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  • Virtual education sessions on spinal cord injury from Spinal Injuries Association
    2 July 2020

    This week Karen Mikalsen from the Spinal Injuries Association shares some information on their work and events for healthcare professionals.

  • Guest blog:Karen Chumley
    25 June 2020

    Thank you to Karen Chumley for a second blog –this time on the local use of an Electronic Palliative Care Coordination system during the Covid-19 pandemic. Karen is the Clinical Director and Deputy CEO at St Helena.

  • Link of the week
    19 June 2020

    This week's link of the week is article by Yasmin Khanagha published in Nursing Times – Why we need to open the conversation about racism.

  • Guest blog: Dr Karen Chumbley
    12 June 2020

    This week we have a guest blog submitted by Dr Karen Chumbley, clinical director and deputy chief executive at St Helena (https://www.sthelena.org.uk/)

  • Social care to become lifestyle brand
    16 April 2020

    Social care is to get a new brand identity as the government seeks to reverse the perception that it is the poor relation of the NHS.

  • Blithering Covid-19 bulletin plays vital role
    2 April 2020

    To fill a gap in the market for timely and relevant Covid-19 information, Martin Plackard, director of global crisis communications at NHS Blithering introduces his latest initiative to reach out to stakeholders during the outbreak.

  • Social distancing the Longstay way
    27 March 2020

    We asked Sir Trevor Longstay, chief executive of the NHS Blithering University Hospitals Foundation Trust and commander-in-chief of the Blithering Covid-19 Taskforce to give us some practical tips on social distancing. Here he shares some of the lessons learned over four decades of leadership – not all of them relevant or epidemiologically sound

  • Nothing left to shift: fears grow over NHS paradigm supply
    12 March 2020

    The government has issued a stark warning that stocks of paradigms and other basic supplies could soon run out if NHS managers continue panic-buying.

  • Matt Hancock’s diary – a week of levelling up
    27 February 2020

    Taking personal charge of global pandemics is one of the perks of this job. I’m referring to coronavirus, of course, and I’m booked to appear on Sky News to talk about it.

  • Exceeding your expectations: the Blithering staff survey
    20 February 2020

    Staff at NHS Blithering feel listened to “at least once a year” and report that their expectations of taking part in surveys have been “met” or “exceeded” in the past 12 months.

  • Martin Plackard’s week: Tuesday
    7 February 2020

    The second in our series of privileged insights to the working life of Martin Plackard, the NHS’s most gifted communicator

  • Martin Plackard’s week: Monday
    30 January 2020

    First in an occasional series of glimpses into a typical week in the life of Martin Plackard, the NHS's most influential strategic communicator

  • A quick guide to quick guides
    24 January 2020

    Few of us have time for long documents that take ages to read or a lot of expertise to put together. That’s where quick guides come in.

  • Towards people and impact
    17 January 2020

    This week the Royal Pharmaceutical Society advertised for a head of engagement and belonging. Such titles can be controversial – but not for Martin Plackard, whose CV features a number of leadership roles in the fields of impact, euphemism management and talent delivery.

  • National log-in reset will change everything
    9 January 2020

    This week the Department of Health and Social Care announced a £40m investment to make it easier to log-in to NHS computers. It’s a laudable aim, akin to fitting a keyless entry system to a Ford Anglia to make it go faster.

  • Martin Plackard’s top tips for making a difference in 2020
    3 January 2020

    NHS Blithering’s Martin Plackard MBE was recognised in the new year honours list for services to strategic communications and meaningful engagement. Here he gives his top tips for others who hope to make a very real difference to people, communities and their own career prospects in 2020.

  • My amazing Twitter year – by Matt Hancock
    20 December 2019

    It's been a fantastic year on social media for the secretary of state for health and the other thing. Here it is in very nearly his own words

  • Sustainability and transformation parties: mandatory guidance
    5 December 2019

    As Christmas fast approaches, system leaders are getting ready for so-called sustainability and transformation parties, the highlight of the year for those who enjoy kinky integration with strangers.

  • All the latest health policy news from the general **** campaign
    29 November 2019

    Because purdah is still in force, this week’s **** has been heavily redacted. Here are the main parties’ plans for government as set out in their manifestos. A full unexpurgated version can be obtained from **** Party HQ.

  • New outfit more splendidly integrated than ever
    21 November 2019

    The emperor has announced plans for yet another new outfit, amid claims that this one will be even more splendid than the last.

Friday, 25 October 2019


"The biggest complaint about the NHS which is beloved by everyone is about the food, and the biggest complaint about the food is about the lack of toast.”

So wrote the food writer Prue Leith, who last week blamed draconian health and safety rules for the disappearance of toast from many hospital menus.

Her remarks caused a sensation. First there was the shock of discovering that after all the worries about staffing, funding and Brexit, dire warnings of a bleak winter for emergency departments and the persistence of numerous public health crises (obesity, mental health, antimicrobial resistance), that the NHS faces an existential threat that no one had properly considered.

Secondly was the reaction of the system as NHS England and Improvement, under pressure from the Department of Health and Social Care, rushed out guidance to restore public confidence in the NHS.

The At-a-glance Toast Checker (ATC), modelled on the Bristol Stool Chart, provides a visual aid for planning and quality assurance. Hospital staff will be encouraged to work with patients to agree the ideal colour, texture and serving temperature of their toast.

Top sliced

Simon Stevens said he would “work tirelessly to ensure that everyone has a person-centred toast experience”. He promised that the centre would roll out personal toast budgets (PTBs) by 2023, allowing patients to choose their health provider based on their preferred toast colour. PTBs are to be funded by top-slicing existing commissioning budgets.

A leading GP warned that the scheme could face practical difficulties: "We’ve been piloting personal toast budgets for a while. They led to more control and higher satisfaction, but we had to call a halt when someone used their budget to buy tea cakes.”

Existing regulations are to be amended to enable GPs to offer patients more choice when referring them to secondary care services. Leading think tank the Nuffield Crust cautioned that the proposed “any toast provider” rules could make it harder to implement integrated care and could increase procurement costs.

Choice agenda

NHS England and Improvement said it would launch a procurement framework to create a “level playing field for providers and enable NHS organisations a wide choice of value for money, quality assured pre-toast [bread]” but independent bakeries warned that the framework would be dominated by the “big four” – Hovis, Warburtons, Kingsmill and Tesco.

Hospital catering staff and nurses’ leaders expressed reservations about the impact of hurriedly drafted toast preparation provisions in forthcoming workplace health and safety standards. This could mean up to three nurses on every ward involved in the daily toast round – one to restock the toaster, one to monitor quality and collect feedback forms, and one with specialist electrical and fire safety training to tackle any small fires.

NHS leaders are privately concerned that the national toast policy will increase the regulatory burden on hospitals, following the news that the Care Quality Commission plans to introduce a new “well-fed” domain to its existing inspection regime.

Implementation and spread

Others have criticised the policy for being too closely geared to hospitals. GPs and voluntary sector leaders questioned why there was no mention of primary care and community services and pointed to research showing that most people preferred to access toast locally, preferably in their own homes.

Simon Stevens said he had listened to the concerns of colleagues but added:  “If we want to make the NHS a global leader in the provision of toast-based services, the whole system will need to embrace innovation. Parts of the NHS already make world-class toast, but now we need to focus our efforts on implementation and spread.” 

Editor: Julian Patterson

Acknowledgement: With thanks to those on Twitter whose gags were stolen for this week's blog. 


Lynne Chellingworth
Lynne Chellingworth says:
Oct 26, 2019 08:02 AM

I’m infatuated (it’s always you, Julian) with this week’s offering. Having laughed at Twitter with all the toast jokes, you’ve brought it all together in one handy toast based newsletter. Thank you.

Anonymous says:
Oct 28, 2019 08:59 AM

Fabulous! Thank you for the laugh out loud moment.

Anonymous says:
Oct 28, 2019 09:52 AM

Oh my word, tissues please - our entire team are crying! Esp. The CQC ‘well fed’ domain!!!

Mike Richardson
Mike Richardson says:
Oct 28, 2019 09:56 AM

Sir Trevor Longstay commented as follows: I believe passionately in Toast as a super food and in response have already tasked Plackard with establishing a Task & Finish Group to look at getting a campaign going. They have already sent me with their initial slogan: - 'We are Toast!' - Its short, its punchy and gets right to the point. I like it! :)

Nicola Smith
Nicola Smith says:
Oct 28, 2019 10:57 AM

I feel like Victoria Coren-Mitchell's fan on 'Would I Lie to You'- I laughed that much I nearly ended up on a ward. Problem is we're on 'Full Capacity Plan' so I'll just look on the NHS website for advice...

Chris Jackson
Chris Jackson says:
Oct 29, 2019 09:37 AM

News just in: According to a inside source, the Transatlantic Toast and Investment Partnership (TTIP) are preparing to lodge an appeal against being locked out of toast supply in the NHS, more soon.