So how blows the breeze at the top of trees? By the sound of it, pretty well. The Darzi road shows are complete and the mood music is rather upbeat.

Reorganisation bad, stability good; institution bad, system good; inputs bad, outcomes good. And there's a unifying theme of quality and clinical leadership, nicely counter-pointed by the need for productivity. I was starting to think that we were on a roll...

And then international capitalism collapses and Lap Dog Lansley promises everyone a single room.

Now whereas the latter is one for the rhetoricians, the former should certainly give us all cause for concern. What will it mean for us dear denizens of the NHS, and how quickly and heavily will the effect trickle down?

To be honest, I'm a little bit too young to say I've seen it all before. My memories of the three-day weeks of the 70s are confined to staying up playing shadow puppets with mum and dad before we all went up the wooden hill to Bedfordshire at some far too early hour. (Being accountable for an organisation facing an increase in energy bills of£1m compared with last year somehow rounds off nicely one of life's little circles, but frankly isn't half as much fun). And as for the 80s, I spent much of it as a student and don't remember anything at all (apart from trying to smash international capitalism, as another ironic little circle closes).

So how will the government and the NHS respond? Tax revenues down, unemployment and benefit claims up, and the squeeze on the public sector looms. And something has to give. And now, dear readers, is our chance to plant the seeds. From the findings of an ill-informed focus group of eight learned folk I put forward:

  • EWTD: it's not as through the rest of Europe isn't going to suffer with us.

  • Cut the percentage of every pound spent on regulation by 50%: Monitor/the Quality Commission/the NAO and who knows how many small-time wannabes - do we really need them all?

  • Merge PCTs with their local authority counterparts. More democratic accountably at half the cost.

So there's your starter for 10. Alternative suggestions below as usual.

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