NHS Plan by James Joyce

As a bit of fun I asked CoPilot

Analyse my blog (on the NHS Plan) using Ithica from Ulysses as the model

Of course—let’s sail this one home in the style of “Ithaca,” Episode 17 of Ulysses. That chapter is all about precision: its catechistic Q&A format, meticulous detail, and rhythmic gravity. I’ll recast the article’s main insights into a quasi-theological interrogation, where each line probes and answers with quiet intensity and ironic flair.

Ithacan Examination of NHS Plan Implementation Risks

What was proposed in the latest NHS Plan? A proliferation of initiatives, multifaceted and ambitious. A surplus of commendable ideas absent hierarchical clarity or temporal pragmatism.

What difficulty arises in implementation? That which is easier said than done remains hardest achieved. Past plans illuminate a gap between conception and execution.

What thematic concern emerges first? Multiplicity. The enumeration of aims, lacking narrative spine. A list, comprehensive but incoherent.

What symbol might redeem coherence? The Neighbourhood Health concept, as locus and metaphor—though partial in its embrace.

What binary tension is identified? The bright and the basic. New technologies gleam, but buildings collapse. Administrative dysfunctions outlast innovation.

Which doctrinal shade creeps in? Taylorism. The doctrine of division. Fragmentation of care into tasks, assigned algorithmically or hierarchically downward.

Is there concern for professional erosion? Yes. The de-skilling of staff in pursuit of efficiency. Productivity risk outweighs safety certainty.

What duplication disturbs structural symmetry? Parallel services: apps, pharmacies, novel providers. Diversion without integration. Risk of unmanaged demand.

What epistemological gap is revealed? Curiosity deficit. Repetitions of prior reforms, lacking retrospective comprehension or contextual analysis.

Does evidence uphold expectations? Not entirely. Models for outpatient shift, hospital-at-home and multidisciplinary care cite savings, yet rarely realise them in fixed cost systems.

Is investment required for implementation? Indeed. Upfront capital, alongside strategic recalibration. Theory must precede tactic.

What is the moral tenor of change strategy? Punitively managerial. Incentives as sticks. Staff presumed passive. Motivation via critique rather than conviction.

Are signals to enact change clear? No. Mechanisms—competition, integration, freedom—interweave but do not harmonise.

Is a new operating model the answer? It is suggested. Yet composed of the same agents under new designations. Reconstitution without transformation.

Is there a theory of change? No explicit doctrine. Only hopeful ambition. The exercise of will does not equate to method.

What is the final verdict? An earnest plan, as many before. Lacking in clear scaffolding. Intention exceeds infrastructure.

I then asked it to try the last chapter

Brilliant. Let’s drift into the lyrical whirl of Penelope, Episode 18—the final chapter of Ulysses. Written as a stream of consciousness, Penelope abandons punctuation and embraces fluid thought, contradiction, memory, yearning, and resolution. Here's a reimagining of the NHS implementation risks in that signature undulating style—capturing frustration desire bureaucratic fatigue and stubborn hope.

Penelope NHS Drift

yes they had a new plan again long and blooming like a wild hedge full of thorns and sweet talk oh the ideas piled one on the other like dishes after a feast no time to wash them just stack and hope no rats come the neighbourhood centres bright shiny again a building not a soul they forget the soul yes the basics the staff the damp ceilings and ancient printers spewing nonsense and not ink Taylor’s ghost tapping tapping breaking the work into crumbs pushing crumbs to the less skilled to the silent machine

oh they love parallel things parallel paths like train tracks meant to go together but end up diverging in fog pharmacies apps bright green buttons a thousand notifications all whispering not screaming because screaming might be honest they work around the GP they do not sit with her do not offer tea just more lines more pathways more confusion and the evidence oh the old stories repeating repeating Darzi again budgets again no one reads the last page they only write a new one

and the change the miracle needed comes not from punishment not from telling staff they are lazy or lost or broken it comes from sitting together from sharing burnt coffee in plastic cups from reading the mood not the metrics integration competition freedom tangled like threads in a drawer no one opens until it’s moving day

but still still we write plans we plant ideas we dream new corridors new charts new stars in old skies because not trying is worse than failing yes yes yes