Interesting development within UK NHS. If you read a bit further maternity care is specifically mentioned!

Edwin


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18th September 2013
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Showboating

News and Comment from Roy Lilley


Most of us don't think about in which hospital we might end up.  The ambulance takes us where it wants.  The GP sends us to where the CCG has a contract.  For most, the local Trust is the only show in town.



If you could chose, would you want to go here:



'... six patients... told us the surgical procedure they were about to undergo had been explained to them and staff had made them feel at ease... all of the staff that they had come into contact with... had treated them with respect. One patient said; Staff have been reassuring and as good as you would hope them to be.'



You probably wouldn't want to go where they said this;



'... some people are at risk because staff are not using recommended and mandatory checks prior to undertaking surgical procedures.'



I suspect you'd take a chance on a place like this:



'Throughout the hospital... patients (were) being cared for in a kind and respectful way. All levels of staff... showed respect when they were addressing patients and (they checked) patients were comfortable and understood what was happening.'



Would you want to go to a hospital, second from bottom in the national patient survey<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAzm-3Zwj8VnWTvUW-xyL9sMqpDZPaQJ_0fslQZ_OVjkIGS5eZrtjYZ242VY_clnytGwro7L9nm6icvC9Qk_6JUIYu0KBrCyePIJYYZiJ09m6Fp49AW5g1Mzt-9hqg5eVtcCjUxKQONZcaaLsj25qki8fYwZp-FORK7v7mEGTSWjWu_eNEF7rLvolugzZ_0p6y7nVvNAz4BfQXNxS37a9_-7qhAsp3BOZ5PXrG6UJAgNkOvMOhgN0JH1NrB1sQbTZxU=>?  I think you would prefer to go to a Trust that had an overwhelmingly positive result in the recent <http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAwj9ch4Ob-4WyU8EIPKH3kXHeYv1MfyHJpgalbe_6EA4DPTiMn5WXOv_k5V34-VENWrwvOYs4sBbsmFB7iFy5BMIByJ6ujg7YZaN4NAgh_EZGDH5csqSs13ZbivY4twS8avic477HmNUbuyZnptYDgZ> F&F Test<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAwj9ch4Ob-4WyU8EIPKH3kXHeYv1MfyHJpgalbe_6EA4DPTiMn5WXOv_k5V34-VENWrwvOYs4sBbsmFB7iFy5BMIByJ6ujg7YZaN4NAgh_EZGDH5csqSs13ZbivY4twS8avic477HmNUbuyZnptYDgZ>.



It's a no-brainer.  Well, it is not that simple; the quotes are from the same CQC<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAwvfua2gFYZo9edTLvbsfki-yJrxGbDnCOfzZkMs8PKNWZFoxiamuPWQTfIcBCvbovoO3F7vDtQwdUcR8Wj6wz4ZFsZENn13eSGUvE_y4sfJOzJzgTCZhGmsV7C8-XxniM=> report<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAwvfua2gFYZo9edTLvbsfki-yJrxGbDnCOfzZkMs8PKNWZFoxiamuPWQTfIcBCvbovoO3F7vDtQwdUcR8Wj6wz4ZFsZENn13eSGUvE_y4sfJOzJzgTCZhGmsV7C8-XxniM=>.  It is the same hospital; it is good and bad, fabulous and not.  This hospital pleases some and not others.  This hospital is Croydon<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAy5OIgJnxrBHPpxPdeOu1pLH3my65U00ExeVGWD5ZAQND_bis40C8d227TjS07SKBxusi2rUMJnQfYGVsHo9oRK0v76KfGV9F4RDSjQIUSfpuIaSWaMU9JHTxLRLfT5-W0=>.



Croydon is a terrific, clean, bright, busy, a well-run happy place that serves a grateful and supportive community.  It also has crippling A&E<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAz2uyLgnQoxwUvD_dLJP_plgx5GoCfiFbT3K-uuH2QRdKULrTY2ikkanmTOfhojCQRHYWZChvVKF45yX-AnnG0FvQuKPYcuqzrqtgm6ZhUwnr37r02ytC28Ig6RkPOQRFe1ows6Ain0lK3lLb6Kjp_uqX2W8kgQyM6N6IYYsowkNibs8-jW-z9ZzBIjMGjq2ABfyVIUGG_qyQ55AR7D7Z-aYT_EA-pQLhlWcFom9MvFGyx54gT7JgUobA4BptFv0MfIt7Hzp_1utg==> staff shortages<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAz2uyLgnQoxwUvD_dLJP_plgx5GoCfiFbT3K-uuH2QRdKULrTY2ikkanmTOfhojCQRHYWZChvVKF45yX-AnnG0FvQuKPYcuqzrqtgm6ZhUwnr37r02ytC28Ig6RkPOQRFe1ows6Ain0lK3lLb6Kjp_uqX2W8kgQyM6N6IYYsowkNibs8-jW-z9ZzBIjMGjq2ABfyVIUGG_qyQ55AR7D7Z-aYT_EA-pQLhlWcFom9MvFGyx54gT7JgUobA4BptFv0MfIt7Hzp_1utg==> but still manages to turn in 96% of patients seen on time in A&E.



Croydon is making gargantuan efforts to be good, better and best.  Croydon also is the 3rd worst place<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAxzrJGNQuUAdJdpB_LF-OTbLwFg87iBHXgC48vJgi1cj2b_6_yXPDZCh624SyAsqW3QXCRlxe8erXyHwdyb2pT0CefP5gA37UimfxlB5UURDn88CgwJdZC7cO10y2rRmfO2JWT3pBKOyG5c7EITbfONeSWTpuXypr1W2II_ZAWrzEwMg9mwaXQVLkL5n839HV6MRrxDvr4lQGHQ-AlzEy1vBkuG0vF-HnLUrOdFjz7Uya3YhKjrmJz3lzave4zy6tw=> in the country to be treated for cancer.  It is in good company.  Flag-ship Imperial College and Bart's were worse.



Croydon has spent a small fortune on refurbishing its new-look maternity<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAygPVRun3XpvO_gXDafA1Sp6LZWZ_arPMNGZ4UTH6gQrnp0RFh4FMCA58KqZwVOWq0En5LyqI_2wPJjX5t3HxgxvuUvNhrTQ-EWDHHcFgxBCPyRtW0I6xprNKCRUTyltQAPnFbztJf7q2arXWAxt_DZbubiW6i1AizKhFh8rlv9PhKi1civHRBsZ6KR89-HPZ8CsvS6kjQhE7idI04P2k2e_DPdkpsfV8VgR8RxnYUrng9v_VeSTBSWtYmqi-EBikE=> ward.  Insiders also tell me they have also spent hours of sweat getting ready for the arrival of Mike Richard's Inspection Army; 20 inspectors for four days.



Croydon has been chosen to be the first trust to be inspected<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAzUQcfTHObWRdlSm4lnM7JCIJd7EzORTFwC_sKRYwK_H1OKqFc4fi-R1KXVGEaBevtTV9mLmK1SHx29h5wWyuhP9DFAL9TVazCmwpYxuU3x3XEyyz5BRmYPWVQNqLnyNSDBZcHwcV7jYw==> because of its size and location.  It was identified as 'high-risk' under new criteria.  Each hospital is given a 'risk score' based on factors such as the number of 'never events' (incidents which should technically never happen) and infections, as well as mortality data and the results of patient surveys.  Apparently Croydon has performed poorly?



Really?  The F&F Test looked good to me and the never events involved eight patients and as terrible as they are, date back to 2009, the causes of which have all been addressed.  Indeed, the latest CQC report highlights; "(In surgery where the never events happened) ... we saw three sign in checks, seven time outs checks and three sign outs." The checklist identifies three phases of an operation, each corresponding to a specific period in the normal flow of work: Before the patient has the anaesthetic, before the operation starts and before the patient leaves the operating room.  Croydon have sorted their problems.



The Hospital Inspector is David Cameron's gimmick<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAytmtshbfmOTrdGiyzLVLojBBEfWnhXu9yVwLmNglPp2pyamSn5owiTLgTMhORy99zp6xM47YZr-ptMdnV3waDTAaPBZldY4OJ2-FX8YO85MXGzozzMjUzBhW0MSOo-D41Yl77WHAyUttHZ2a79DCMkSjbFoiKm_H_0wk_9PH5WKEcYRz3gs1WpaXooE3haA_eL9C0PNOl0jQ==> to look busy after the Francis Report.  What will his sleuths find in Croydon?



I can write the report in a paragraph; 'There are good things here, there are bad things.  Some of the public swear by the place, some curse it.  They suffer because they are near enough London for local staff to travel to work there and get paid more.  It is busy and busting a gut'.



We know bad is never acceptable and good is never good enough but what is the upshot of all this?  I'm told one hospital, expecting and inspection, closed a ward to get ready.  Another took nurses off the wards to update manual records. One closed a ward to redecorate.



Croydon is like so many other Trusts, a victim of its location, falling prey to demand, suffering the consequences of inadequate primary care, a casualty of NHS funding and battling against a suffocating top-down bureaucracy.



How does 'inspection' fix any of this?  Is it me or is this malarkey all meaningless, political show-boating?


Join in and comment on the Manager's Network Forum now<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAyugvpalEfyouyyUrReMbee82M3DdkiCzYPw3YV3JS93nrk3Eqmbln162p0tQFZ1mKF1EUrlk6mXtdXYWQwpajpwrtato9rzzGVBAPbpJwiZx4OjWHiJdFiP7ogY9XNs9HVtPh_a1h9H4Qey7So3yMksgHkEDBUZ2xELuhUGTaWxZNLKmQRFfn_A3XktZxvthTIfGgbwCrn2bjbbfBun8zVryd5XDaqLH9TcRd6L279nButoIv25i7->.

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Medicine for Managers
2012 compendium here<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAxByA_8Adqm58sJdqPPYPY77_ZuoW4xjp6NyI4MYvsPxdoOsSyt1Lkesdwqd1KNTOiyg1ZiKxk6d8Ei_htxYcEUwAeevFVVWwFlWnUxNq3Ug3d1FhHEGTIgU7dXX8e53mwbkqONuj7KbkYzUpt7N-VzpVNrRtbiw0a2dc-HPIUa6BuKHvPwWHOLLwyjW59m9uKECWYoUpVjC-T7XL2NNzsQ>
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Dr Paul Lambden
Leukaemia<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAzXrKhdngGY73F5fPhj-47ACqWkQOJ8mAY1aLNzRv7Mmd5pnorC-i_G1leWUk-TZxJjQo4TWZ74NApYp0JRZqVOnFsJ_GlkYnILnbiLskFqN5sGHaxnyDneHLmaSd4Xxw_EL0_zygysSKqL450U2XvSJCJj0COv4Dou_gzk3iHzIL8Xk8DZY7FFW52nVBS2_qGOsmf1IhDa3w==>
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Jaci<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAxbvJ5cmysIvxuIZSdqlXattTFFwRg15Icxt9ktD49T3pXaNHlZL3PTbO6huOFp3nO97_gNnMlzhJVxWUW-2L-K1Qm_rXi516xsPnVCgYrktyV0Avb2-7DhAUuw3X-VPdoANPBEICoVjA==> Joyce<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAxbvJ5cmysIvxuIZSdqlXattTFFwRg15Icxt9ktD49T3pXaNHlZL3PTbO6huOFp3nO97_gNnMlzhJVxWUW-2L-K1Qm_rXi516xsPnVCgYrktyV0Avb2-7DhAUuw3X-VPdoANPBEICoVjA==>
A porter's tale...There's a lesson here for all senior managers.<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAxbvJ5cmysIvxuIZSdqlXattTFFwRg15Icxt9ktD49T3pXaNHlZL3PTbO6huOFp3nO97_gNnMlzhJVxWUW-2L-K1Qm_rXi516xsPnVCgYrktyV0Avb2-7DhAUuw3X-VPdoANPBEICoVjA==>
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Book Review
Valerie Iles
Discusses
Geoffrey Rivett's
'The Development of the London Hospital System'<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAyE3MlrZOfD9wr3pYOmZv4Ei8IwyYfAB3dfKRF1O3BA1lEiuYUGZhgnh6zu1j5e_kaEeP6cus6he5fHifhVUX_0MHt5uW-_YcQItqreYdZHeOt4YunCfee-EyA6jUQMoQvH5k4h1Wk-BA_zFrnrGEJ4IIdfgAoqI1QI-yENtsBBSqrg31ZpqmIhdm_qixb1tAAL0ajUdhy7UBDbRA-uo9gF6QkCdNmyP15EFy9rqTeOInKQ-M4xmLq1v93ESW7BVdsZBkx7aIO1AcotfzZo4PBj9PSVUKma_aU=>
'...understanding history allows a fresh look... I cannot do justice to the spirit conveyed with the book.  Fascinating.  Includes the role of the King's Fund and the influence of the Lancet.'
'... nothing in London is the result of chance.'
-------------------
New JOBS
 Did you know you can
Advertise your jobs for free - just post them yourself here<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAxeZdi0LzsJTgDyZsEfiSeui6hi0vDFSGnNumIRgjbBzSM5UBlX_9XwjPZkVrVwI9DSfElIR5TGaQ5_k3EAlGJBBcanMNGT2fFUJS5qYTtr6K3WOw3sAZZgG-i_UrIIby33W6VNOidwWQ==>.
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Conferences
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The Silver Book Summit<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAzNKMr63XLowBDSYYbq8quEajLlall8qScdCK4P7WwE5Cvo9pfzx3fyoHn3Bt-Viru652AAY7iRNCrrjLOCLItJMCDXkIskmuCN9PKpHsepu8sxA8pzmj7niTWJRowpoiiOYkJxjlxy6A==>
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Huge interest in this hot topic <http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAzNKMr63XLowBDSYYbq8quEajLlall8qScdCK4P7WwE5Cvo9pfzx3fyoHn3Bt-Viru652AAY7iRNCrrjLOCLItJMCDXkIskmuCN9PKpHsepu8sxA8pzmj7niTWJRowpoiiOYkJxjlxy6A==>
Prof Clare Gerada
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29th October<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAzNKMr63XLowBDSYYbq8quEajLlall8qScdCK4P7WwE5Cvo9pfzx3fyoHn3Bt-Viru652AAY7iRNCrrjLOCLItJMCDXkIskmuCN9PKpHsepu8sxA8pzmj7niTWJRowpoiiOYkJxjlxy6A==>
Given the problems everyone is facing this is turning out to be a hugely popular conference.
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HealthChat
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Peter Carter
in conversation with Roy Lilley
Future of nursing, staff ratios, recruitment, training, HCAs registration.  Hear it all first hand.
Evening - October 23rd - King's Fund
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Booking Fast
------------------------
>>  As if to underline the chaos building in London - Boris has hired Prof <http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAwX0iTVkaDjVopkwBxrdyOdfywmW-Rq9lTa86ueXF8fEQoTyXFHWPj0VoOQkawwxLMHIJc-dyxCfVvIfAYFtSPV14NKkACnF6Sn7xSRF33988V0OnA_FsHs1zxpCXwpKd391MFYBNcgPn70Vn_ZGTvW872WEOcfOgn3-xXqp4O3vv5qVP7OT1faHXFK-QBG8Iz3j0Lh4TZOhlSlmR75856loBlX-hrMOeB1gRKo1fiYMHDCb8A6OK5SZhzmxuPfI6W6EXRozt1984Q9tIYKxIBd> Dazi to develop a 5yr strategy for Londoner's Healthcare.  If this isn't 2 fingers to the DH, tell me what is!<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAwX0iTVkaDjVopkwBxrdyOdfywmW-Rq9lTa86ueXF8fEQoTyXFHWPj0VoOQkawwxLMHIJc-dyxCfVvIfAYFtSPV14NKkACnF6Sn7xSRF33988V0OnA_FsHs1zxpCXwpKd391MFYBNcgPn70Vn_ZGTvW872WEOcfOgn3-xXqp4O3vv5qVP7OT1faHXFK-QBG8Iz3j0Lh4TZOhlSlmR75856loBlX-hrMOeB1gRKo1fiYMHDCb8A6OK5SZhzmxuPfI6W6EXRozt1984Q9tIYKxIBd>
>>  Boris and Daisy's London Health Board - launched<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAyiGlOj1Zhn5edW14uY1pUtwEwVO_EvsT97g8kqgZAi5gH6TXkfSkT0KCg8fQR0vx9B9TZ58NfQUQa7ixYiOHWZwVqDW-w-p_LOcVoZVd5YJIDgPZTPeib-YUWeyWY8F81Eb_m9x4OU1ifcKPY7SiOqrurJWdEFyJc=>.
>>  No-Man Lamb - calls for X-party talks on the <http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAw7M38x3Ka0WIAOUUNNg6u_o7u9rxvMdzPsmVQROZPwc1E3dRWG156oadjCn_3-h951WWhuyzi6-TgyI74HPvGUmgyKuJiHhx31BZsv2zlcqInOrdyMkoM043L7hgu2Yd6MBvUMbSI1APNAMUjalP4KOIL4RorvpMgHpiBaap55Rtx846sqBE-9jv5x_ARXyS2NahF-tlv8S8KiFtLfkFlH> NHS.  He says the <http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAw7M38x3Ka0WIAOUUNNg6u_o7u9rxvMdzPsmVQROZPwc1E3dRWG156oadjCn_3-h951WWhuyzi6-TgyI74HPvGUmgyKuJiHhx31BZsv2zlcqInOrdyMkoM043L7hgu2Yd6MBvUMbSI1APNAMUjalP4KOIL4RorvpMgHpiBaap55Rtx846sqBE-9jv5x_ARXyS2NahF-tlv8S8KiFtLfkFlH> NHS will have to save <http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAw7M38x3Ka0WIAOUUNNg6u_o7u9rxvMdzPsmVQROZPwc1E3dRWG156oadjCn_3-h951WWhuyzi6-TgyI74HPvGUmgyKuJiHhx31BZsv2zlcqInOrdyMkoM043L7hgu2Yd6MBvUMbSI1APNAMUjalP4KOIL4RorvpMgHpiBaap55Rtx846sqBE-9jv5x_ARXyS2NahF-tlv8S8KiFtLfkFlH> anoth £20bn after 2015 and thinks everyone should talk about it.  Good idea but I think he has two chances; none and fat<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAw7M38x3Ka0WIAOUUNNg6u_o7u9rxvMdzPsmVQROZPwc1E3dRWG156oadjCn_3-h951WWhuyzi6-TgyI74HPvGUmgyKuJiHhx31BZsv2zlcqInOrdyMkoM043L7hgu2Yd6MBvUMbSI1APNAMUjalP4KOIL4RorvpMgHpiBaap55Rtx846sqBE-9jv5x_ARXyS2NahF-tlv8S8KiFtLfkFlH>.
>>  Doc Rodney Jones - looks at <http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAxOM6GoJ3W--_SVB-xd4kyelAh1SHkm-L9QVDdGtgcykCxVNxdYmoAN43eE2g_XiO3ZdDVvHDgpSEaENQx38w_5hakfV-pcbbPXuw-nF02xPxPC00I7PsluO-g3LkYcHNednDb1XpoJ2bLWI7qvfm2Y> A&E attendance and decides it is the tip of a wider trend.  This is today's Hobnob and cuppa read<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAxOM6GoJ3W--_SVB-xd4kyelAh1SHkm-L9QVDdGtgcykCxVNxdYmoAN43eE2g_XiO3ZdDVvHDgpSEaENQx38w_5hakfV-pcbbPXuw-nF02xPxPC00I7PsluO-g3LkYcHNednDb1XpoJ2bLWI7qvfm2Y>.
>>  Surgery wants out of 0844 contract - but faces £25k penalty<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAw3cSlFy_w4DzFD2fjWqEUYqUDVxB7y8Dz0EAzOvUajosxK4N-0UslcUjs17LuiF5lDuxuu89EJe57hz0SCcFnsRY-cPXs10bszQUrzisSLaDEE194pg8YpeIu50I2nE76qfxs8NeyGGK167WF1qzcjDFC-mFi0JAY-PRGpzcBBp7ZxycDpdu4RMpm4QQklj5wcMDXP4gCJKQgWX6W40Rsf3X0k25IQwa7X4Irvw-Ol6Xh3yGAskPbF>.
>>  <http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAxc9KX72DK_UoN1_jATbKn4o9-CxnFSUOdV5tCA8IOOrQK4PvLS-Y-DacldWL0KHsD0XikRY5PaMJ1nx2IQLhV4WQS5tr9H7g_faWYAQT2huqW74N6MyCcQHlB4zP7YCACJ-DLQs60b8aR_48ejwfQgqGjl4D6VUHvyIK82crKDFdEqiqcywMHKkhiqiuC99_1l3_D_oaZ7f8xfLOIMQbYubTYPoRldAVg2yFSfMlfMN5IQUWUVOHDwl8a95XGn6rwrEZX-RscqanbQYjWzYJzB> NHS can't afford to treat us all for free- ex Marie Curie boss says 'unsustainable<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAxc9KX72DK_UoN1_jATbKn4o9-CxnFSUOdV5tCA8IOOrQK4PvLS-Y-DacldWL0KHsD0XikRY5PaMJ1nx2IQLhV4WQS5tr9H7g_faWYAQT2huqW74N6MyCcQHlB4zP7YCACJ-DLQs60b8aR_48ejwfQgqGjl4D6VUHvyIK82crKDFdEqiqcywMHKkhiqiuC99_1l3_D_oaZ7f8xfLOIMQbYubTYPoRldAVg2yFSfMlfMN5IQUWUVOHDwl8a95XGn6rwrEZX-RscqanbQYjWzYJzB>'.
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Gossip
[http://ih.constantcontact.com/fs065/1102665899193/img/1082.jpg]
This is what I'm hearing;
if you know different,
tell me here<mailto:[log in to unmask]>
>>  I'm hearing the big brains at the DH are extra worried about the coming winter 'crisis' having discovered there are no feed-back-loops.  There is no real-time data so they are flying blind.
---------------------
>>  Infection Prevention Conference - London 30th Sept; if you go, remember to wash your hands<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAxYRsKzAQi2t4RqUZ8-yZP_yLXJZt1w54Aav3RAg5zgQJeRdCFhqqtmrcFRaZQ2PJMBU1eAlonG5E9w9mJc0OzxNWZISDc4i-yyO3DXnIPjhQ==>.
>>  Life in the fast lane - really nice blog about the management of change.  Excellent.<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAzv1XufJsKFlAd8vz1iyWPeJNu_xEcrH1DL0_vXKPZ0D6oAkquXuU_1azhMKd-wlWbiwrCpE_EVyy1QiQILPMRyaowAapFrD61H_UWOI6NqJEU5EhSUsOgw_fklUwVHQkMEgko7AcLV-SdLgx0ToJX0HBpK_KcuDTYGEnXSYu5wQA==>
>>  King's Fund - Commission on the future of health and social care.  I suspect this will be an elegant piece of work<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAy5JatYsMmoKciJAMmMYZmPH1puhEanCx2l-qmwd2lHEn0qJmhEzHUj4QJcoFUccLcE-uvyYruc-ZfzFgUcUmpC_gzG4pzz1qsPPUz0K9oaIAyJzDBza-EhYW-V_tPfi1h_eGAjKK_Lzq4uYyup6w81T1xt9o256pa6NnudNcnQiVjaNFgYp1c7lZhbUHAeKbs=>.
>>  Diary of a CCG boss - very informative Blog; must read<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAyXaFo_EqAR9lyjIn9BKX-JS2YtoaAaf-SmdqhD0NEWKn1ADINXWRBAcNiB-iHI_XFmfsTet3ON5WCMpZZhymYqb5fQUFfyUI1w751cLJE9uqR5m5u1n1ZlZSKttVRoqU6jO11ROIaM8O_-1K1dhWm58PSnZ8HpleMRZ-4PyHcrOZlZE3jYuOQ8dd29IPgsrsM=>.
>>  Idealism - is the enemy of the <http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAzjcRQBurCQAnwxa9oZtIzumX0gezvv6FmP1FvSlLpSq-Bq2uTOxQLF4JnTPh9iNtRnmq_sG3l3JTlNwTi8jGt70_tnMbLwrdqjjSGP6_AWkozZCn1mp2XGU_LmKjzftNbk7ROLClKBr9yrhLfV_bsH0B6oAjmTtuUughDw6H8TVd23Q18_Q6WiW2OgUDH4ILHCLUnNOTeSrZNX4vyzwBWK> NHS.
>>  MH<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAzUSdPDV4lA5rf1rEHChf8e4hvkm_sI-SM_3oycphy68AMbElv3VmAfpQzke-1O8YqoHCpgh2wFFNX0FrjJQVU_5qEznQjzxlMn0mhv9dowKtxN_7kSadni3PfI7vOzCzxSSTAEWSJo-LF4xYrKQ0Ej7IjZRqev3Bjc8DnFY3CSp5RLpizOmaZSm_K3c_4v8-Sj0PdjbHlBWw==> patients - need more support to stop smoking<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAzUSdPDV4lA5rf1rEHChf8e4hvkm_sI-SM_3oycphy68AMbElv3VmAfpQzke-1O8YqoHCpgh2wFFNX0FrjJQVU_5qEznQjzxlMn0mhv9dowKtxN_7kSadni3PfI7vOzCzxSSTAEWSJo-LF4xYrKQ0Ej7IjZRqev3Bjc8DnFY3CSp5RLpizOmaZSm_K3c_4v8-Sj0PdjbHlBWw==>.
-----------------
Today's Larf
[http://ih.constantcontact.com/fs136/1102665899193/img/1169.jpg]<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAzSEYutYa_4xxNhTD-Ovy_t69KNkC87DwPfBdWky65f2l6xnvUV6EHkUrbcvtnDtJoWdX-YE79dks632tRIau7CRQ5ULiarkTuikax7gsbfa2x8uqw81Pa0_oFgfKWRM9YZqyJjVChpeu71ZAYNkH6cSNcNmXwNYKBSCq9NCjy0qWqw8Eo1VWI5>
Martin Shovel<http://r20.rs6.net/tn.jsp?e=001TSnsxoLZkAzcoIR7xqL4SP1pWo8vhUNimU92meZMTYLy8DSbbpfaiLsehh7cTFQqgm09b3oxxRkO2QBCRWXU7xg2RQtIIf2lK1O-6wKaMkfvQzaTrja1iLWnhwmoGUPBAzM-j0mHAcf3V6GvSbLoTFge32n4_Ed9FzaipuTmYUEM352tgq4mCV6JHL68FHxO>






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