Oops. The latest NHS performance metrics issued by The Kings Fund demonstrate the first oncoming signs of Mr Excrement's pugilistic and percussive approach to Mr Fan.

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I quite enjoy saying 'I told you so'; most recently here, in paragraph nine.

The iridescent John Appleby and his co-authors James Thompson and Amy Galea find that Nicholsonian financial grip has achieved a surplus. Indeed most organisations have delivered a surplus - yet 40% failed to deliver their cost improvement programmes.

This is a concern. Because we are only one financial year through the immediately-known 'Nicholson Challenge' period of financial austerity relative to the 'peak NHS' 2000s.

The achievement of £4 billion in efficiency and productivity gains in 2011-12 has, in reality, had a lot to do with pay freezes, tariff reductions and the easy savings.

This means that 2012-13, 2013-14 and 2014-15 will see more tariff reductions, further pay freezes and more difficult savings.

The NHS has been performing heroically well on general waiting times, as previous Kings Fund quarterly reports and the excellent monthly summaries of Rob Findlay's NHSGooroo have tracked. There has been particular success with regard to cutting the very long waiting patients in most providers.

Waiting times in A&E increased significantly in the second half of last financial year. And we must note that this happened in the context of a really mild winter with no flu epidemic.

A&E kicks on to the rest of the hospital. It also sets public perceptions of the NHS. And choice is generally not an issue, because, well, you've just had an accident and / or it's an emergency. (And if it's neither, they should tell you to go forth and multiply.)

This comes on top of the BMA's ballot finding its members widely in favour of a strike on June 21. Turnout was over 50%, and 79% of GPs, 84% of hospital consultants and 92% of junior doctors voted to strike.

The strike is mainly for internal consumption by angry doctors. It is symbolic, and assuming that doctors are not stupid (which we must hope is the case), it will be the one and only such that stops routine patient care.

Because the Government's reforms rely on "putting doctors in the driving seat of the NHS, rather than bureaucrats" (if I recall the rhetoric correctly).

That means something, and doctors who are interested in getting what they want out of this dispute would do well to pay attention.