New NHS reforms announced today. Seems to be a story of two parts, plus a missing character. Quick thoughts (1/):

Part 1 of the story is a set of technical fixes wanted by NHS leaders to encourage collaboration in the health system. The direction here makes sense—and fits with what the NHS has been doing for ages. Competition is (mostly) out; collaboration is in: good (2/)
And the need for legal changes to tidy the mess left by Lansley’s 2012 Act has long been recognized. But... (3/)
The benefits of integration are often way overstated, and the risk of reorganizations underplayed. In its first 30 years, the NHS’s structure was relatively stable. But over the past 30, the NHS in England has been on an almost constant treadmill of reform and reorganization (4/)
Overall, evidence suggests that previous reorganizations have delivered little measurable benefit. They can also distract and disrupt, depending on how they’re done. The list of other things for the NHS to be doing during and after the pandemic is very long. So be cautious (5/)
(Plus there’s still quite a lot of detail left to be filled out about how ICSs will actually work in practice) (6/)
Part 2 of the story is a set of political changes proposed by government to increase ministerial control over the day-to-day workings of the NHS in England. The rationale here isn’t very clear (7/)
Jeremy Hunt—the last health sec—claimed he never felt he ‘lacked a power to give direction’ to the NHS when he needed to under the 2012 Act. But Matt Hancock must feel less powerful (8/)
The leaked white paper seemed to claim that the pandemic illustrated the need for these changes. But evidence that stronger ministerial control would have boosted the NHS’s pandemic performance is hard to find (9/)
The missing character—as ever—is a comprehensive plan for reforming adult social care in England. Sure, this bill is mostly about the NHS. And a plan for social care is promised (you guessed it…) later... (10/)
But we’ve been hearing that for an awfully long time now. Continued government inaction on social care amounts to choosing to prolong major public policy failure (11/)
Some more analysis with context, nuance, better word choice, etc here:

https://t.co/GChxwuvEF4
https://t.co/0tYunQaWkz
https://t.co/bMB9vvZm8t

(12/12) @HealthFdn
@nedwards_1 @HPIAndyCowper @mancunianmedic @so_says_sally @Davewwest @ADMBriggs @TimGardnerTHF etc - hopefully feels sensible

More from Health

Let's talk honestly about "informed consent."
Someone with decades of training gives someone with none advice usually packed into 1-3 mins. Huge amount is based on trust. Huge potential for bias built in. But also there is no obligation to provide real alternative options.


I am classified as 'gifted' (obnoxious and ableist term). I mention because of what I am about to say. You all know that I was an ambulatory wheelchair user previously - could stand - but contractures have ended that. When I pleaded for physio, turned down. But did you know...

I recently was chatting with a doctor I know and explaining what happened and the day the physiatrist told me it was too late and nothing could be done. The doctor asked if I'd like one of her friends/colleagues to give second opinion. I said yes please! So...

She said can you send me MRI and other imaging they did to determine it wasn't possible to address your contractures.

Me: What?
Dr.: They did a MRI first before deciding right?
Me: No
Dr: What did they do??!
Me: Examined me for 2 minutes.
Dr: I am very angry rn. Can't talk.

My point is you don't even know if you are making "informed" decisions because the only source of information you have is the person who has already decided what they think you should do. And may I remind you of a word called 'compliance.'

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The first ever world map was sketched thousands of years ago by Indian saint
“Ramanujacharya” who simply translated the following verse from Mahabharat and gave the world its real face

In Mahabharat,it is described how 'Maharishi Ved Vyasa' gave away his divine vision to Sanjay


Dhritarashtra's charioteer so that he could describe him the events of the upcoming war.

But, even before questions of war could begin, Dhritarashtra asked him to describe how the world looks like from space.

This is how he described the face of the world:

सुदर्शनं प्रवक्ष्यामि द्वीपं तु कुरुनन्दन। परिमण्डलो महाराज द्वीपोऽसौ चक्रसंस्थितः॥
यथा हि पुरुषः पश्येदादर्शे मुखमात्मनः। एवं सुदर्शनद्वीपो दृश्यते चन्द्रमण्डले॥ द्विरंशे पिप्पलस्तत्र द्विरंशे च शशो महान्।

—वेद व्यास, भीष्म पर्व, महाभारत


Meaning:-

हे कुरुनन्दन ! सुदर्शन नामक यह द्वीप चक्र की भाँति गोलाकार स्थित है, जैसे पुरुष दर्पण में अपना मुख देखता है, उसी प्रकार यह द्वीप चन्द्रमण्डल में दिखायी देता है। इसके दो अंशो मे पीपल और दो अंशो मे विशाल शश (खरगोश) दिखायी देता है।


Meaning: "Just like a man sees his face in the mirror, so does the Earth appears in the Universe. In the first part you see leaves of the Peepal Tree, and in the next part you see a Rabbit."

Based on this shloka, Saint Ramanujacharya sketched out the map, but the world laughed