Two stars of the show? Maybe, maybe not.  I had my favourite in mind before the meeting, but I was willing to be convinced that Penderyn was not the star!!

Award winning, and absolutely resolutely proudly and excitingly Welsh.  Yes, it’s good enough to fuel Roy Lilley’s e newsletters….but not his NHS Health Chats…he saves it until after the event…

Pensive and thoughtful – not just the audience!

Usual health warning…my views alone here, so biased and opinionated. If you want to check yourself, watch the recording on the You Tube link. Here…

How often do you get the killer question in the bar? I was sitting next a BBC journalist who had interviewed Roy Lilley that afternoon. He had invited her to witness the NHS world via a Health chat at The Kings Fund. “A lot of that went over my head” she said, ” But why can’t one size fit all? Why should the care and delivery and outcomes be different in different parts of the country?”. I blustered and flustered. She asked the same of Roy in the same bar. He blustered the same as me.

Maybe it is simple? Maybe it should be central edict? The pendulum swings. As it always does in management and leadership? And in reforms.

I just find the scope of Simon Stevens job just too mind boggling. He feels like the ultimate polymath who is a hyper generalist – and has to have specialism too. Can one organisation do that? Can one leader?

Or is it just rearranging the deck chairs on The Titanic?

A lot of the trends look good? 0.8%improvement in cancer survival rates sounds small. Until you factor in 300 000 new diagnoses per year. 2 400 families will have their loved one at home for Christmas this year who would not have had them last year.

And what about the differences – late presentation (a big determinant of survival) worst among blue collar males? My view – perhaps we have to live with that? Keep up the health education pressure, but not everyone will listen and act?

Will we always end up robbing Peter to pay Paul?  Simon has to intervene to attempt to save the Mental Health budget being dipped into. But then something else will give?

What a job!

The 5YFV – five years forward view now has 200 weeks left – a growing and ageing population to care for, and austerity budgets with deficits (possibly political?) the norm, and hoping that 2% of the savings will come from reducing demand! And A&Es will not fall over this winter and what about social care?  (If you need a reminder – this is the ‘easy read’ option from NHS England – here)

OK…a long and badly constructed sentence, but I am just trying to give you a feel for the complexity. It feels bonkers.

Will the 44 STPs really be the answer? Well, it should be a great focus? Or will as Roy suggested, the consultation process kill any major change ideas. Local hospitals always want to be saved by local people….even if they can be proved to be offering a better service after a local closure. (Simon had local news from one of the questioners hospitals on his smart phone as the question was asked – smart indeed!).

There does feel like a lot of positive change. 1 million fewer smokers than 10 years ago. Down to 7 million. Tax or health ed? Or none on TV and none in pubs? Or a bit of each? Can NHS England influence that? Sure it can.  One thing I have noted all year is the passion from the top of the NHS mirrors the passion of the best from all levels.  Let locals fix the local agenda, and the centre set the policy and direction? Can it be that simple, getting back to my original questioner? The myriad of questions from the great and good in the audience certainly prove the passion is there. And it may never be as simple as ‘there’s just not enough money’ . Perhaps the 5YFV does set the right agenda and the STPs and the Vanguards and the highly copied ideas from FAB NHS.net and continued centrally derived strategic direction will get us there.

But we maybe have to think totally differently.  Let’s maybe steal other ideas from other parts of Europe (I am very enticed by Buurtzorg social home care from Netherlands, for example), (RCN updated briefing here) and get past some of our sacred cows, we might get more for this amount of GDP. It is pretty good, but maybe we now need to future scope stuff. We might need to consider interoperability of IT and data transparency systems.  The next efficiency level could be in the realms of real time information systems that are truly enterprise or nationwide? Why not?

Why does the NHS management development scheme become oversubscribed with the best graduates, when there is so much crap going on? Maybe it entices people who want to fix the messes, because it is a huge opportunity to make change, realistic and long term, happen? As Simon said, we don’t want to be short term smart and long term stupid…

It feels like that is why Simon Stevens does his job. If he can just get past the treacle stream of vested interests, his passion and intellect and deep networked knowledge could see us through to an NHS still existing in 2022, and maybe even thriving.

Enjoy the Penderyn all who came and took a sample! And toast a rosy future for our NHS. We are all in this together. It’s not just up to Simon and his team…

Roy’s favourite whisky – Welsh and award winning! (Miniatures lined up by Hannah!) (Click on photo to see their web site)