Plans slip for replacement anti-ship missile for Royal Navy

OK Daniele, this requires a seriously considered response so I’ll have get to you on this – stuff to do in the real world 🙂

Cheers CR

Oh. I maybe misunderstood your post? I thought you were making the point of being against military in procurement roles, which I was agreeing with, and had written “in uniform” in reference to them.

I agree, I think I read your meaning wrong.

Hi Daniele,

In effect, yes that was what I am argueing. However, the military would not accept that for very good reasons, and frankly my experience in procurement highlighted a need for military input and participation in certain critical phases of the process. Civilians with the best will in the world cannot possibly understand the needs of the armed forces on the battlefield. Working with the military is a huge positive.

However, I would not let them anywhere near the management or technical leadership of a procurement project and certainly keep them well away from contract negotiations! They are not trained and or experienced in those fields and why should they be!

Where they are very good is highlighting their need and wants, explaining how they do stuff but most crucuially explaining how they might use something new and gucci, especially if they see it as having a serious military application.

They are also very good at fixing stuff and letting you know if the support package isn’t right. They have their ways of doing stuff learnt on the battlefield. The great thing is they are usually only too pleased when ‘boffins’ ask for their input. Better still when you give them early heads up of what is really coming their way – provided its real and clearly useful – they are seriouly grateful and appreciative. We gave the services an early heads up on what became the F35 and they were very surprised, pleased and slightly disbelieving of what was being developed. However, it gave them a head start for developing conops, rather than wait for the first examples to enter service and then spend the next 10 years learning to get the best out of it!

Likewise, civilian techies are better placed at understanding the march of technology because it is what they do! Mind you there are some techies I wouldn’t let anywhere near management or even technical leadship of a procurement programme. Some are very much better suited to lab and or design work. It is often what they enjoy the most, which is a crucial point to note.

Leadership and management roles need people with social skills to ‘lead’. They need the ability to quickly grasp the operational and techical issues with sufficient clarity to keep things on track and spot fails long before they become an issue.

These are specialists in their own right but are overlooked. It is not merely about project management, you need a generalist kind of mind one that can bone up on the various specialities involved in a given project and visualise how it all fits together. This in turn means they can ask the telling questions in a timely manner which allows them to hold it all together. On really complex projects e.g. SSN’s, this may need a small close knit team especially given the complicated supply chain that needs to be monitored and Quality Assessed.

The problem is there is no adequate ‘label’ for this skill set – a generalist who specialises. It is not a daft as it sounds. The generalism comes from the ability to relate to a wide range of people and skill sets and to pull it all together an dmake sense of it all – no easy task and it would need to be at an appropriate aggregated level. The specialism comes on the output side which essentially is project management decision making based on operational and technical inputs. A Generalist making Specialist decisions.

The point is that these project management engineers (I’ll call them to highlight that they have the ability to understand and control complex engineering situations) are more than just managers and they are key to success. They are not specifying, designing or building stuff, but they control the whole system.

The key difference is that I believe that this type of person is required on the MoD side of the contract as well as on the contractor side (where in fact most of successful projects have their techically capable project managers). On the MoD side they would have the authority to nail things down and then ensure stuff was delivered on time and to cost. In effect their role would be to agree risk sharing with the contractor at the start and then hold the MoD its delivery schedule and thump the contractor hard if they failed to deliver against the agreed contract.

I think the main difference between your position and mine is that I would put them in uniform to reasure the military. However, they would not have to join on the bottom of the ladder as they would need to be experienced industry people. They would have to do basic training of some sort (they’ll need to knwo how and who to salute at least), but in effect they would be noncoms or civilians in uniform. This would be quite a step for the military to get its head around I should think, but it is one that is reportedly being discussed in senior military circles.

Whilst I would select and appoint these Project Management Engineers to areas of speciality e.g. armoured vehicles, I would definately NOT cap badge them as RTR for example. Instead, I would set up a Joint Procurement Command that answered directly to the Joint Chiefs / Ministers. These people would have real power and top cover possibly with a second sea lord level flag officer at the top table, but with it serious responsibility.

Critically, they would be identifiable, responsible with authority and they would need to be very capable. They would be high powered and well rewarded roles and performance would be expected.

Of course, politicians and or the Treasury could still torpedo the process, but then I would make sure parliament could stick its’ nose in and the project management engineers would have sufficient backing and legal cover that they could spill the beans when needed – but that is a whole different debate.

I think the civilians in uniform is where we differ, but with this I am reflected where we are – I wouldn’t start that’s for sure.

Of course, this is fantasy procurement stuff and could ever really happen. 🙂

Cheers CR

Morning CR.

Some right up.

“I think the main difference between your position and mine is that I would put them in uniform to reassure the military.”

You’re mistaken. I don’t have a position, and as I said above I misread your meaning in your original post thinking you’d written it wrong…when you hadn’t….never mind!

Ah, thanks Mate,

And sorry 🙂

Cheers CR

Agreed the only parts of the process the armed forces should be involved in are the initial specification and user acceptance testing.

speciallist? we’re talking about the u.k armed forces its never had specialists and if they’re real they should be scrapped.

Hi Jonathan,

I think I have misled you. I was using the word specialist to describe the procurement expert to use your phrase. Same meaning different word. Otherwise I suspect we would agree as I well recognise the ‘debates’ you describe. Experts or specialists always think their area is the answer to the world’s problems. As a generalist I fundementally disagree – the answer is more often than not a compromise. Seems to really irritate some people 🙂

Hope that clears it up.

Cheers CR

Yes compromises are the way to go, trouble is most people see black and white, shades of grey are so very boring. I’ve got great respect for those that have to find the compromise. I’m very lucky in that my present specific line of work is to highlight the black and white within complexity And then offer the balances so others can make moral and ethical judgements, I’m what’s called a professional Cassandra.

Hi Jonathan,

Sounds like you need to be diplomat as much as anything. Lots of luck and respect…

Another issue is that in the West we like to resolve contradictions, failing to recognise that contradictions are part of life and in some cases represent sensible checks and balances in a system… Try arguing that through with a bunch of entrenched fundementalists (not necessary of the religious type more of the black or white world view type, if you catch my meaning?).

Cheers CR

Observing MOD procurement from the benches:

1) We need a Committee to oversee this project so let’s table a meeting to decide the criteria for being on the committee.

2) Right we have the criteria so now let’s plan a meeting to decide the members of the Committee

3) Right we have the Committee to oversee the project, now let’s decide their terms of reference.

4) Right we have the terms of reference now let’s plan the agenda for the first meeting of the oversight Committee. By the way, what are we overseeing?

(Normal person – That Norwegian Missile looks like a good solution. Tried, tested, it works and an easy fit on our ships. Let’s buy a few as an interim until our new missile comes along – Job done).

MOD – Idiot, there’s a proper process for such things! Another Gin Nigel?

I see Douglas, you want to stop transportation because people die in accidents.

False equivalence – that’s just silly my man!

Agreed Douglas. As of today we have over 1000 admissions to hospitals per day for Covid – up over 300 per day in the last 7 days. The point of any future measures (were a resistant variant to strike) is to stop the overwhelming of the health service which will result in much greater suffering and death in non-Covid cases through catastrophic failure to treat illness and accident properly. See India where they ran out of Oxygen supplies entirely. No surgical operations of any kind possible as a result. Try Hanging on mate until we can buy some and fly it in!

Well said

Really? We are now at herd immunity. What more do people want? I really do worry about people like you and what our grandparents would think about this post war set of generations. Indeed what would the post WW1 generation think that suffered 50 million dead in total from the flu pandemic? They would wonder why you are all hiding under your bed sheets. No wonder China will rule the world with people like you are the helm…

you really don’t get I do you, the 1918 flu killed around 228,000 in the U.K. in 1918/19 but like all pandemic flu it burned for a couple of years and was gone. Covid 19 has killed around 150,000 up to now. But covid 19 is not the flu, Covid is never ever going away, immunity to corona viruses does not last and this virus is very good at knocking out nasty mutations. Covid 19 is never ever going away and we will never have long lasting immunity, that means hundreds of thousands of hospital bed days every year, ongoing rolling vaccine development and programmes for ever as well as an ongoing death rate that not likely to be less than 50,000 every year for your whole life, with 7-14% of people with symptomatic Covid getting some form of long covid.

Im pleased you can just get on with it, But I’m the lazy NHs worker working 70 hour Weeks in a health system that’s literally falling to pieces under the strain, with the knowledge and training to know just how fucked we all actually are.

Have a nice day and can you guess how much you private ITU bed will cost you when you get Covid when your old… lets just say you would be selling your house.

To be honest in the 1918 flu (another Chinese pandemic from just after WW1) 50 milllion people died and do you think our great grandparents stopped their lives – hell know they didn’t as they had greater guts and determination than the baby boom generation that quite frankly is starting to look selfish in the extreme. I think you, and others like you, are the reason this country is declining and in debt – for the last thirty years. If it happens to me I will accept my fate knowning I wasn’t a burden to society as I stated clearly in my post. More people died through catching covid-19 in hospitals and others unwlling to accept the flu jab. Now we are mostly jabbed it is time to get on with our lives and stop hidding under our bed sheets like timid mice. I want my life back and so do the majority of British people and we are unwilling to wait for people like you. I’ve been double jabbed so I’m happy to expose myself to a disease which won’t kill you in the majority of cases. Those that lived an unhealthy lifestyle or are elderly need to take the jab and then everyone else get on with their lives.

Sorry that’s balls, the 1918 pandemic was an avian flu that most likely the made leap to humans in Europe and was then spread by returning soldiers to the US and across Europe. It was not a Chinese flu. Read some actual research papers before speaking rubbish on a subject you clearly have no knowledge of.

Please read the following for the origin of the 1918 pandemic:

https://www.nationalgeographic.com/adventure/article/140123-spanish-flu-1918-china-origins-pandemic-science-health

Andrew that is not a scientific article from a peer reviewed publication, is a speculation piece by a historian. Interesting in is discussion and possibilities but it does not changes the decades of scientific research on this subject that has provided evidence ( of the scientific type) that the 1918 pandemic started in Europe.

Time we also stopped hero worshipping the NHS. It’s a poor service delivered in an exceptionally poor way. Try a different system as I have in Japan and then you understand we pay over the odds for the NHS which has essentially will cause more deaths through delayed operations because GPs are still not back at work even though they were the first to be double jabbed…I would imagine you are one of those that clapped the NHS…

Bloody hell Andrew, that’s a bit strong!

Many NHS staff put their collective arses on the line when the pandemic started and still work hard keeping Covid under control.

The vaccination programme itself is an amazing national undertaking, something we should all be very proud of.

Most would agree that the NHS requires substantial root and branch reform, to ensure money is spent in the most effective way. The problem is, any talk of serious reform is always shouted down by the Unions and the Labour party, who howl privatisation from the roof tops. The reality is, if I need an an operation ( just had one as it happens at a lovely private hospital, courtesy of the NHS) who cares if it’s NHS, or private, as long as it’s done and free at the point of need?

Jonathan has touched on the duplicated and massively overblown management and commissioning structure before and it’s a good place to start.

It’s the same with the Police, huge duplication of command structure, it’s high time we axed regional forces and just had a National Police force with regional HQ’s …. You can well imagine the uproar with Police force unions then, as massively duplicated and cushy jobs for the boys disappeared!

The equivalent is each County has its own army, with a Commander in Chief and full command and logistics structure, that would be insane wouldn’t it ….

My cousin works for the NHS and got her jab well before others in more need. She is fat, smokes and drinks so had to self isolate as she was at major risk. I was totally ashamed of her for taking the jab when she didn’t go to work. I now use a private GP as my NHS GP doesn’t do face-to-face meetings. I find a private GP more motivated, listens to you properly and if you need a scan it goes done the next day. My brother works in the NHS as well and even he agreed many NHS workers (especially management) are lazy and overplayed. It needs massive reform and not a George medal. That may sound strong but sometimes the truth does hurt. Japan is the model the UK needs to adopt.

I wouldn’t argue re GP’s, I’ve a particularly good local surgery, but many do seem to be very happy to continue keep the public at arms length!

GP practices are literally dying, we forgot to train the appropriate number of GPS over the last 20 years and now we have run out… so practices are literally dying and primary care as you and I have known it is almost gone. I spend most of my time trying to keep collapsing practices running for as long as possible. most GPS are now old and want to retire, they are independent business and not owned by the NHS so when they pack their bags and say “piss off this is not worth it” I’m not running a business with hundreds of thousands of pounds of liability and the chance of lossing everything just to earn 50k a year and be abused. We loss the service and there are no young GPS willing to pay the price of a house to buy into get only average money and a lifetime of abuse and worry.

I can only go by my local practice Jonathan, like I said, very good and all young GP’s!

It’s gradually taken over most of the old GP surgeries where I live and it’s a breath of fresh air, marked improvement over the old surgery!

I’m surprised at the £50k a year, I thought Cameron gave them a massive pay rise, closer to £100k, as part of a change of contract??

Hi john, what most people don’t realise is that GPS are not employed by the NHS. Almost all GP practices are Independent businesses that use a partnership model ( unlimited liability) The partners are mainly General practitioners with some having nurse or practice managers, who own the business.

These businesses then employ all the other staff they need ( salaried GPS, nurses, managers, reception staff, clearness etc).They also have to pay for locum cover for sickness, holidays etc, pay the utilise and rent etc.

The business has a core contract with the local NHS commissioner to provide GP services ( paid an agreed amount each year per head), with the local system contracting for extras it wants the practice to do ( so warfarin monitoring again paid by each person monitored).

The GPS who own the business can then take drawings, profitability depends on: how sick your population is and how many locum,agency staff you had to pay for ( locum agency’s stiff the practices as there are less Dr and Nurses by a long way than clinical sessions).

At the low end of the scale I know partner GP partners with decades of experience who earn no more that £47,000 ( while working 10 hour days) at the top end I see GPS who earn up to £125, but they are lucky in their population and keep their locum costs low ( but that’s rare) most are in the £50,000 to £75,000 range.

Most young GPs refuse to become a partner, due to the financial buy in ( you have to Pay to become a partner) and the unlimited liability, what we are finding now is you end up with a Practices that should have 4-5 GP partners run by a single GP partner who’s last man standing left running a business dependent on locums, making piss all money but who cannot retire or get out because he/she will be responsible for the redundancy payments for a staff of 30-50 people ( and will end up bankrupt in retirement).

But we can’t get away from the model because the Partnership model keeps all the financial liability away from the nhs and is cheaper by far than any primary care services offered by Virgin etc ( who demand far more than standard contract to take on the primay care of a population) and the clincial commissioning groups are only given the funding to pay for the partnership model.

add in the fact we have somthing like 10,000 to few GPS even for the very lean U.K. model of healthcare it’s a bit of a bugger.

The politicians have know it was all falling apart for for a few decades, but did not have the moral fibre to tell the British public they had spent the last 50 years underpaying for their healthcare to the tune of a few hundred billion and a bill was due. Covid has basically hammered the nail in the coffin of the decline ( buildings rot, new machines are needed, the population has grown, we are all living decades longer, new treatment costs more, saved lives cost more than dead people and staff trained 40 years ago are all retiring).

The UK health system has always been resourced on the just enough to get us through this year without the public blaming the government mentality. But now we have let it break ( and it had broken down) and it’s going to take at least a decade of work to put it back together again.

As ever, thanks for the illuminating reply Jonathan. Certainly, like social care, it’s a can that just keeps getting kicked down the road.

A new cross party agreement needs to be reached, we need to decide what we expect the NHS to do and where to draw the line, to let the private sector work.

It simply can’t do everything, you could double the budget and it still wouldn’t be enough….

I do find it depressing that the Government comes up with a workable plan for social care and the NHS via NI increases and Labour immediately criticise it!

First sensible attempt to do something about this for decades and Labour cry foul…..

Yes John I agree, it’s actually the very first time any government has actually turned around and said “look guys it’s not nice and we don’t want to do it but….” so I’m a bit upset that labour could not have been a bit more constructive ( modern politics is alway more about points scoring not outcomes) .

My only concern really is on the balance of settlement between adult social care and the NHS. Even though I work for the nhs and would love more budget for Primary Care I recognise the greatest increase in demand For Primary care ( and other nhs services) is because of a lack of social care and the bulk of the new funds needs to go there as early as possible. It’s far more sensible to pay a Plummer to fix the leak than spend the money on a bigger bucket. But it’s a very complex question of balance with no completely correct answer, so we pays our money and work through who needs what when, and keep our fingers crossed we got it somewhat right.

Spot on Jonathan…..

I will tell that to all my colleagues most of whom work way more hours than they are payed for. If I add up the Unpaid hours I’ve give to care for patients or finish a staff appraisal, listen to one of my team in tears.

The nhs is not the best service in the world by a long way, but every internationals study recognises it’s just about the most efficient and and equitable, I happen to know because This overpaid nhs worker not only works about 15 hours a week extra with no pay but also studies in his spare time to keep current.

Your view your right and maybe one day we will have the private healthcare system you clearly crave and I will be laughing my arse off on twice the pay I am now with an insane overtime rate ( because unlike you I know what my skills are worth on the international market and it’s around $130,000 dollars a year, which is well over twice what our most efficient NHS pays me, so bring on the private healthcare….I will take your money and bill you for every intervention, until you run out of money then you can well… die in pain wishing for a cradle to the grave free at the point of delivery service.

I’m actually getting paid $200,000 when I move to the US next month and I get free healthcare on top from an excellent private provider. If you were really worth $130k you would do what I’m doing. Instead you moan about your poor pay and long hours. Personally I think what you say is non-sense. I have many family members in the NHS and I and many others know it’s the worst service on all measures and needs to be more like Japan – a mixture of private and public funds. GPs are also earning £250k in some cases like my NHS GP practice in London. They have no issues recruiting GPs. You speak utter tosh in my opinion which I’m entitled to have.

Well off you pop then, I think your talking so much ball about a subject you know nothing about, have fun with the US health system, as anyone who actually knows anything about health will tell you it’s an international joke.

What happens when you lose your job in the states, no more healthcare, income. Don’t come crawling back here wanting nhs help as you have clearly said it’s pointless. I really hope you never fall on hard times and have to eat you own words

I’m not moaning about my poor pay. I’m highlighting that you calling NHS stafff lazy and overpaid, is not only an insult but is plain wrong and actually contemptible ( come back to me on lazy and over paid when after working 8 hours sold in a busy ED spend another 6 hours battling to save a child’s life, when you were due home four hour previously).

I do my job because I want to make a difference and the pay is fine. I work the hours because I want to keep Primary care working for the population and when doing clinical active so that person in front of me does not suffer due to the lack of staff, just so I can get home to my children, wife and have dinner with them.

lets be honest we can both have our views but actually your insulting a million hard working NHS staff is being a total shit.

Look Jonathan there are some wonderful health care professionals on the ground. However, it’s very patchy and we both know it is true (both from my family who work in the NHS and from experience of being a patient). I think the implementation of the market into the NHS has been a complete disaster. I would be much more happy with a Japanese system where people pay through taxes as well as private as well. They seemed to have got things perfectly implemented and it is a very smooth system (having experienced it myself). The Doctors are motivated, dedicated and hardworking as are the Nurses. The management pay is relatively small and the differential pay between managers. doctors and nurses is not massive. In the UK (across the board) managers are cr*p and this is pretty universal in both the private and public sectors. We pay managers way too much in the UK and we don’t have enough foot soldiers doing the work. We seem to think paying managers massive salaries yields performance benefits when it really doesn’t. If I had one tip for the NHS it would be centralise all purchasing, reduce managers and admin cr*p and focus improved salaries on consultants and nurses. Cut management salaries from £250K per annum to around £100K maximum (a cap in public sector). I could apply the same logic to many private companies in the UK – in short the UK is incredible poor at management!

Hi Andrew, I think we can agree on the internal market, it was a stupid idea to set up a sudo competition process in a system that only really works well if it collaborates.

I don’t disagree with some individuals not being great at their jobs, the nhs like everything promotes you to the level of your incompetence and is stuck with a very stupid promotion process that all depend on a 30min interview not your track record of success.

to be honest execute pay in the NHS is not as high as you think, a chief executive of a CCG with the responsible for care of a million people and a billion pound budget will be on around 150,000. The problem is senior leaders fixation with management consultants and day rate professionals. They come in spend a few months swanning around telling the middle managers and clinical managers what they already know, make a few wrong conclusions write a report for directors ad take away a check for millions, when actually the staff doing the doing know the problems.

But and this is really important to remember, almost all nhs staff are there because they want to make a difference, healthcare systems are the most complex systems ever created by man and literally no one is able to full grasp the vast complexity of how all the bits interact. And no nation on earth has a perfect health system, just the system that suits them.

The U.K. has just about the cheapest system in the western world than focuses on equity and utilitarian Paradigms. our weakness is we don’t resource for personalised Care, our social care system has collapsed and is taking the health system with it, we don’t invest in training appropriate amounts of our own Health care professionals and have depended on steal other countries.

The US probably has the biggest mess to sort our for all health systems. A lack of management control of costs and services by state and federal authorities has created a monster system that takes more funding from the tax base per head than the NHS does, then charges the same again to the individual ( via direct billing or insurance) and still only provides about 70% of the population with anything like a western level of healthcare. But if you have the insurance, understand it’s costing twice as much as British healthcare the acute care is very good, management of chronic care is a disaster as when the insurance and money runs out you sell you house and when that runs out you die.

basically if you want to really get a good understanding of the strengths and weakness of each nations health system you need to get under its skin and look at why the nation has gone that way and what are the limitations it’s put on its health system ( the us spends 14.5 % GDP on health and it’s killing that nations finances). The US commonwealth mirror mirror studies are well worth a look, every few years they do a comparison of 6 wealth nations health systems, it’s a real eye opener.

I think we are on the same page in many ways – perhaps it doesn’t come across like that as I don’t sugar coat my opinions (maybe a defect in my personality). The system needs root an branch reform and there are some good models out there. Getting everyone to pay some means tested up-front fees as well as through general taxation is a good model that the Japanese use extensively. This promotes a healthy respect for when people need and don’t need the service (as you think carefully when you have to pay a small fee). Miss GP appointments for instance, people getting drunk and people that eat unhealthily, smoke or do drugs should all treated as a health issue first and then for persistent bad behaviour with financial penalities (the stick and carrot model). We need much less replication of managerial layers, closing of hospitals that underperform or have low patient numbers and a proper centralised procurement programme nationally that finds the best value for money in terms of both quality and cost. Efficiency has never been really attempted in the NHS and the internal market has become a monster now and needs eliminating completely. You don’t need an internal market to drive down costs you just need healthcare professionals to care as much about the reduction costs and efficiencies as they do about patient welfare.

Don’t disagree on most of that.

now this is a rant, not at you but it’s my brain dump of the key areas needing change:

British culture around healthcare:

One of the big problems the NHS faces especially in ED and primary care, out of hours and ambulance services is abuse of the service, people in the U.K. have a real problem with self care. We as a society need to change our attitude to health, the NHS Needs to be seen not a magic pill but a rare wounderful thing you only call on if you must, health Care system are not a right they are about duty and we all have a duty to preserve them for need only.

after a while staff start to really get irritated and burned out with how so meany people use valuable resources. I’ve had People using ambulances cus their ankle was sore after playing football or they cut a finger, etc then get funny with staff when They are told is just a sore muscle or minor graze and then given a paracetamol and told to go home and rest a bit. one guy I saw even started shouting because I would not order him an emergency ambulance to get him back home to the next town. he had a sore foot after playing football..at the end of the match got changed then called an ambulance to come to ED as he could not walk home, he got both barrels from a very pissed off emergency nurse Practitioner who told him bluntly he had taken the only ambulance in the town ( true) away for 30 mins for a sore foot he had played football on for an hour and if someone had suffers an MI he had probably killed them and no he was not getting an ambulance home.

Ive had someone with a splinter in a finger actually come up and start shouting abuse at me because they had waited an hour ( for a splinter) at the time I was standing outside resus in full PPE with a kids blood literally spattered all down me and just about to go back in after the X-ray…I just stared at her, gestured to all the blood, pointed to the sign on the resus door and walk back in. When you are charged up on adrenaline, walking on the thin line of someone’s life, it’s hard not to really let go( I have uncounted faces burnt into my mind, one lot are the dead and the next are the idiots I would have loved to have punched).

so much of our emergency resources are wasted on broken nails, small cuts, colds etc. In truth a lot of the British public need to learn a bit of shall we say perspective.

At the other end of the scale we are also the worst for reporting long term symptoms of cancer Or symptoms of life threatening illness and almost alway leave it to late ( people who don’t hesitate to seek help for a small cut, will leave signs of prostate cancer until it kills them). I have treated so many people who have shattered their lives ( and cost the nhs a fortune) by waiting to long.

for me cash needs to be spent in educating people how to look after themselves ( schools need to teach basic first aid, what is a serous symptom etc), we also need to put money into making sure frail old people are well feed and looked after, a few quid spent on keeping an older person healthy at home will have massive savings.

last but not least we need to break people’s believe that medicine and healthcare is some sort of miracle, if your old and your body is at the end of its time, we should not be dragging you into an acute hospital bed, pumping you full of drugs or cutting you open. We need to accept dying when it’s your time is ok and instead of spending all the money on medical interventions in your last days of life, literally most of the healthcare spend on a person is in the last few days of life, to extend the suffering a bit more. What the money should be spent on is keeping you healthy for as long as possible and then at the end giving good end of life care to all ( some of the worst moments as a ward nurse is when you have an end of life patient who’s on their own and you know is going to die shortly and you can’t hold their hand because you have a drug round to do).

in regards to structural reform of the NHS, there is one very big problem…. political control. Hospital management, local nhs planning and commissioning ( CCG who plan the care for a county) is all actual pretty efficient in a good portion of the NHS ( some are crap but you always get that). I’ve been a clinician, team leader, governance manager, service design manager and safety lead in every imaginable healthcare setting and even worked in hospital kitchens, as I set out to actually try and fully understand it all, (and not just march strait up the career ladder ) and I can hand on heart I tell you the big problem is centralised control, the department of health and NHSE linked in with a reform cycle based around the ideas of every new minister of state for health who has no clue, the leaders at local level and guys on the ground get bombarded with central instructions ( I did a review of all the guidance from the DOH in covid wave one, it took me a week to read it and tons of it was mutually excused the only senior politician who has had any real understanding of the nhs was hunt, I did call him the devil himself to his face once, but he actually knew his stuff, unlike langsley who debilitated the NHS for a decade ( it was less austerity and almost all the langsley reforms that have been at the heart of the NHS difficulties). The best reform the nhs could have is total local control at a population level ( your average county works), let the people that know an area talk to its population and then have a local plan for how health and social care money is spent ( I would even think about having a directly elected chair of a health area so the public could kick him out if services are crap).

you mentioned staff need to think around finance as well as healthcare, that’s actual the improvement skills we now teach in the NHS. improvement needs to be led by the people that do and can be, better outcomes, better patient satisfaction, happier staff, and cost savings, we try to focus on improvements that provide all four. Trouble is we keep getting told what to do centrally Even if it is not the right thing for sussex, Essex, Somerset, Lancashire but is a lovely fit for London ( yes Londoners have more hospital beds per head and more resources spent on them than anyone else, NHS London is like its own Healy we resources county).

Jonathan that is the best comment I have ever read about the NHS and actually I agree with 110%. Everything you said makes immitable sense to me and on local control and reduce central control I would heartily agree with you. If would vote you as secretary of Health tomorrow.

My GP has been at work throughout the pandemic. She’s phones me every 4 weeks so I’ve had a chat about how this is has effected there workload etc.
U appear to be very heartless. Our society is built around helping the needy and that is meant to keep everyone safe. Maybe America or one of the other countries with a very poor safety net system is where u would prefer to be.
I get the frustration and most of what you write is understandable to start with. Your personal insults and assumptions of people is to far tho

“Our society is built around helping the needy and that is meant to keep everyone safe. “

So you want a concentration camp.
If you don’t create, if you dont produce you are nothing.

It is ironic that with Brexit, UK is getting with less freedom and even more socialist. Looking at British media and Academia do not surprise me, 1984 is for them a manual not a warning.

And historically not really surprising, it is all explained with 2WW Fabian “consensus” that saw UK by 1970’s with only 2/3 of income of the country they help destroy 30 years before: Germany.

I think by and large surprisingly we are on the same page. I hate the management costs and inefficiencies of the NHS and its patchy delivery. A vast majority of healthcare foot soldiers (Doctors and workers) do a great job but to say all do wouldn’t be something I subscribe to as well.

It’s a sad state of affairs. I’m sure a lot goes right but big and necessary items like this it is basically keeping the armed forces “naked”. I whince everytime I see photo of an underarmed T45/T23 and a seeming lack of spread of defensive armament of the two carriers. Let’s hope they come to their senses and get this issue sorted pronto. With the T26s coming into service mid decade I hope they’ve stated ordering for their ASMs now and in sufficient quantity. 24 x 8 = a lot of silos to fill. It will interesting to see if they go for a mix or single missile for these silos.

The Israelis have a different mindset on this.

In the UK we will start out by having to develop our own very cutting edge/best sensor and platform for ourselves. Then we, probably, set about creating a unique software platform to support that.

The Israelis will generally have a look at what is out there and choose some mid/high level sensors that are off-the-shelf and maybe tweak them a bit. They will then create some, quite clever, software that fuses a range of mid level sensors to give something quite formidable.

Hence you take a lot of risk out of the R&D as you are not on the bleeding edge of everything.

Knitting stuff together is where it is at IMHO.

Look at IRON DOME – various US contractors were very surprised how quickly and cheaply IRON DOME was put together and how effective it was/is.

Of course this is also greatly helped by the fact that a) Israel is a regional power mostly interested in self defence; b) most of her enemies are of a lower level of technology.

Difference is stuff gets built fast and is pretty good. So good, that a lot of the mods are sold back to the UK, US etc.

My summary point really is: slow R&D is the enemy of good kit as it is inevitably out of date by the time it is in the field. And you then get locked into a vicious and expensive cycle of iterative R&D where the original thread and raison d’etre is lost and the design gets swamped out.

Anyway those are my thoughts for what they are worth.

Israelis now appear to contribute significant hardware to Europe defence.
Of note is the cooperation they have with Germans.
The F125 destroyer radar upgrade for BMD seem will have Elta-Hensoldt radars.

Israel benefits from free access to the wallet of the US taxpayer, so as good as the kit is, a like for like comparison on procurement foul ups is difficult and I doubt the joint elements of systems like Arrow etc are transparent.
We could shop off the shelf there. Stunner missiles integrated into Sky Sabre. ( which has israeli C+c elements anyway)
LORA 300km ballistic missiles mounted on trucks could be planted within R.A batteries,
Gabriel 5 has been offered by them for RN use.
If we had the money, Israelis products could significantly boost our forces.( via the USA)

I wouldn’t be surprised if the delay was so that we could properly evaluate the target discrimination technology used in Gabriel V.
https://www.bbc.co.uk/news/world-middle-east-55214359

😆 just noticed his snipe at me and my repose was removed. Pity! Was hoping for more.

Though the bollox bit sounds fun! I’d be at that stage after 1 pint these days though…😏

The sad truth is I’m the same, once I’d have a good time and be hours in before stage bollox talking kicked in, now it’s half a shandy and I’m off.

We have to be prepared, there will always be countries that hate us and go against our interests whatever we say or do, take Iran as an example, they have developed an anti-ship missile called Khalij Fars (Persian Gulf) it Flies at Mach 3 has 650Kg warhead and range of 300km …what do we have to match that ? nothing…. and knowing that emboldens them.

The RN have been dealing with the Iranian threats very nicely for decades now in and aroundthe Gulf. Does this missiles actually work? Because all i have seen the Iranians do is sink there own vessels in incidents. They don’t exactly have a proven record of having anything that comes close to western capabilities.

Well, the marines from HMS Cornwall got captured by the IRGC in 2008 and we did nothing militarily in response. We know their missile tech works, they used the Fatah version of this missile against the Al -Asad airbase in Iraq, In fact, the worst thing we can do is dismiss a potent and belligerent foe as inferior and incompetent, we have made that mistake before.

I think the RN knows what it’s doing don’t you? Would you be brave with a 50 cal pointing at your face?. We didn’t need to escalate that confrontation otherwise those Marines would probably have been killed, and a major international crisis would have been started. Calm heads are sometimes required. There missile tech sunk one of there own vessels back in May 2020 with 19 killed and another 15 injured. Another reason why AshM are not the first weapon of choice. A very good chance you will hit the wrong target.

33 years actually since a harpoon was fired in anger during operation ‘praying mantis’ other anti-ship missiles have been fired in anger since. In 2006 INS Hanit was hit by a C-802 fired by Hezbollah. The Russians fired P120-Malakhit missiles during the Georgian war in 2008.

I reckon GB will know if the missiles are there and not just empty tubes, his post was a little to tongue in cheek sarcasm….of which I approve !

Instead of die for his country don’t you mean get almost dead, bleed a lot and loiter around for months or years taking up resources for his county ?

Just a question, out of the final RN fleet of 7 Astutes how many would able to be at sea at one time? Up to 4? If the RN had one or two more maybe then up to 5? That would be very helpful to having two CSG groups at the one time if ever needed plus and or other long range patrols. Or to have an additional diesel sub fleet and UUVs for regional closer to home patrols and using the nuclear fleet for more global deployment.