This week I attended the European Conference on Diabetes in Lisbon where I talked to a group of British diabetes clinicians. As is usual in these events they had spent the day talking with European colleagues about the latest clinical developments and were now spending the evening looking at the much more organisational issue of NHS reform.

The first very significant thing about their understanding of the reforms, and one which has been something of a theme over the last year, was that no-one had spoken to them to explain why the changes are needed and what they are meant to achieve. They had been left to themselves and their employing organisations to make sense of the enormous changes. From the questions and discussion it seemed that they did not know the detail of what was going to happen.