Like most peers I try and get out and about to keep in touch with what’s happening in my old field, in my case in mental health services, by speaking about parliament and in return listening to staff concerns. It doesn’t give the full picture. For one thing these visits don’t include patients and their families, I have to go elsewhere to reach them, but it’s a valuable snapshot of clinical professionals’ day to day concerns about their work. Yesterday I visited Prospect Park Hospital mental health services in Berkshire to talk with trainee psychiatrists, nurses and other professionals about the House of Lords and get their take on the Health and Social Care Bill. They belong to an NHS Foundation Trust and were not terribly worried about the Bill’s major provisions but were concerned about the implementation costs and the ability of the Clinical Commissioning Groups to ‘get up to speed’. There was more concern about how they could address the rising costs of drugs, especially the new dementia drugs, and how to redesign services to meet the constant demand for annual costs improvements and the total lack of growth which is forecast for the NHS. The rapid rise in the number of people over 85 will probably have more impact on the NHS than any other foreseeable change or economic event. The CQC report on acute wards for the care of the elderly clearly indicates the need for radical change in the culture of nursing and the quality of leadership at ward level.