As I listened to the Queen’s Speech last week, it suddenly dawned on me that the apparent oversight of the much-overpromised social care reform might be due to the government believing that the woman making the speech was representative of the elderly population in the UK.

While we continue to ride a populist wave of politics, where a catchy soundbite and an amusing appearance is enough to garner a vote, most of us in health care have had to develop a thick skin and a low expectation threshold. Promises to ‘focus on health’ or to ‘support the NHS’ seem less important once votes have been secured.

When a draft white paper was leaked last year, outlining proposals to reverse major parts of former Health Secretary Andrew Lansley’s controversial reorganisation of health services, most of us greeted this with some relief. Particularly so, when hearing that proposals included the formal abolition of requirements for competitive tendering within the NHS. Goodbye CCGs. Farewell to the scrapping of locally tailored schemes to be replaced by commercial ventures offering cost-effective alternatives. Hello to primary care centred schemes, making full use of community ECPs and reducing unnecessary burden on secondary care.

However, I have just heard about the replacement of the excellent and long-running Croydon Community Ophthalmology Service by a tender granted after minimal collaboration within the optical sector, a tender which appears to favour secondary care outreach efficiency to primary care specialisation. Will this be an isolated incident or are we to develop yet thicker skin as more proposals are side-lined or put under further consultation?

When my son was born, my football-mad Uncle Rory rang to congratulate us. ‘Another Birmingham City fan enters the world,’ I said. Uncle replied, ‘You had best prepare him for a lifetime of disappointment.’ Useful preparation for current health policy.