Choice; yes please!

In at the deep end this morning with a session on procurement and commissioning in health with the Department's top expert Bob Ricketts. I've known Bob for some time and like him a lot. He has a very clear understanding of the role that diversity of providers brings to the choice agenda and how valuable a role our sector can play. We had a good canter around the tricky issues behind the current political debate and I emerged with some ideas I can try out and discuss in the listening exercise.

He was pleased with my interview in the FT that morning; as indeed was I. The article was accompanied by 3 talking head quotes; me, Ed M and Andrew L!

I needed to clear my head so walked to my next meeting; lunch at Mon Plaisir with the marvellous Nick Seddon from Reform, the think tank that has had some interesting , if sometimes controversial, ideas on health reform. He has promised me lots of evidence and research on how competition extends choice and provides better value for the NHS, including evidence from Europe. And we chat on where Big Society has got to!

Back to my office at ACEVO to meet further people to continue the evidence gathering and to remind my ACEVO team I'm still alive! They have not yet changed the locks...

I'm chuffed at a letter I have received from the Chancellor, cousin George. It's about the Community Investment tax relief scheme. It was recommended for abolition but , in the end George Osborne decided to retain the scheme. The only one of the many reliefs that were recommended for abolition that he saved. He had added a postscript to the oficial letter; he wrote " your letter helped persuade me ". How cool is that: ACEVO saves the CITR ! Official !

Dinner with Stephen Thornton who runs the Health Foundation and is a leading expert on the health service- back in time for a particularly poor debate on Question Time on the health reforms! They should have had me on there to correct Peter Hain MP for his nonsense on EU competition law! This will need a better explanation !

Some thoughts so far;

# Choice in our NHS is not simply about what hospital to go to but more importantly , how to get involved in all clinical decisions about our own treatment and care.

# Lansley's marvellous declaration ," no decision about me without me" needs reinforcing.

# How might we extend the success of personal budgets in social care to health care? With long term conditions being handled so imperfectly in the current arrangements ; giving citizens more control of how budgets are spent on their own care has to be both right in principle and a better use of money. It's a disgrace how much money is wasted in the NHS on expensive retinal eye tests carried out in doctor surgeries when you can get it so easily and more cheaply ( and at weekends and evenings! ) down at a High St optician! Let's hope GP commissioning will sort that out!

# How can we sort out lack of choice in making choices on end of life care? How shocking that many people who want care to be provided at home or in a hospice end up dying in an expensive hospital bed ( average cost £2000 per day ! ).

# Many people have bad experiences of the care our current system gives to older people. How many people do you know who have horrible stories of the way their elderly parents are treated? One thing is for sure , the baby boomers - that's stroppy people like me - won't put up with the type of treatment often meeted out in some parts of our current system for vulnerable old people . And as we live longer the NHS will need to get this sorted.

# Are professional interests too powerful? We need the strength and skill of our health service professionals. But we also need empowered patients and citizens with voice and choice . How can the current reforms strengthen our power to make decisions about our own health ?

# There is so much evidence from mental health and disability charities that shows giving more power to the patient or client improves their health and well being. So more partnership in developing care plans, is crucial . Again I hope that GP commissioning will start to look for innovative new ways to empower citizens and new partnership working that promote professionals working with patients to ensure we are in charge of our own health and well being .

And now I'm off to Guys hospital for my annual scan. I think I shall mention my role on the Future Forum after the scan rather than before; we don't want anything going wrong do we!