Alice through the Looking Glass, at the NHS England AGM


October 26, 2016 by Protect Our NHS

Attending NHS England’s AGM on 25th October 2016 was the strangest experience. Like Alice, there were two worlds – the real world that I recognised and a fantasy one that was put forward from the platform. Here are some examples of the two worlds:

The real world that I recognise The NHS England fantasy world
Simon Stevens opens with how he told the government how much money the NHS needed and how they gave the NHS much less.  He explained that there was nothing he could do about this (!) as it was the government who made funding decisions …. ….But it is all okay and not to worry because the Five Year Forward View and the associated Sustainability and Transformation Plans (STPs) show how we can make it alright by making better use of the money we have.
NHS underfunding is so severe that more and more CCGs and NHS Trusts are running up huge deficits and going into ‘special measures’ ( By 2015/16 year end, NHS providers were £2.5bn in the red). Services are rationed, waiting lists are escalating…. …. (panel of experts speaking) we are seeing real progress now with projects across the country. e.g. GPs in Surrey are now providing urgent care from 8am to 8pm. We can deliver with the money we have by new thinking.
The NHS is increasingly fragmented. NHS services are being contracted out to a mix of private and third sector organisation and competing NHS Foundation Trusts are making increasingly autonomous decisions about what services to provide…. …. (another panel of experts speaking)  the key focus of the plan is on integration of services. STPs will develop plans for integration across GP and hospital services and across different providers to increase efficiency and make savings. Develop plans and – Hey Presto, it will all happen!
(speakers from the floor) NHS staff are on their knees; despite working many extra hours they cannot provide the services required; many staff are leaving and not being replaced; wards are dangerously understaffed.  Even GPs cannot recruit new partners. ……(Prof Jane Cummings, Chief Nursing Officer speaking) We will save money by reducing the number of temporary and agency staff and increase permanent staff numbers. We will expand staff in areas such as adolescent mental health. We will train 1500 more doctors to solve the problem in the longer term. We have provided £450 million for hospitals to look after staff.
(speaker from the floor)  What about privatisation? By 2015/16 year end, NHS providers had purchased nearly £1bn of care from non-NHS bodies. This is money flowing out of the NHS, some of it straight into shareholders pockets. The NHS picks up the work whenever private medicine runs into trouble or doesn’t provide sufficient care. Not only is this costly but medical records are separate and care cannot be co-ordinated. The time has come,” the Walrus said,
“To talk of many things:
Of shoes–and ships–and sealing-wax–
Of cabbages–and kings–
And why the sea is boiling hot–
And whether pigs have wings.”

(Lewis Carroll, from Through the Looking-Glass and What Alice Found There, 1872)

I couldn’t decide whether the NHS England speakers believed this fantasy/ideology that they were spouting or not. But speakers from the floor certainly weren’t fooled. I just wish I could wake up and discover that it was all a bad dream!

`Twas brillig, and the slithy tovesjabberwocky
Did gyre and gimble in the wabe:
All mimsy were the borogoves,
And the mome raths outgrabe.

(from Jabberwocky, Lewis Carroll)


Dr Charlotte Paterson


5 thoughts on “Alice through the Looking Glass, at the NHS England AGM

  1. Santino says:

    44 local STP footprint plans were/due to be submitted Friday of last week to NHSE.
    Little in the way of engagement with the public,NHSE has imposed STP’s across the footprints.
    Question is if s13Q Health and Social Care Act 2012 or s242 NHS Act 2006 apply to contentious issues to emerging reconfiguration of services in the BNSSG footprint in order to account for £400 millions of savings by 2020/2021.

    • Frank – please come to the 1 December three-councils joint scrutiny meeting at Bristol City Hall at 2.30 to reinforce this point. Questions must be submitted by end of Froday 25 November. Have a read of the STP here:

      Public consultation e.g. people have been locked out of consultation – there is a paper on consultation:

      Question this statement in the plan
      Although no formal consultation has taken place a large number of partners and stakeholders have been involved in the development of our plan. Existing feedback from service users, carers and the public from across BNSSG has informed the development of the STP. This includes information from public engagement activities, local surveys and local health scrutiny committees, and information collated from ‘friends and family’ test data, patient complaints and Care Quality Commission reports. This has helped to ensure that our thinking is being shaped by the issues that the people who rely on our services have told us is important to them. Really!! Figures – how many consulted? Councillors? HealthWatch? Vol Sector? Staff?
      Plans to change / cut services have not been consulted on – legal position (see below)
      Who has been involved in the development of the plan, apart from ‘partners’.
      Evidence that GPs had input?
      Absolutely disgraceful that the changes proposed have not been discussed outside the NHS – actually scandalous!


      A duty to consult the public Section 242(1B) of the National Health Service Act 2006 (“2006 Act”), as amended by the Local Government and Public Involvement in Health Act 2007 (“2007 Act”), provides as follows: “Each relevant English body must make arrangements, as respects health services for which it is responsible, which secure that users of those services, whether directly or through representatives, are involved (whether by being consulted or provided with information, or in other ways) in– (a) the planning of the provision of those services, (b) the development and consideration of proposals for changes in the way those services are provided, and (c) decisions to be made by that body affecting the operation of those services.” Subsections (b) and (c) need only be observed if the proposals would have an impact on: (a) the manner in which the services are delivered to users of those services; or (b) the range of health services available to those users.

      • Santino says:

        Hi Mike?
        NHSE has a duty under s14Z2 H&SC Act 2012 to consult patients directly, but given the local nature of each STP’ footprint then s242(1B) will apply, looking at BNSSG engagement and communications plan it looks like they will use each of the three local Healthwatches to act as our representatives, this will not do, this needs to be made clear that you,me and everyone else with a voice need to be heard. We are all stakeholders and a full resourced and funded BNSSG STP Public stakeholder group needs to be formed.

        The question to the text below needs to be asked if it will directly engage or via ‘Representatives’ if the latter then pressure needs to be applied to directly involve users of services.

        Each relevant English body must make arrangements, as respects health services for which it is responsible, which secure that users of those services, whether directly or through representatives.

  2. Hi Charlotte, really enjoyed reading this (well, apart from the fact that it shouldn’t have to be written!) would it be OK if we share the post on our site ?

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