James Lorigan
@jlorigan.bsky.social
NHS policy - regulation, payment, competition and eyecare.
We do it at Moorfields. Osteo-odonto-keratoprosthesis.
There are some pretty astonishing things going on in ophthalmology.
There are some pretty astonishing things going on in ophthalmology.
September 12, 2025 at 3:08 PM
We do it at Moorfields. Osteo-odonto-keratoprosthesis.
There are some pretty astonishing things going on in ophthalmology.
There are some pretty astonishing things going on in ophthalmology.
My mum always taught me to give a book 50 pages. If I hated it after that give up. I think it is worth giving up 50 pages to engage with different views but life is too short if I am really not enjoying it.
August 1, 2025 at 5:33 PM
My mum always taught me to give a book 50 pages. If I hated it after that give up. I think it is worth giving up 50 pages to engage with different views but life is too short if I am really not enjoying it.
I used to work on tariff (was editor for two of them). I think it’s been about 6-7 years since that team had the right skill sets to do year of care tariffs. I think robust nationally mandated year of care tariffs would take at least three to five years of development from where we are now.
July 4, 2025 at 8:16 PM
I used to work on tariff (was editor for two of them). I think it’s been about 6-7 years since that team had the right skill sets to do year of care tariffs. I think robust nationally mandated year of care tariffs would take at least three to five years of development from where we are now.
There are a lot of magic bullets and no focus on the really hard yards that need to be made to allow transformation to flourish. No coherent underlying theory of change that ties it into the wider social context. Finding it a really hard read for that reason.
July 4, 2025 at 5:23 PM
There are a lot of magic bullets and no focus on the really hard yards that need to be made to allow transformation to flourish. No coherent underlying theory of change that ties it into the wider social context. Finding it a really hard read for that reason.
To clarify, I don’t think LeGrand was right, I think he provided a plausible theory around which a narrative/ plan can be built. They need a plausible theory now.
May 26, 2025 at 5:17 PM
To clarify, I don’t think LeGrand was right, I think he provided a plausible theory around which a narrative/ plan can be built. They need a plausible theory now.
I think that is very good but I think the narrative drift was before AP. The internal mkt vs collaboration clash was there in 2019. No attempt to reconcile the theories and we are in a policy/ delivery mess now (see ophthalmology). This Labour needs their own LeGrand to provide a narrative
May 26, 2025 at 5:17 PM
I think that is very good but I think the narrative drift was before AP. The internal mkt vs collaboration clash was there in 2019. No attempt to reconcile the theories and we are in a policy/ delivery mess now (see ophthalmology). This Labour needs their own LeGrand to provide a narrative
The new ICB blueprint makes much of skills such as market management and payment mechanisms but not the technical skill sets required to do this well. There is a risk that, as has historically happened, execs will be recycled into roles that are required but they have no expertise or aptitude at.
May 15, 2025 at 12:14 PM
The new ICB blueprint makes much of skills such as market management and payment mechanisms but not the technical skill sets required to do this well. There is a risk that, as has historically happened, execs will be recycled into roles that are required but they have no expertise or aptitude at.
There has been no investment in creating a minimum standard for commissioning since 2008 and yet they are blamed for a lot of the dysfunction. This lack of development has been a major reason for the failure of CCGs and sows the seeds of the failure of ICBs.
May 15, 2025 at 12:14 PM
There has been no investment in creating a minimum standard for commissioning since 2008 and yet they are blamed for a lot of the dysfunction. This lack of development has been a major reason for the failure of CCGs and sows the seeds of the failure of ICBs.
100% agree. Need to carve out more time for policy people for this and take longer over the policy process. I accept that speed is sometimes required but I think we rush too much (possibly all) policy
May 6, 2025 at 9:52 AM
100% agree. Need to carve out more time for policy people for this and take longer over the policy process. I accept that speed is sometimes required but I think we rush too much (possibly all) policy
I was on a jury for a coroners enquiry in a difficult case. I learned more about prison heath policy and implementation through that process then about any health policy I have ever worked on. I like the idea of rigorous challenge by lay people supported by experts in big spend/picture initiatives
May 6, 2025 at 9:25 AM
I was on a jury for a coroners enquiry in a difficult case. I learned more about prison heath policy and implementation through that process then about any health policy I have ever worked on. I like the idea of rigorous challenge by lay people supported by experts in big spend/picture initiatives
I am shocked by this. The system is already struggling under the lack of local planning and control. With further cuts to acute mgt staff announced and many local authorities on the verge of bankruptcy I don’t see how coherent system change is possible. What is the theory of change here?
March 13, 2025 at 9:24 AM
I am shocked by this. The system is already struggling under the lack of local planning and control. With further cuts to acute mgt staff announced and many local authorities on the verge of bankruptcy I don’t see how coherent system change is possible. What is the theory of change here?
Agree. I was lucky to get out but I have many friends trapped in this mess. The last three years of reorg has been awful and now this. NHSE is less then the sum of its parts but that is not the fault of most of the people working there. There is no theory of change here just headline grabbing
March 12, 2025 at 10:41 AM
Agree. I was lucky to get out but I have many friends trapped in this mess. The last three years of reorg has been awful and now this. NHSE is less then the sum of its parts but that is not the fault of most of the people working there. There is no theory of change here just headline grabbing
new labour and even lansley had a theory about how the health system delivered value and what changes needed to take place. Without a theoretical underpinning all you can do is react or chase truisms (AI will make it all better)
March 12, 2025 at 10:25 AM
new labour and even lansley had a theory about how the health system delivered value and what changes needed to take place. Without a theoretical underpinning all you can do is react or chase truisms (AI will make it all better)
I can’t help but feel that the policy heavy lifting has not been done. Sitting on the inside of health policy I can’t see any theory of change to underpin the reforms or tackle the major problems. As such much of the internal health policy is ‘work harder/faster/cheaper’
March 12, 2025 at 10:22 AM
I can’t help but feel that the policy heavy lifting has not been done. Sitting on the inside of health policy I can’t see any theory of change to underpin the reforms or tackle the major problems. As such much of the internal health policy is ‘work harder/faster/cheaper’
I recognise all of those in my time in the NHS and I’ve seen them all more than once. I do think that there is a major issue with how we develop and promote people though. Several traits feel more like functions of promotion without development/support.
March 5, 2025 at 9:36 AM
I recognise all of those in my time in the NHS and I’ve seen them all more than once. I do think that there is a major issue with how we develop and promote people though. Several traits feel more like functions of promotion without development/support.
5. Most functions need to be pushed out to regions/ICBs. Policy needs to go back to DHSC. Central should focus only on the stuff they can do or are asked to do by regions.
February 25, 2025 at 12:42 PM
5. Most functions need to be pushed out to regions/ICBs. Policy needs to go back to DHSC. Central should focus only on the stuff they can do or are asked to do by regions.
3. The NHS policy landscape is a mess. No over arching theory of change, chasing magic bullets (pifu, virtual wards) without doing the boring hard yards to make the system work better.
4. NHSE policy operates in silos, DHSC has been hollowed out. Real first principle rebuild is needed.
4. NHSE policy operates in silos, DHSC has been hollowed out. Real first principle rebuild is needed.
February 25, 2025 at 12:42 PM
3. The NHS policy landscape is a mess. No over arching theory of change, chasing magic bullets (pifu, virtual wards) without doing the boring hard yards to make the system work better.
4. NHSE policy operates in silos, DHSC has been hollowed out. Real first principle rebuild is needed.
4. NHSE policy operates in silos, DHSC has been hollowed out. Real first principle rebuild is needed.
I recently joined a provider from NHSE and have a few thoughts:
1. NHSE is unmanageable and she was sold a lemon but she hasn’t made a great job of it.
2. There is real talent there but it is operating at less then the sum of its parts. Based on NHSI, not sure Mackey is the man to fix that.
1. NHSE is unmanageable and she was sold a lemon but she hasn’t made a great job of it.
2. There is real talent there but it is operating at less then the sum of its parts. Based on NHSI, not sure Mackey is the man to fix that.
February 25, 2025 at 12:42 PM
I recently joined a provider from NHSE and have a few thoughts:
1. NHSE is unmanageable and she was sold a lemon but she hasn’t made a great job of it.
2. There is real talent there but it is operating at less then the sum of its parts. Based on NHSI, not sure Mackey is the man to fix that.
1. NHSE is unmanageable and she was sold a lemon but she hasn’t made a great job of it.
2. There is real talent there but it is operating at less then the sum of its parts. Based on NHSI, not sure Mackey is the man to fix that.
The NHS publishes its costs so you can see www.england.nhs.uk/publication/...
NHS England » 2022/23 National Cost Collection Data Publication
NHS England » 2022/23 National Cost Collection Data Publication
www.england.nhs.uk
December 8, 2024 at 11:07 AM
The NHS publishes its costs so you can see www.england.nhs.uk/publication/...
Let’s stop using the word outpatients. It’s a sign above a door representing a whole range of specialist inputs into patient care. We can vary who, what, where & when those inputs are delivered but only if we unpack it. The word allows lazy general solutions (e.g block payment for all follow ups)
November 28, 2024 at 10:36 AM
Let’s stop using the word outpatients. It’s a sign above a door representing a whole range of specialist inputs into patient care. We can vary who, what, where & when those inputs are delivered but only if we unpack it. The word allows lazy general solutions (e.g block payment for all follow ups)