Editorial Thursday 5 June 2014: Thoughts on NHS Confederation conference, day two

You can say (or indeed sing what you like about Care Services Minister Norman Lamb, but he's honest about his desire for the Lib Dem manifesto to commit to a top-down redisorganisation of the NHS when the inevitable electoral landslide next May sweeps a triumphant Prime Minister Nick Clegg into Downing Street with a majority of 53.

Now of course Stormin' Norman said that he wants to see a legal responsibility to pool budgets between health in the NHS and social care in local government, and was careful to suggest that should not require any redisorganisation of structures.

The only slight problem with that thesis is that it's bollocks (to use an arcane, technical term).

Why? Because as soon as you replumb the finance into pooled budgets, you've just screwed up the governance and oversight. Now you could argue that this doesn't matter, because nobody in the NHS ever disagrees about contracts, activity and payment.

Or you could join the real world, where this happens all the time and where lots of the NHS England specialised commissioning contracts with the big acute providers have still not been signed off.

More to the point, the consequence would be to hand the health and care budget over to the UKIP councils in parts of England. Perhaps not a first-rate idea, on reflection.

"Vote Lib Dem  For A Top-Down Redisorganisation Of The NHS!" Sounds great. Where do I sign?

There's a GMB demo outside protesting at selling off the NHS.

It's windy in Liverpool, and the sky is grey.

Later today, we have The Mascara Kid and The Bellflinger, sadly not dancing The Masochism Tango together cheek to cheek, but each in his own special way seeking to define their position on the use-to-ornament value spectrum for the NHS leadership community present.

If you like that sort of thing, it is the sort of thing you will like.

Andy Burnham
I'm not traditionally The Mascara Kid's biggest fan, but he actually gave a solid speech and set out his policy stall - NHS preferred provider; person-centred care pace the Oldham review ("a health and care system offering a single service, with the tide of provision going towards home not hospital. A single service, with a single budget to  unite the physical, mental and social in full care personalisation").

It was well-expressed, although his little hint about reconsidering the self-employed status of GPs was a bit interesting. The nationalisation of general practice (and indeed general practices as physical buildings) might be a policy step too far in austere times.

He outlined the dismal political debate that followed 2010, but pointed optimistically towards an emergent cross-party consensus that the NHS needs better integration. He did not, of course, define integration. There we go.

But TMK didn't dodge the bullet of the  funding: he has no plans to respond to the Oliver Twist ('please sir, may I have some more?') until the health and care system's dis-integrated Berlin Walls have come down - quite a good phrase.

He also outlined an idea that could be made to work: a repeat of the 1948 'Your NHS Explained' leaflet outlining the offer and the reform of local providers required to make it work financially. It would have to be carefully written, trailed and above all not distributed alongside pizza flyers as happened to the Care.Data leaflets.

BME Leadership Forum session
To the BME Leadership forum, to be reminded yet again that the NHS has still got a very long way to go until its senior workforce in management levels accurately reflects the ethnic and cultural diversity of the nation. Hopefully, someone will start doing some kind of annual survey of BME representation among managers, to keep the pressure up on this important issue.

An index of Simon Stevens' class is that despite what's probably the busiest schedule of anyone, he had made time and requested to come along to speak at the session, emphasising the importance of this issue and restating his purpose to keep this issue on the agenda.

Jeremy Hunt
Health Secretary Jeremy 'Bellflinger' Hunt was OK. He matched Andy Burnham by not promising any new money for the NHS.

The Trappist consiracy over the funding situation has become like the Mexican standoffs that end so many Quentin Tarantino films, with all the key players pointing guns at each other's heads.

An anti-virus sweep has addressed some of the virus in the machine code for the arms, though Rob McCargow on Twitter caught this fabulous photo of his 'I'm A Little Teapot' moment.).

Hunt did his greatest hits: his thank you stuff; his patient safety stuff; his holding on to the lessons from Mid-Staffs stuff; his quality saves money stuff; his front-line work experience stuff - and in fairness, he did genuinely try to connect and show his gratitude to NHS leaders and to the front-line staff working so hard. Hurray.

He thanked the chief inspectors for their hard work, but was woefully silent on the issue of the Chief Inspector Of Chief Inspectors' contribution.

There were some hog-whimperingly comic bits, albeit somewhat unintentional. He said, out loud in the real world that "transparency and peer review are better change mechanisms than Stalinism and top-down targets". Chief executives are doubtless never again going to  be fielding his phone calls about four-hour breaches in A&E. (Ahem.)

He was rightly upbraided by a GP for having described the Pothole Care Fund as "new money when it is repatriated money". The same questioner asked where the funding was going to derive for the extra 16,000 GP appointments he'd promised. Hunt replied that they were planning to train 5,000 more GPs, which is very nice - but not an answer to the question.