Dear Sir Galahad,

Your noble intentions in pursuing the Holy Grail of increased productivity in the NHS have been noted. As you know, I am a ‘shape shifter’ (i.e. I can appear in a variety of forms). This has enabled me to attend covertly various meetings in Whitehall village and Quarry House, Leeds and listen to the often chaotic burblings and confused intentions of those in charge of NHS policymaking.

The cacophony (as you can imagine) has been considerable because the imminence of the election and the Stalinist efforts of the Coalition to curtail expressions of panic.

In 2006, I wrote up a conference report of an event on urgent and emergency care for my friend Rick Stern, now chief executive of NHS Alliance.

The hog-whimperingly unsurprising current demand pressures on A&E made me think it would possibly be useful to reopublish a couple of sections from that report, which appear below.

Integrating primary and secondary care
‘Cracked it?’ - Rick Strang, head of unscheduled care, Hammersmith and Fulham PCT

What are we trying to crack?

Health economist Professor Alan Maynard gives a masterclass in the taxonomy of knights and productivity ruses

Sir Galahad (also known as Simon Stevens) is continuing his search for a means to bridge the £30 billion funding gap in NHS finances in period 2015-20.

Denial is much more than a river running through Cairo. It's an understandable, if unhelpful, response to a fairly grim reality, such as the NHS's is currently.

A very smart friend recently observed that just now, the NHS is working to two planning strategies.

The NHS “is a triumphant example of the superiority of collective action and public initiative applied to a segment of society, where commercial principles are seen at their worst”
Aneurin Bevan, In Place of Fear, 1952, page 85

‘Where there is no vision, the people perish: but he that keepeth the law, happy is he.’ – Proverbs 29:18

Simon Stevens is a subtle subversive: a highly effective character type. NHS England’s Five-Year Forward View sets out his broad direction of travel. And it sends a neat, subtextual message to political and system leaders, which they may even at some point notice.

Today's Times leads with a well-briefed story about how senior Tories (no names, obviously) now regard having gone ahead with their NHS reforms.

The piece is unambiguous that the chaotic, hugely disruptive nature of the reforms was understood before the party's MPs supported what became the 2012 Act in vote after vote after vote.

It is, however, silent on why they went ahead with them regardless.

Folly or knavery?

With the delivery of Secretary Of State Jeremy 'Bellflinger' Hunt's conference speech yesterday and Prime Minister 'That Nice Mr' David Cameron's speech today, health policy fans have much to digest.

Let us start with Mr Hunt.

Mascara Kid Andy Burnham's speech to the Labour Party conference today told us little that had not been extensively trailed in his previous speeches and in the party's policy review led by Sir John Oldham.

Well, I have this from a very good source. "£2.5 bn fund (mansion tax, fags) to fund 20,000 nurses, and 8,000 GPs, 5,000 social/community care workers and 3,000 midwives by 2020".

There are problems with going down the workforce number target route. Not because it isn't important to have the right workforce - skill mix and numbers. It is important.