Hi Alf I heard it too. Bloody love DIDs. What stuck with me was his warmth & also the way 'hate' momentum can build (eg the lad who attacked him hadnt even read Satanic Verses), but his courage to keep going. Human spirit😃 Have a lovely weekend

Listening to Salman Rushdie on Desert Island Discs- wonderful stuff. His lovely lilting accent is so engaging….and sounds very Welsh

When I retire in the not too distant future, I swear I will never, ever use email again. It is a curse on our lives.

Everyone interested in AI- that means you- really needs to look at this trail. Amazing.

Re: cancer MDTs and shared decision making- SDM. I heard (again) yesterday about a cancer MDT that makes decisions *for* patients, taking into account clinical characteristics, but not personal preferences. Does anyone know of a cancer MDT that incorporates SDM into its ways of working?

I’ve learned today- again- that if you are an ‘expert’ in a consensus group and they don’t listen to you, don’t blame them. Blame yourself for not articulating your case clearly enough.

On the Expressions of Sheep

Wow. This should be headline news. But guess what, it’s not (on the BBC).

I’ve said it before and I’ll say it again (and again and again…). An integrated team is necessary but not sufficient to deliver coordinated care- let alone care that aligns with patient goals and priorities, minimises the burden of treatment and enables people to live well.

Paid my tax today and reflecting on how well the money is spent. Answer re: NHS is poorly. At least 20% of NHS spend is waste: over diagnosis and over treatment, low value treatments and processes, provider capture of the market, unwarranted variation. Did anyone spot any of this in the 10YP?

This is why it is very important to design targets very carefully so they align with the goals you want to achieve.

LinkedIn is all very well but shouldn’t there also be CheckedOut for retired folk like me?

Could I propose that ‘Reimagining medicine’ is not going to help? Public health and medicine have extended lives and got us into the situation we are in. But medicine itself is not going to get us out of the NHS crisis. We need to fundamentally rethink healthcare and what it is to be healthy..

I visited Kaiser Permanente in SanFran about 20 years ago. Their mantra ‘every unscheduled admission is a system failure’ had face validity and led to a massive and long lasting impact here. Yet we’ve never quite solved the problem. It’s high time we dropped the idea as a marker of system quality.

Having been involved in the roll out of social prescribing it’s good to see that there is indeed an impact. This team used sensible outcome measures and showed a small but definite change in multiple indicators. Time to stop trying to answer daft questions about SP tho (eg reductions in admissions)

PRIMM2025 has a fantastic line up of keynote speakers covering digital medicine, data to AI and polypharmacy. Join us in Manchester 12 Dec 2025. Register here… primm.org.uk

1/2 Our update of the PREDICT breast prognostic and treatment benefit model is now published by BMC Research Notes. rdcu.be/ePXTJ

We are a long way indeed from systematically collecting and acting on the voices of patients. Abolishing Healthwatch and handing responsibility for its work to ICBs (which are themselves undergoing massive reorganisation) is in my own view a very bad move indeed by DHSC.

💻Today our chief executive, @chrisgrahamuk.bsky.social, chaired @hcuknews.bsky.social's 'Patient Involvement and Partnership for Patient Safety' virtual conference. It was a great day of insightful sessions about the power of patient collaboration, including discussions on: [1/3]

Listen to this lovely guy. It needs to be said: Trump is a thin skinned, self absorbed, wicked (yes, wicked) tyrant.

People living with multiple LTCs currently experience multiple condition specific annual reviews. This study attempts to reduce the burden on patients through offering a more holistic review.

In the upcoming #UKBudget, does it make sense to "protect the NHS"? Our #NHSProductivityCommission analysis suggests we were already getting poor value for money pre-pandemic, relative to comparator countries. Full report here: bit.ly/3WPxu76 #dataisbeautiful

Reminded me of this ever green modern classic statistically-funny.blogspot.com/2013/12/what...

Which one is more English?

Inbox— next cover of the New Yorker: “Mayor Mamdani,” by Edel Rodriguez

There are some very important and very neglected lessons here about NHs management: www.kingsfund.org.uk/insight-and-... But there are two big issues with it...

I’ve been told about a nationally significant piece of work, led by academics and now far too complex to actually implement. I’ve heard this story so many times in my career. IMHO academics should know as much about implementation as they do about their research topic. This is rare Over and out 🙂

‘In order to improve the efficiency of our railways, we are going to remove the engines from our trains so that we can pay for twice as many train drivers’ …..ends

The #NHS10YearPlan sets out a clear ambition: to build a healthcare system fit for the future, shifting care from hospitals to communities, from analogue to digital, and to strengthen quality, safety, and equity for all. Delivering that vision will also depend on how people experience care. [1/2]

We’ve published ‘Learning from the Best – celebrating patient experience innovations to help deliver the 10 Year Plan’, which maps the #PEN25 Awards winners to the Plan’s key chapters, and now includes direct links to the project presentations for easy learning: bit.ly/PEN10YearPlan. [2/2]

📢 ISDM 2026 Conference: Call for Abstracts is OPEN 📝 Submission deadline: December 8, 2025, 11:59 PM EST (*Check: www.worldtimebuddy.com) 🎟 Early bird reg opens: Sept 30, 2025 Join us for the 13th International #SharedDecisionMaking #ISDM2026 Conference! 👉 More Info: sites.dartmouth.edu/isdm2026/

Wes Streeting talking passionately about ‘patient power’ on radio 4. Yet the NHS plan pays scant attention to patient engagement, and shared decision making is not mentioned at all. ‘Choice’ encompasses choice of treatment and choice of provider…

As a result, the system is good at managing and averting crises, but much less good at doing other things like improving productivity, improving experience, changing service models, planning ahead etc.

I'm still frustrated at the staff engagement for the plan. Zoom calls with 200+ people, with Menti. It just repeated predictable dominant narratives, there was minimal space for critical thinking, dialogue, or getting underneath the surface. But it led to claims that 'we engaged with 1000s of staff'

Exhausted but elated after incredible week rethinking clinic letters for the modern era. Brought GPs, @uclh staff, patients together for a huge push. The time, safety challenges, cost & impact on GP & hospital staff is vast. Got down to 9 key solutions, 1 worked up prototype & we’re done ✔️

And symptoms can be very “total”- not just physical but emotional, spiritual as well. The meaning of pain (reminder of cancer diagnosis for example) can exacerbate it hugely for good reason

The 10 year NHS plan and what it means for patients. Been re-reading and thinking. Bottom line is that there’s some good stuff but overall the plan is regressive. There is scant mention of coproduction which imho should be the core cultural shift. Disappointing for the future of the nations health.

Jesus would be proud of this guy who wants to bring ‘Christianity back into the heart of Government’

aheblog.com/2025/10/14/c... Cost-effectiveness thresholds under political pressure: where are the health economists There have been occasions I've disagreed with Chris's take on some matters Im 100% with him on this one

Theres soon to be a test on whether those who opine about screening actually understand the principles on which screening programmes are based Get your revision done In the meantime here is a masterclass from Prof Baum (More advanced classes are available)

Posting this again because I am now using ChatGPT as my coach to help me reduce my cardiac risk. I’m health literate, I have my data, I know where to look for the evidence but *I am now not relying on the NHS to help me make decisions about managing my cardiac risk* @finnikin.bsky.social

Thanks to the many coauthors of this primer for clinicians about shared decision making ... link.springer.com/article/10.1...

Indeed. I've quoted it recently to demonstrate the absurdity of raising the QALY threshold since NICE already approves too many low value (high cost/QALY) interventions.

A 2025 review in the Lancet (www.thelancet.com/journals/lan... shows that our current spending on new medicines skews overall health spend away from more effective interventions. But it looks like we are about to spend more on meds, thus depriving our population of more effective healthcare.

Don’t get me started on “brave” people who “fight” cancer or “lose their battle with” a disease 😡

I just walked for an hour through Belgravia and I didn’t see a single Black person. It’s a disgrace.

I’m 65 years old and only today realised that crabs don’t have 8 legs

This guy sounds like a fucking lunatic.

Famous words of many Nobel Peace Prize winners.