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9th July 2024

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News and comment from

Roy Lilley

Understand it...


So, you’ve got a new job. 

It’s a big step-up for you. Your dream job.

It’s your first day, meeting the new team.

What do you do?

If you know anything about management and leadership you’ll understand people will be suspicious of you. You’ll need to win them over.  

There are five things.

1 Celebrate what they’ve achieved.

Even if there’s not much to celebrate. Do your research. Find something to big-up and tell them they can be proud of what they’ve done and they can use that platform to do more.

2 Understand the organisation culture.

You may not agree with it. You may not like it but it’s important to understand it. Get a feel for why things are like they are and find the go-buttons. What makes them come to work.

3 Get stuck-in.

Roll up your sleeves. Spend time doing the job, from the ground-floor up. Talk to people, find out how they do the job and what would help them do the job better, safer, or quicker.

4 Be present.

Don’t send messages like; ‘my door is always open’. It takes a lot of courage for people to walk through that door. Open the door and walk through it yourself. Leaders are visible. There’ll be backs that need patting. Find one, every day.

5 Tell people who you are and what you want.

People won’t do the right thing if you don’t show them what you think it is. Leaders are visible, have a vision and share it often.

Simple, eh?

What you don’t do is to turn-up in a new job and slag-off everything. Tell everyone that their organisation is broken and that from now on, the policy is, they are working for a broken organisation.

The implication being it is broken because they have been complicit in breaking it or stood idle, watching it break.

Only a real fool would do that. Only a fool, or Wes Streeting who said;

'From today, the policy of this department is that the NHS is broken…'

People ask me why we’ve dubbed him ‘silly-boy’. There you have the answer. An example from his first ten-minutes in the job.

If he knew anything about leadership or management he'd have followed the five basic steps. He could have said;

I know the NHS has gone through a terrible time. Goodness knows how many secretaries of state, changes in direction and the pressure and grief of Covid.

This great organisation is on its back-foot. I am here to help you get back onto the front foot. 

From today, my priority will be to reduce waiting lists. In the next three months I will be visiting as many hospitals and surgeries and community settings as I can because I want to hear from you, what your priorities are and how we can work together.

Together, we can get back to being the top rated health system that our NHS once was.

Silly-Boy can’t do that. Why? Because he is well, silly and thinks it's all about how tough he is. 

A broken NHS?

  • The NHS sees 1.7m people every day, the equivalent of the populations of Birmingham and Leeds, more than at any time in its history.

Does that sound broken to you? 

  • It deals with more 999 and 111 calls than it has done since 1948. As of early 2024, ambulance services handled approximately 828,345 calls in January alone... a 22% increase compared to the same period in the previous year​.

Does that sound broken to you?

  • Provides care to a bigger population, of older, more vulnerable people. Poor people and socially disadvantaged people… with two thirds of the beds the NHS had 25 yrs ago.

Does that sound broken to you?

  • GPs see 365m people a year, that’s the equivalent to one in ten of us every week. 70% face-to-face, most of the rest on the phone or facetime. Nearly half, on the same day.

Does that sound broken to you?

  • The very smart NHS App has more subscribers than Netflix.

Does that sound broken to you?

  • NHSE has subsumed NHSImprovement, NHSX, NHSDigital and HEE into its organisation. The biggest reorganisation Whitehall has ever seen and reduced staff by nearly one third.

Does that sound broken to you?

  • It has trialed and established 12,000 virtual wards to help fix discharge and admissions demand.

  • Coped with rejigging 1.2m appointments lost through strikes… over which it has no control.

Does that sound broken to you?

  • Since early 2024, the trajectory of patients on the waiting list is starting to move down. In January 2024, the waiting list fell to 7.58 million from 7.6 million. A decrease of about 192,659 patients. The numbers could be better if it wasn't for the strikes.

Does that sound broken to you?

The service has coped with cuts to its budgets, idiot, useless politicians that don’t have the wit-nor-guts to sort out social care. 

Damage to its workforce through Covid and Brexit… and along the way, established 160 new diagnostic centres and watched powerless, as bits of hospitals have fallen down, through the lack of capital investment.

The NHS is not broken. It's battered and struggling with;

  • a lack of supply-side capacity,
  • a dearth of investment in capital projects
  • the collapse of social care.

You'll get all this but don't expect Silly-Boy to understand it.

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Dr Paul Lambden


'... first identified over a century ago, it was originally introduced for the management of diabetes in the late 1950s and is believed to be the world’s most widely prescribed anti-diabetic drug.  However, more recently it has been investigated and introduced for a variety of other uses and it may join the list of agents known as truly wonder drugs.

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