bill makes no room for them.

 

"FT's have a lot to gain from the reforms and a lot to lose without them." On that sinister note, he is gone. With such mastery of the brief, is it fair to assume Colonel Gaddafi may be safer than he knows?

 

LaLa is now in the chair. The silent Chief Listener, Gis-a-job Field listens. LaLa wants to know why everyone is talking about cuts. "We've kept our promise to ring fence the NHS." He is irritated.

 

He turns to one of the Knights of Healthcare, the boss of one of the biggest FTs in London, England, the world and the universe. "How much was your budget last year?", he demands. "£722 million" is the sure-footed reply.

 

"How much is it this year?" "£700m". Stunned silence. "....and that is why I'm losing 500 staff."

 

"How has this happened?" says LaLa, turning to Big Beast Nicholson, he demands to know; "Where's the money?"

 

Big-Beast says he doesn't know. The Knight of Healthcare doesn't know, LaLa doesn't know. No one mentions the little matter of SHA's, PCTs debt, redundancy, demand, costs of reform............and all the rest.

 

The meeting dissolves in an inconclusive muddle. No one is listening. The Big Beast vanishes. Everyone else walks to the security gates at the end of the street and out into Whitehall. A Japanese tourist takes their picture; in case they are somebody.

 

Was this a dream, flashing through the mind of the FT boss and ballerina chauffer, knapping, on the train to London? Is this a dream where the PM does not to know what his Bill is all about and everyone plays pass-the-parcel with money, gift wrapped in debt? No. It's a nightmare. It happened.

 

Ask anyone who was at the FT Network meeting at Downing Street on Tuesday. It was for real. You couldn't dream it up.

 

Have a good Easter - I hope you get a big chocolate one!

Edited 21 April, 2011 by Minty

[Baj]

Interesting (tho would be more interesting if I knew what FT stood for!)

[PaulSaint]

Interesting (tho would be more interesting if I knew what FT stood for!)

 

Fat T|ts (Anne Widdecombe)

[Minty]

Foundation Trusts... sorry, should've made that clear.

 

I didn't want to comment on it myself before others because it might be perceived that I had an agenda... but I think the story speaks for itself. I am rather concerned.

Edited 21 April, 2011 by Minty

[Minty]

Here's an 'official' preview of what the meeting was about:

 

http://www.egovmonitor.com/node/41779?

[EastleighSoulBoy]

Foundation Trusts... sorry, should've made that clear.

 

I didn't want to comment on it myself before others because it might be perceived that I had an agenda... but I think the story speaks for itself. I am rather concerned.

 

Ask Stanley to clarify it all. Us plebs don't matter because Stanley and his ilk can afford private health care so feck the rest of us.

 

Apart from that? The voters are reaping what they sowed back in May 2010.

[Gemmel]

Apart from that? The voters are reaping what they sowed back in May 2010.

 

No soul boy, the voters are reaping what they sowed between 1997 and 2010

[Minty]

Let's not get into those tired old arguments. Let's stick to the relative merits (or otherwise) of the reforms as they stand.

[badgerx16]

Let's not get into those tired old arguments. Let's stick to the relative merits (or otherwise) of the reforms as they stand.

That would be 'otherwise' then !

[Minty]

That would be 'otherwise' then !

 

Well, I'm more than happy to hear about any merits if anyone knows of any... no one can ever accuse me of not giving the opposing view a fair hearing!

[hamster]

I'm not clever enough to understand the detail but it sounds like a lot of people unwittingly (or otherwise) voted BUPA into government.

 

Maybe this is a good thing for a majority in the long run (im undecided) but come on people let's not forget those less fortunate than us.

[The Cat]

My sister is a paramedic, her boyfriend an A&E Consultant. Both voted Tory at the last election. Now, neither will ever vote Tory again. To them it's not about the deficit Labour left behind, it's how you deal with it, and cutting vital NHS sevices is not the way forward.

[Special K]

Sounds like an clip from "Yes Prime Minister", but without the humour. The Coalition need to get someone with big kahunas to sort out the mess that the current dickhead is generating.

[Deano6]

A budget of 700 from 722 is only a 3% cut. Hardly earth shattering.

[trousers]

My sister is a paramedic, her boyfriend an A&E Consultant. Both voted Tory at the last election. Now, neither will ever vote Tory again. To them it's not about the deficit Labour left behind, it's how you deal with it, and cutting vital NHS sevices is not the way forward.

 

My wife and sister-in-law work on the front-line in my local NHS hospital stroke unit. Both voted Tory at the last election and both will continue to do so. Vital NHS services are NOT being cut. (FFS)

 

Two sides to every (agenda driven) story....

Edited 21 April, 2011 by trousers

[trousers]

http://www.dailymail.co.uk/news/article-1379091/Thousands-NHS-jobs-advertised-exposing-great-cuts-myth.html

 

The thousands of NHS jobs still being advertised which expose the great cuts myth

 

On an almost daily basis, we are told by the BBC and the vociferous health unions that the NHS is in ‘financial crisis’.

 

The Royal College of Nursing is predicting 40,000 job ‘cuts’, while it is claimed that patients are being denied hip replacements and even cancer treatments in order to save money.

 

Ward closures are being predicted by the King’s Fund think-tank, and there are dire warnings that patient waiting times are expected to get much longer.

 

How strange, then, that the official NHS Jobs website should be doing such brisk business at the start of the new financial year — the very year the ‘cuts’ are supposed to bite.

 

The site, where all vacant health service posts are officially advertised, is predicting 20,000 jobs will continue to be available each month.

 

And, on a single day this week, there were 6,175 posts available — with salaries totalling hundreds of millions of pounds.

They range from nurses and doctors to well-paid administrative jobs with such dubious titles as ‘5 for Life officer’, ‘psychosexual counsellor’, ‘BME (black minority ethnic) inequalities outreach worker’ and, bafflingly, ‘anthropologist-in-residence’.

 

Indeed, some 265 of the jobs being advertised pay more than £90,000-a-year — hardly evidence of an NHS in the grip of an austerity drive, facing what has widely been described as the ‘biggest challenge in its history’.

 

The fact is that for all the disingenuous bluster of the Left-wing media and shroud-waving unions, there has not been a ‘cut’ in the NHS budget. In fact, an extra £3 billion is being ‘invested’ (the euphemistic word that Labour, and now the Tories, use when they mean ‘spent’) on the health service this year, taking the total to £105.9 billion.

 

The Institute for Fiscal Studies has confirmed that next year David Cameron will meet the Tories’ specific election pledge to increase the NHS budget. Indeed, over the course of the Comprehensive Spending Review, the overall NHS budget will increase by 0.4 per cent in real terms.

 

The reason the vested interest groups are so furious is a requirement that — in return for this increased funding — the NHS must make ‘efficiency savings’ worth £15 billion to £20 billion over the next four years.

 

Again, these are not ‘cuts’. Any money saved is ring-fenced and must be pumped back into patient care.

 

The sensible intention is to reduce the amount of money being squandered by health service managers whose budgets, and own remuneration, ballooned under Labour.

 

For the truth is that figures from the Office for National Statistics estimate that since 2000, total NHS productivity fell by an average of 0.2 per cent a year, and by an average of 1.4 per cent a year in hospitals.

 

Overall, the decline in productivity — the value provided to the taxpayer, for each pound spent — was a dreadful 15 per cent, a collapse that would lead to bankruptcy in any private sector concern.

 

Clearly, there is more than a little fat to be cut from the NHS budget.

 

However, the question is whether the savings are being made in the right places. This is where the RCN may have a point. For healthcare experts fear that efficiencies will come from frontline services, rather than by reducing the number of penpushers.

 

The real scandal is that bureaucrats — many of them performing non-jobs — were the main beneficiaries of Labour’s spending boom.

 

In 1999, there were 23,378 managers and senior managers in the NHS. By 2009, the number had almost doubled to 42,509, with manager numbers increasing six times as fast as that of nurses.

 

Instead of reducing this army of bureaucrats, the NHS managers claim that they must remain because they are the only ones with the necessary skills to make ‘efficiency’ savings. As a result, it will be nursing posts which won’t be replaced. Meanwhile, administrators will continue to pick up fat cheques.

 

Certainly, a glance at the NHS Jobs website suggests that, like town halls — which are closing libraries and axing lollipop ladies while paying their chief executives more than the Prime Minister — the priorities of the NHS are utterly wrong.

 

For example, County Durham and Darlington NHS Foundation Trust recently said it would be losing 300 nursing posts by 2014, as part of a £60 million cost-cutting exercise.

 

But, at the same time, the trust is advertising 13 vacancies, including one for an ‘academic clinical fellow’ on up to £46,708 a year.

 

Elsewhere, Kent and Medway plans to slash its nursing, midwifery and health visitor workforce by 264, yet has money to advertise 27 jobs this week, including a ‘psychological well‑being officer’ on a salary of up to £27,534.

 

Kingston Hospital NHS Trust plans to get rid of 214 nursing posts — but, according to NHS Jobs, is ready to pay a new chief operating officer a staggering £120,000.

And the list goes on and on. Birmingham and Solihull Mental Health Foundation Trust said that, to save money, it is shutting down a programme which helps people with mental health problems.

 

Yet it has managed to find up to £55,945 a year for a ‘head of employee and staff relations’. There are also vacancies for three human resources managers, on £34,189 each.

None of these will be doing much to help the mentally ill — or probably anybody else for that matter.

 

To leave nursing posts unfilled while hiring yet more human resources staff will rightly enrage nurses and the public.

 

In other areas, on the NHS payroll are many people who seem to have little to do with healthcare — such as those helping to run a children’s summer playgroup in Peterborough for youngsters with English as a second language.

 

While the Government’s communities department has taken up the fight and is challenging council chief executives to explain why they are cutting frontline public services when their chief executives pocket bloated salaries (and bonuses), the embattled Health Secretary Andrew Lansley (who is fighting to rescue his NHS reforms in the face of a revolt by the Lib Dems) has yet to show the same mettle. Admittedly, he probably fears being considered an ‘enemy’ of the health service.

 

Instead, it was left to the NHS chief executive Sir David Nicholson to say: ‘There is no excuse to reduce services for patients when the NHS will receive an extra £11.5 billion of funding. Every penny saved from measures taken to reduce costs will be reinvested in patient care.’

 

Mr Lansley should point out that, as yet, there is no evidence that anybody is suffering.

Meanwhile, far from preparing to shed 40,000 jobs, including 20,000 nursing posts, the latest published figures show the number of nurses has gone up by 1,272 from September 2010 to December 2010, and by 2,677 since September 2009.

 

To be fair, the Federation of Surgical Speciality Associations (which represents the country’s surgeons) says growing numbers of patients are wrongly being denied a new hip or even cancer treatment because of NHS cost-cutting.

 

But the truth is that while operations are being refused or delayed so that primary care trusts can balance their books, the NHS can find £40,157 a year for an ‘anthropologist-in-chief’ to work at Devon Partnership Trust; £101,829 a year for a ‘director of performance and innovation’ at NHS South West London; £31,664 a year for a European projects administrator, based in Brussels; and £67,134 a year for an associate director of HR (organisational development) in Rotherham. This is nothing short of scandalous.The truth is that the NHS swallowed huge sums of money under Labour and, unlike the rest of the state sector, continues to be offered special treatment by the Coalition government.

 

But where savings of wasted public money need to be made, they should come from the back office — not from doctors and nurses trained in saving lives.

[Lord Duckhunter]

My Mrs is a midwife and for the first time in years, all 3rd year student midwives have been promised a job with her NHS trust.

[trousers]

My Mrs is a midwife and for the first time in years, all 3rd year student midwives have been promised a job with her NHS trust.

 

Sssshhhhh....that's hardly going to fit the left wing's "The nasty Tories are decimating the NHS" agenda, is it?

 

FFS

[Jonnyboy]

OK, none of us want less nurses, but who's going to sack the managers if they wont do it themselves?

[Saintandy666]

OK, none of us want less nurses, but who's going to sack the managers if they wont do it themselves?

 

Trust me, you need good managers and enough of them for something the size of the NHS to work efficiently.

[trousers]

Trust me, you need good managers and enough of them for something the size of the NHS to work efficiently.

 

Indeed. So, how do we replace the current crop of NHS 'managers' (sic) with good ones...?

[Saintandy666]

Indeed. So, how do we replace the current crop of NHS 'managers' (sic) with good ones...?

 

I think a lot of the managers in the NHS are extremely good. I say this as a governor at my local hospital and so having witnessed how the whole place is run for the past year.

[trousers]

I think a lot of the managers in the NHS are extremely good. I say this as a governor at my local hospital and so having witnessed how the whole place is run for the past year.

 

What percentage would you gauge as "good"?

 

I too come from a position of first hand observation - over 20 years - (ok, via my wife and sister-in-law, but near as damn it) and I would venture that c.20% are "good" and the rest are "completely out of their depth".

 

My wife was also a school governor for 4 years so I could shed some light on how schools are 'managed' too if that helps....

[Jonnyboy]

What percentage would you gauge as "good"?

 

I too come from a position of first hand observation - over 20 years - (ok, via my wife and sister-in-law, but near as damn it) and I would venture that c.20% are "good" and the rest are "completely out of their depth".

 

My wife was also a school governor for 4 years so I could shed some light on how schools are 'managed' too if that helps....

 

My other half also works in the NHS and it seems that, like in most areas of the modern workplace, becoming a manager is seen as a way to increase your pay packet and get off the frontline.

[bridge too far]

My other half also works in the NHS and it seems that, like in most areas of the modern workplace, becoming a manager is seen as a way to increase your pay packet and get off the frontline.

 

Although many of those classed as 'managers' are still front line staff. My departmental manager, in my lasts NHS job, was a nurse practitioner with responsibility for 9 community nurses (specialising in COPD and Home Oxygen). As well as managing her staff and her department, she also went out to patients in the same way as her staff did.

 

So you could say it was a department of 9 nurses and a manager but, in reality, it was a department of 10 nurses, one of whom managed the service.

 

A very dear friend of mine - with 25 years service in Theatres at QA - has just been made redundant. He was classed as a manager but he provided a front line service as well as managing the rest of the ODPs.

[Jonnyboy]

Although many of those classed as 'managers' are still front line staff. My departmental manager, in my lasts NHS job, was a nurse practitioner with responsibility for 9 community nurses (specialising in COPD and Home Oxygen). As well as managing her staff and her department, she also went out to patients in the same way as her staff did.

 

So you could say it was a department of 9 nurses and a manager but, in reality, it was a department of 10 nurses, one of whom managed the service.

 

A very dear friend of mine - with 25 years service in Theatres at QA - has just been made redundant. He was classed as a manager but he provided a front line service as well as managing the rest of the ODPs.

 

of course we need managers and planners etc but their patient contact is reduced by high levels bureaucratic meetings (Much increased by these needless tory reforms) but maybe thats just the view of a lowly bitter grade 5-er ;-)

[so22saint]

I have a mate who's very very high up in the NHS, a client who we provide services for who support FTs, a wife who is an intensive care nurse and a mum who is dying of cancer at the moment so I see all sides of the argument at the moment. My comments:

 

* Private industry takes the **** out of the NHS - mainly through NHS incompetence (though also through immorality and greed in my opinion)

* The NHS couldn't negotiate a contract out of a paper bag. Our client helped save 2 of the trusts £2bn through actually WRITING SOME CONTRACTS WITH SUPPLIERS. The IT bit did nothing - basically they had no set prices for anything so the suppliers could charge what they liked month to month

* The ringfencing did happen and NHS budgets were frozen at a round £100bn, but supplier inflation in the NHS runs at an average of 5% (see first comment) so it was effectively a 5% reduction in real terms

* A great deal of front line staff are superb and really care. Intensive care and A&E are amazing. Cancer care (in Southampton at least) is a ****ing joke - charities are the only thing keeping it going

* Too much money goes on "management" staff who aren't really managers - the people who don't even negotiate contracts for instance. It seems to attract a certain kind of person who doesn't live in the real world - who thinks a central planning approach and work next to but ignore a free market economy. In addition, the NHS is a pass master at ****ing money away offshore that'll never come back to the UK (IT, NHS Direct, staff) in tax etc. Another mate who works in care leasing told me a story over a pint of the month after New Labour (they're not Labour) got in and one of his trust clients refreshed the entire management car fleet from Mondeos to BMWs. Good spending chaps, new budget went on the important things eh!

* Basic free healthcare is a good thing - it's a must to improve living conditions and create a stable, happy and healthy workforce. The NHS is a good idea. It needs some reorganisation to focus on medicine and care and not ********

[anothersaintinsouthsea]

What percentage would you gauge as "good"?

 

I too come from a position of first hand observation - over 20 years - (ok, via my wife and sister-in-law, but near as damn it) and I would venture that c.20% are "good" and the rest are "completely out of their depth".

 

My wife was also a school governor for 4 years so I could shed some light on how schools are 'managed' too if that helps....

 

Wow, with first, sorry second hand experience like yours I reckon the Tories should get you in to consult both Health and Education.

 

People talking about waste and efficiency in the Public sector always makes me chuckle. I've only ever worked in the Private sector and can confirm that even the (considered by others) very successful blue chips that I've worked for that you find plenty of waste and plenty of crap managers.

[Saintandy666]

What percentage would you gauge as "good"?

 

I too come from a position of first hand observation - over 20 years - (ok, via my wife and sister-in-law, but near as damn it) and I would venture that c.20% are "good" and the rest are "completely out of their depth".

 

My wife was also a school governor for 4 years so I could shed some light on how schools are 'managed' too if that helps....

 

Well, in my experience, all the top dogs as in those on the board and so on come across very well and compliment each other. Then again, my local hospital is an extremely good and well run hospital.

[Thedelldays]

Well, in my experience, all the top dogs as in the board come across very well and compliment each other. Then again, my local hospital is an extremely good and well run hospital.

 

aren't you about 18 years old..?

[Saintandy666]

aren't you about 18 years old..?

 

Correct, and I have been a governor representing young people at my local hospital for about a year now. So yes, I do have some experience in seeing how the NHS works.

[trousers]

Well, in my experience, all the top dogs as in those on the board and so on come across very well and compliment each other. Then again, my local hospital is an extremely good and well run hospital.

 

I'm talking more about the bloated middle-management tier. Most boardrooms will seem 'impressive' to someone sitting in every now and then in a governor capacity.

 

How many middle managers have you observed in action day-in-day-out for best part of 20 years...?

 

The hospital I'm talking about is also seen as being a 'good' hospital in the rankings but, from my near-first hand experience, it could be improved significantly by having a better and leaner middle management tier.

[Verbal]

I'm talking more about the bloated middle-management tier. Most boardrooms will seem 'impressive' to someone sitting in every now and then in a governor capacity.

 

How many middle managers have you observed in action day-in-day-out for best part of 20 years...?

 

The hospital I'm talking about is also seen as being a 'good' hospital in the rankings but, from my near-first hand experience, it could be improved significantly by having a better and leaner middle management tier.

 

I'm sure that's true. But then why the **** doesn't your galumphing hero Lansley do something about it instead of introducing 'reforms' that hand managerial decisions over experienced in-house clinicians to outside, less talented and remote GPs, and then parcelling off chunks of the NHS to similarly inefficient and remote (+ greedy) private companies. As waiting lists soar - which they have been since the Tories came to some sort of power - Lansley's widely acknowledged (even by Cameron) screw up is already having the combined effect of massively depressing staff morale, forcing casualty patients to wait ever longer for desperately needed treatment, causing organisational chaos, and providing yet more opportunities for private-company grafters to cream off easy profits at virtually no benefit to patient care.

 

Getting rid of middle managers is one thing. Destroying the NHS in order to do that is the height of a kind of stupidity that (Lansley aside) no one even in your beloved party is prepared to defend.

[um pahars]

Getting rid of middle managers is one thing. Destroying the NHS in order to do that is the height of a kind of stupidity that (Lansley aside) no one even in your beloved party is prepared to defend.

 

That is the crux of the matter for me.

 

I don't believe anyone supports an inefficient, wasteful and under performing NHS and would always be supportive of looking for ways to gain better value for money. From a performance side, many of the indicators are good, so perhaps the emphasis should be on value for many, ridding it of ineffiecient or outdated practices, ensuring as much money as possible hits the frontline (but accepting that backroom roles are necessary to support this) and making sure evry £ is widely spent.

 

But I think that is a million miles away from what Lansley is proposing (that's if anyone realy knows what Lansley is proposing) and I'm not sure such radical proposals should be rushed in, particularly when (a) no one is overly sure what they are, how they are going to work etc (b) there appears to be widespread opposition (not just your usual opposition), © I don't remember it being in their manifesto or election campaign, (d) opposition from within the coalition and other parts of the Government and (e) a real worry that without perhaps running some pilots then this could just all fall apart around our ears.

[trousers]

I'm sure that's true. But then why the **** doesn't your galumphing hero Lansley do something about it instead of introducing 'reforms' that hand managerial decisions over experienced in-house clinicians to outside, less talented and remote GPs, and then parcelling off chunks of the NHS to similarly inefficient and remote (+ greedy) private companies. As waiting lists soar - which they have been since the Tories came to some sort of power - Lansley's widely acknowledged (even by Cameron) screw up is already having the combined effect of massively depressing staff morale, forcing casualty patients to wait ever longer for desperately needed treatment, causing organisational chaos, and providing yet more opportunities for private-company grafters to cream off easy profits at virtually no benefit to patient care.

 

Getting rid of middle managers is one thing. Destroying the NHS in order to do that is the height of a kind of stupidity that (Lansley aside) no one even in your beloved party is prepared to defend.

 

I agree about the implementation.

 

As ever, politicians have executed a perfectly good plan badly. I lump politicians into the same bracket as the inept middle managers that I highlight.

 

Just because the politicians (on all sides) that implement policies are crap doesn't render the underlying policy as crap (per se)

 

It's a catch-22. The NHS needs to adapt and streamline but the people we (the electorate) get limped with to deliver the end result are actually part of the problem.

 

So, once again, you are wide of the mark with regards my supposed love for Tory politicians. I admire the policies rather than the muppets we're saddled with to implement them (muppets = the middle-management + politicians).

 

Now, if the whole thing was to be handed over to the private sector we might see some decent implementation... (much winking)

[um pahars]

As ever, politicians have executed a perfectly good plan badly

 

But what is this good plan????

 

Could you explain it the outline plans, efficiencies, targets, priorities etc or point me in the direction of something on the net as I've honestly struggled to get my head around what is being proposed and how it will be mplemented

[Saintandy666]

I'm talking more about the bloated middle-management tier. Most boardrooms will seem 'impressive' to someone sitting in every now and then in a governor capacity.

 

How many middle managers have you observed in action day-in-day-out for best part of 20 years...?

 

The hospital I'm talking about is also seen as being a 'good' hospital in the rankings but, from my near-first hand experience, it could be improved significantly by having a better and leaner middle management tier.

 

Well, compared to you I obviously know little.

 

Are you advocating less managers or just better ones?

[Verbal]

Well, compared to you I obviously know little.

 

Are you advocating less managers or just better ones?

 

Thinner ones, I think. Can't really tell.

[trousers]

Thinner ones, I think.

 

^This

[Verbal]

I agree about the implementation.

 

As ever, politicians have executed a perfectly good plan badly. I lump politicians into the same bracket as the inept middle managers that I highlight.

 

Just because the politicians (on all sides) that implement policies are crap doesn't render the underlying policy as crap (per se)

 

It's a catch-22. The NHS needs to adapt and streamline but the people we (the electorate) get limped with to deliver the end result are actually part of the problem.

 

So, once again, you are wide of the mark with regards my supposed love for Tory politicians. I admire the policies rather than the muppets we're saddled with to implement them (muppets = the middle-management + politicians).

 

Now, if the whole thing was to be handed over to the private sector we might see some decent implementation... (much winking)

 

But why is it 'a perfectly good plan'? This is not about that hoary old canard of 'presentation'. It's just a mash-up of incredibly bad ideas - and by 'ideas' I mean the absence of them. To put it in terms a little closer to your home, a central plank of the reforms, if applied to the banking sector, would mean that merchant bankers' investment decisions would be vetted and approved by a local bank manager in Eastleigh.

[trousers]

But why is it 'a perfectly good plan'? This is not about that hoary old canard of 'presentation'. It's just a mash-up of incredibly bad ideas - and by 'ideas' I mean the absence of them. To put it in terms a little closer to your home, a central plank of the reforms, if applied to the banking sector, would mean that merchant bankers' investment decisions would be vetted and approved by a local bank manager in Eastleigh.

 

And I thought my analogies were bad... ;-)

 

I'm off to compare apples with oranges...I maybe some time... ;-)

[Saintandy666]

Thinner ones, I think. Can't really tell.

 

.

[trousers]

.

 

.

[bridge too far]

.

 

You really are a little winker, aren't you

 

[trousers]

You really are a little winker, aren't you

 

 

More of a cult I would say