Ed McIntosh

A dramatic day as it becomes clear that 'radical' change to NHSE is not just political rhetoric. All roads seem to lead to a slimmed down centre focused on improving the numbers, on performance and finance, but given the state of waiting lists and the local pushback on cuts it's an uphill battle

Also, it's not immediately clear how the government can publish the Mandate unless the Planning Guidance is agreed, as it confronts the same issues (not that the Mandate has ever been a particularly impactful document, but you might hope that a new government could take a different approach)

Seems like officials are struggling to make the sums add up with the focus on the elective target - a hard task without the commitment to start directing more £ into the community next year. Hard to see how this will be squared, unless through a push on CDCs (ignoring that some are in hospitals...)

Oh indeed, I suppose the gamble is whether they can afford to effectively lose a year when the public's expectations are pretty high that things will get better - whatever its merits, 'the other lot broke it' line is already coming under a fair bit of strain across government!

Quite a brave choice to have a holding year given the current policy is that the NHS is broken! Will be interesting to see if they manage to avoid cutting the usual suspects (tech/capital), given the rhetoric on the 'shifts'

Hard to see how they publish planning guidance without a clear 10YP steer - a lot of capacity is being burnt up on electives atm so seems a stretch they will be in a position to signal more broadly pre Christmas