Excellent.

Ditto

+1
Although, I am worried they're a bit late to the party. I wonder if they'd call a strike over it...

Sitting is his study, making last minute arrangements for the Boxing Day celebrations; he knew he didn't feel right. A tightening then a crushing pain in the centre of the chest. An indescribable heaviness. It's never a good sign and in a man turned ninety, definitely a bad sign. It wasn't long before the helicopter was scrambled and he was in one of the best heart hospitals in the world.

At the other end of the country an older man, well into his nineties, was walking back from Tesco's, making last minute arrangements to join a family Christmas. Overcome with a pain in the centre of his chest, he sat on a low wall. He felt heavy. A passer-by asked if he was alright and kindly took his shopping bag and walked him slowly back, up one flight of stairs into his spotless apartment, where he lives alone.

He didn't like to make a fuss. "No, the ambulances'll be too busy to bother with me"....... eventually, late afternoon, a relative was alerted and negotiated that they go to A&E, by car.

By the time the helicopter had landed the on-call cardiologist was ready to meet him. The chief executive was on his way, a startled press officer was already cranking up the press machine. Within hours he had been diagnosed and treated with a stent. Routine, standard practice.

His visitors were met, greeted and taken to the side room to see their grandfather. No, they didn't want any tea, thank you. They didn't want a fuss. Four days later a procession of Land Rovers swept him out of the hospital, smiling and waving.

A&E was quiet but it was 1am before the man found sitting on the wall had been seen by a triage nurse, a doctor and admitted to the Cardiac Unit. Amongst the machines and monitors two nurses were busy but attentive. One wore a Santa hat.

Visiting the Cardiac Unit took determination. A blizzard of signs, union strike notices, press cuttings, posters, health and safety advertisements, clean your hands campaigns and League of Friends activities made it tricky to see what was where. Reception was in darkness. Past the cleaning and delivery carts, through the well worn corridors and past a room with the lagoon of water on the floor. Past the coffee shop; locked and abandoned for the festivities; eventually the lift.

On the ward, among the monitors, no sign of a cardiologist. "They won't be in 'till Tuesday" said the nurse in the Santa hat. And, no, she didn't know about the man's two outpatient appointments in the next few days; haematology and renal clinics. It would appear Christmas has an electromagnetic pulse effect, rendering parts of the NHS dysfunctional.

He was stoic. Didn't want a fuss. There were no chairs for the visitors. They stood around his bed for an hour. His clothes were bundled into a plastic bag, abandoned on the floor, under the bed. Covering him a beige blanket. No TV, no news papers, no distractions. The Friends' shop locked and dark. It's at times like this you find out who your friends really are.

The hospital is pushing a £30+m bow wave of debt in front of it. It looks like it. Worn, exhausted with the effort of staying afloat and helping to save £20bn to keep the Big Beast in a job.

The man in the helicopter was the Queen's husband, treated at Papworth. The man on the wall is my Uncle Les, Wednesday morning and still waiting to see a cardiologist at St Helier's Hospital, Sutton.

Breathtaking.

Happy New Year! Welcome back! I've learned a few lessons in life, hence; I don't do predictions and I resolved along ago, not to do resolutions but as we get off to a new year I want to say five things.

First; I have been in and around the NHS since 1974 and I have seen (I think?) 17 Secretaries of State. With the close exception of Patricia Hewett, who was universally hated but did a good job; LaLa is the worst.

Downing Street knows the damage he has done to the Tory NHS brand. However, they are not fools. But for the complications of Coalition politics plus the fact that LaLa gave Cameron his first job in politics, he would have been shuffled long ago. The backbenchers are starting to regard him as tedious. He will go this year. So, ignore him.

Second; the 'reforms' don't matter. The Bill will become a rag-bag Act of some sort. Operationally, to carry risk and cover costs we will have to end up with 80-or-so PCT-like organisations running healthcare. The DH will pretend they are new. They are not; they are salvage. GPs will have a bun-fight, squabble over money, overspend and fiddle around with local care pathways but they won't commission. Nothing will really change except waiting times; they will balloon.

Third; if you belong to the BMA, Royal Colleges, Confed, NAPC, Alliance or any other organisation that claims to represent your interests, ask yourself; 'what did they really do for me last year?' Ask: Did they take any notice of me; did they communicate with me, electronically and in a timely way? Did they seek my views and act on them? Did they survey me regularly to see what I think and how I feel and do something about it? Did they invite me to conferences at ludicrous prices or do they webinar when I can join in? Do they distance themselves from bad practice or avoid the fact that some of their members are crap? As the NHS is saving 20% of the budget, are they cutting subscriptions by 20%? If the answer is 'no' to any of these questions - leave, you don't need them. Join the AA it could be more useful.

Fourth: 'It's the economy stupid'. It will get worse and NHS demand will go up. Instead of the DH saying; "Look; you know the nation's finances are in a precarious position, we've been sheltered financially but the time has come to be frank. Please use the NHS resource sensibly, you may have to wait longer than we would like. Help us to help you." ....they will conspire to pretend funding is adequate and everything is innovative, integrated, fast and lovely. It's not. Get over it and get on with what you can. They are in a different place. The Big Beast has lost the plot. I doubt he really knows what's in the Bill. You know the truth. Tell five new people a day.

Five; quality standards in the NHS, taken as a whole, are not good enough. There will be more grief. To get it right means you, YES YOU, every time you go to work asking yourself this simple question, "Is this good enough for my family?" If it's not, fix it. If you can't; tell someone who can make it good enough for your family and theirs. If that doesn't work; tell the Big-Beast direct. He's paid a shed-load of money to put patients, not politicians, first. His email address will be in the same format as everyone else at the DH.

In 2012, let's shine a bright light on some of the dark corners of the NHS.

If you ever become Prime Minister you will be rewarded with three Boxes; a Money Box, a Tool Box and a Toy Box. The idea of the Money Box is to put in as much as you can and take out as little as possible. It's called the Treasury. The Tool Box is Parliament, with which you can repair, demolish and build whatever. The Toy Box contains soldiers, sailors, airmen and women, teachers, doctors and nurses.

Last Friday Dave decided to get out the Toy Box and play with the nurses. He announced nurses will do regular ward rounds, talk to patients and cut red tape. A new Nursing Quality Forum is to be established to identify good practice and patients will inspect what's going on.

My guess; the majority of nursing is very good but we cannot ignore the fact that one fifth of complaints about the NHS concern the care of the elderly. So, is Dave's foray into the Toy Box going to change anything? It's a gimmick that Labour has already tried.

I do not believe men and women, who enter a profession founded on vocation, jettison their beliefs and abandon their craft deliberately. I believe their standards are eroded, eaten away and corroded by pressure, cuts and impossible demands. The culture of care gives way to getting-by and getting-done.

The RCN say, on average, the nurse patient ratio on an elder-care ward is likely to be one nurse to ten patients. On a children's ward the ratio is one to four. As I am writing this I have one ear on a BBC Radio 5Live phone-in. A nurse just said she works on a general ward; 35 patients and five staff, often four.

The root of the problem is staffing levels and money. When the cash is cut, so is care. They are inextricably linked. We know from Stafford and I know with the irrefutable witness of my own eyes. Isn't it a bit rich, Dave complaining about poor nursing standards when it is patently obvious it is his policies that are the cause?

Can Dave use his Boxes to fix this? His Money Box is empty. His Tool-Box could have helped. He had his chance. Just before Xmas the House of Lords debated an amendment to the Health and Social Care Bill, imposing minimum staffing levels on hospital wards. The Conservatives voted against it. His opportunity lost.

So, now we are faced with the prospect of nurses, to prove they have spoken to a patient once an hour, ticking the box on a form. The forms will be collected, collated, audited, and published. Data will be compared. National Forums on nursing will arrange conferences and meetings. They will create a web-site and publish a report. They will preen themselves as they find something good and take the credit. Honours Lists will be looked forward to with greater than usual expectation.

A new industry is born. The economy is saved.

Armies of do-gooders and watchers will march into hospitals and create an industry of inspectors. Why? Every hospital already has them - they are called family and friends; visitors and customers. The problem is; no one listens and no one knows when they complain.

The Prime Minister has the wrong three Boxes. He needs three clear-plastic Boxes stationed by the entrance door to every ward and clinic of every hospital and surgery. They are marked 'Fabulous', 'Fair Enough' and 'Frightful'. Every patient should be given a red token and every visitor a green token and on every visit, the should be asked to pop their token into whichever box they think is right. No forms, no data, no audit just commonsense. Take a picture of the boxes and put it on the DH web-site, YouTube, MySpace, Twitter or Linked in. All for free.

Transparent, for everyone to see; the press, parents, visitors and even half blind NEDs. A visual early warning that something is wrong or everything is right.

Thinking inside the box.

RCGP members have overwhelmingly backed moves for the Health and Social Care Bill to be scrapped, with morethan 98% of respondents to a new poll calling on the College to seek the withdrawal of the bill alongside other Royal colleges.

The RCGP survey, which polled nearly 2,600 GPs, was announced last month by chair Dr Clare Gerada to test the water on the College's position on the NHS reforms.

More than 98% of respondents said they either strongly supported (66%) or supported (32%) asking for the health bill to be withdrawn as part of a joint approach with other medical Royal colleges.

Even without joining forces with other colleges, more than 90% of respondents still said that they either strongly supported (56%) or supported (37%) the College in proceeding alone in calling for the health bill's withdrawal.

Overall opposition to the health bill remained largely constant since the last RCGP survey in October, but 60% of respondents said they felt more negative about the impact of the health bill on the NHS than they did when the College's last survey in the autumn, with only 5% feeling more positive.

Health and Social Care Bill, post-Committee /pre-Report

Position Statement from Labour House of Lords Front Bench Team

Labour’s frontbench in the Lords continues to share the view of almost every external stakeholder organisation to the NHS that the Health and Social Care Bill is unnecessary and poses risks to the patient care. Despite the legislation remaining incomplete, the unprecedented scale of reorganisation continues apace, bringing destabilisation and huge additional costs at a time when the NHS is facing major financial pressures.

During 15 days in Committee, the much delayed Bill came under thorough scrutiny from peers across the Lords, led for the most part by Labour, often working with crossbenchers and, occasionally, backbench Liberal Democrats. As with the Commons stage of the Bill, the Government has to date given no significant concessions while at the same time losing most of the arguments.  With the next version of the Bill just published, Lords Report Stage will start in early February and last for 4 to 5 weeks.

During the Committee stage, we have effectively seen a second “pause” in the Bill, so that issues around the duties of the Secretary of State can be examined.  There is general agreement that the Bill has to be changed in this area, backed up this week by a report from the Lords Constitutional Committee recommending significant changes

The thorny issue of the lack of availability of the Bill’s Risk Register remains unresolved, raised through an FoI request by Labour. Consequently, the final timetable for Report Stage has yet to be formally agreed.   

The main concerns with the Bill remain unresolved and in considering the key Part 3 (which deals with Competition and the role of Monitor as Regulator), Labour put forward a full rationale for an alternative approach to NHS reform (see accompanying document).  Whatever concessions are made before Report, it is clear the government will not be persuaded that changing the NHS from a managed system into a full blown market will be detrimental to patient care.

During Report, it is already clear that many key issues will have to be addressed.  Many Labour peers have signalled their intention to put down amendments for consideration and in January we will circulate further briefing material. For now however, these are the areas likely to be covered:

Secretary of State’s (SoS) powers and autonomy

SoS must remain both politically and legally accountable for a comprehensive NHS
Powers and duties of the SoS must be broadly compatible with those in the 2006 Act
The complete removal of any (unearned) autonomy presumption.
Competition and Monitor

A provision should be inserted that defines the NHS as a universal system provided for the purposes of social solidarity – to deter inappropriate intrusion of competition legislation
Monitor must be the financial regulator of providers not the economic regulator of the health system; the role as regulator of Foundation Trusts (FTs) must be separate
There must be no presumption that competition is necessary or required or to be promoted; it is to be used when appropriate within a framework defined by the SoS
The poorly thought out regime for dealing with “failure” must be simplified extensively and the power to de-authorise FTs continued
Governance of new bodies:  Clinical Commissioning Groups (CCGs) and NHS Commissioning Board

CCGs must be coterminous with local authorities and be free of Conflicts of Interest
CCGs must have proper governance arrangements including a Board with a majority of independent non-executive directors
The NHS Commissioning Board should not commission local services
Independence for Public Health England

Many issues have been raised by the professional bodies to ensure Public Health England is adequately funded, has enough influence within local authorities and remains connected to the NHS
Independence from Care Quality Commission (CQC) for Health Watch England (HWE)

HWE should not be part of CQC
Powers for Health and Wellbeing Boards (HWBBs)

HWBBs must produce an integrated commissioning plan covering NHS, PHE and social care
HWBBs must agree the commissioning plans of CCGs
Other amendments certain to be moved by others, will include:

Training & Education
Research
Monitor’s role in continuing oversight of FTs
Private Patient Cap
Regulation of the workforce
Labour’s position on these matters will depend on the actual amendments proposed but in general terms we agree with views already expressed that extensive changes to the relevant aspects of the Bill are required.

Credit rating agencies such as Standard & Poor's and Moody's will be asked to assess whether hospitals are financially robust enough to treat patients under proposals put forward by the government's NHS regulator.

The agencies – blamed for failing to spot the credit crunch in 2008 and currently engaged in a diplomatic row over their downgrade of eurozone countries – would be required to vet the financial strengths of any provider of NHS services in case they go bust.

In a series of papers, Monitor, the NHS regulator, proposes replacing its current assessment, which looks at clinical quality and how well hospitals "co-operate" in the NHS, with a new regime that will ask "major credit ratings agencies (Standard & Poor's, Moody's and Fitch)" to give "a clear indication of the financial strength of the [healthcare provider] and the perceived capabilities of its board and executive team".

Under the proposals, any provider, either a hospital trust or private company, that failed to achieve an "investment grade" rating – BBB- by Standard & Poor's, Baa3 by Moody's and BBB- by Fitch – would risk losing its licence to operate in the NHS.