Wednesday, 30 March 2011

A contagious condition – Healthbill Hysteria

It may be the nasty cold that makes my head feel as though it’s full of cotton wool, but as I sit at my p.c. to write my latest blog posting, I can’t seem to gather a single lucid comment about the Health and Social Care Bill.

Should I talk about the story in the UK Sunday Times stating that freely donated organs have been given to overseas patients in NHS hospitals, who are not being charged for the organs but are being charged for the surgery. Are they queue jumping? Is this against the wishes of the 17 million people on the organ donation register? How do the 10,000 patients waiting for transplants feel about this? But before I launch into ‘indignant from London’ mode, I check the National organ donation website where it clearly states that organs will first be offered to NHS patients but if no suitable matches are found, rather than waste the organs, these are given to overseas patients. These operations can bring valuable income to Hospital Trusts and ensure that an additional life is saved.

That’s OK then – I won’t worry too much about organ transplantation and competition.

Perhaps I should discuss the privatisation of the blood donation service? 1.4 million donors freely giving 2 million units of blood a year. The well run service has already saved £3m in administration costs since 2008, could a private company improve on this? And will they pay for blood? Will there be a competitive market for blood?

I can feel panic rising.

What about the fact that Andrew Lansley has changed the wording of his bill to say that commissioning of services can be open to ‘any qualified provider’ instead of ‘any willing provider’. One would hope that the GP consortia would have included some quality assurance standards within the commissioning process.

Not particularly reassuring.

Then there are the adverts now appearing in the press and recruitment websites, looking for chief executives/commissioners/bid experts to work with GP consortia. Six figure salaries.

Doesn’t bode well for savings methinks.

Then I read that Claire Gerada, chair of the Royal College of General Practitioners estimates that the cost of taking GPs out of their consulting rooms to run commissioning consortia will cost the NHS around £300m a year. When are they going to find time to see patients?

Now the hysteria is taking hold.

I then see in the Health Services Journal that Andrew Lansley is hitting back at his critics saying some of the concerns are ‘not valid’ and oppositions from the unions was ‘not necessarily representative’ . No facts or figures to verify his comments of course.

I’m just going to have a lie down……

Sunday, 27 March 2011

How to be a really bad manager (from the Fabio Capello school of bad management)

As a football fan, I would normally look forward to an International match, but such is my disillusionment with the English squad, and the way they are managed, that yesterday I voted with the remote control and watched the English cricket team instead, even though they were losing their world cup quarter final match in India.

In a nutshell, Fabio Capello’s management of the England football team has led to one (and many more I suspect) disgruntled customer. Not good management skills. Whether you are managing a sports team, a multinational business, a group of sales people or clinicians, the application of good leadership principles are vital to success.

Here is a summary of the very worst things you can do as a manager, all of which, in my opinion, have been demonstrated by the English football team’s boss.

Don’t speak the language of the people you are managing: pretty basic you would think, but after three years in post, Capello still sounds like a bit part player from ‘Allo ‘Allo.

Don't keep the lines of communication open with your staff: Another good reason to speak the language. And maybe Rio Ferdinand, who Capello recently replaced as team captain, would have appreciated a discussion with his boss on the subject. At last year’s world cup, not telling the team members if they were selected until the day of the match wasn’t very clever either.

Talk about your staff to their peers or customers without advising them first: Capello’s treatment of David Beckham was unforgiveable. Saying that Beckham was ‘too old’ to play for England again, without advising Becks of this judgement was at best bad manners, at worst, very bad tactics which alienated literally millions of fans.

Don’t stick to your decisions or have courage in your convictions:
Feb 2010: John Terry sacked as captain and Capello confirms that while he is manager, Terry will never be captain again.
March 2011: Capello appoints Terry as ‘permanent manager’
May 2010: Wives and girlfriends (wags) to be banned from the team hotel in South Africa for the World Cup
Jun 2010: Ban is relaxed as Capello sees that the players are unhappy.

You could argue that this is ‘adapting to circumstances’ rather than ‘changing your mind’ Of course a good manager will change their mind and give valid explanations why. But if they have any sense, they won’t suggest that their original idea is set in stone, leading to credibility gaps.

Don’t show appreciation for a job well done or appear to care about individual successes: When the England players celebrated the goal that meant they qualified for the World cup finals, the manager stood, motionless and emotionless, with his arms crossed. Very demotivating and what a strange message to send to the millions of fans who were already doubting his commitment.

Don’t understand the culture of your marketplace: he may be a respected league manager but clearly still doesn’t get the difference when you run a team for a country. In Italy, hints and innuendo may be an accepted form of communication, but in the UK, we expect management speak to be clear and unambiguous. When not in Rome….

Stay in post, even when you appear to be doing a poor job, especially from the customer’s viewpoint: What a pity the FA renewed his contract just before the World Cup. I guess at £4.8million a year, Capello won’t be planning on going anywhere else...

Friday, 25 March 2011

Assumptions in healthcare

I was having dinner with friends earlier this week in a London restaurant when a couple sat at an adjoining table. The elderly man was very distinguished looking with great presence and he was accompanied by a stunning young woman, probably a third of his age.  She didn’t look entirely at ease but seemed happy enough, engaged in conversation with her companion. My two friends and I all immediately jumped to the same conclusion, that this lady was a ‘rich man’s plaything’.

How wrong we were. Later in the evening as we all got chatting, it transpired that this beautiful young woman was a highly respected barrister, a colleague of the lovely gentleman, who spoke with great affection about his wife, children and grandchildren. This was an entirely innocent business dinner.

I felt ashamed that I had allowed such an erroneous assumption to cloud my judgement and this got me thinking about the assumptions we make in healthcare.

Complaints made along the patient pathway are often due to assumptions, normally made on the part of the clinical team. Here are the most common ones:

Patients want to die at home:
Much is written about ‘dying at home with dignity’. ‘Dignity in death’ can mean very different things to different patients.  Not all people want to die at home – in fact some may be terrified at the prospect, especially if the level of care at home cannot be guaranteed. There is some wonderful work currently being done in the NHS, training clinical staff and carers how to have the appropriate conversation regarding care plans with patients and relatives.

Patients want full details about their diagnosis, treatment and prognosis:
Some do, some don’t. I have direct experience of two family members with terminal disease. One was involved in his own treatment and decision-making throughout the course of his illness, the other one didn’t even want to put into words the name of her disease.

Diagnosis can be done on face value:
Happily, most clinicians are not guilty of this assumption. But I feel I must mention the GP who took one look at me before he examined my very painful knee and advised me that it was ‘my age’. Following my insistence, an MRI scan and repair for a torn meniscus ligament proved him very wrong!

Patients understand what their medication is for:
Pharmacists and doctors often go to great lengths to explain to the elderly or those with learning difficulties how they should take their medicine, but they still get confused. You should never assume the medication is being taken properly, and always check. I had an elderly friend who for years took her pain killer every day, thinking it was her ‘water tablet’ and then took her diuretic (the water tablet) when she had a headache.

The patient doesn’t know what they are talking about:
Often they do. My brother was admitted to hospital with chest pains. The staff took one look at this sweating middle aged man and assumed he was having a heart attack, despite his insistence that his leg was painful. Fast forward a day and he is the only patient on the chest ward on crutches! The palpitations and sweating were due to a badly infected leg following an insect bite. No-on had listened to him.

Patients know their own bodies:
Probably quite a good assumption, or at least something to consider. Patient’s instincts should never be ignored.  There are many, many stories of women whose doctor told them a breast lump was nothing to worry about but whose nagging instinct was proved right when they insisted on further investigations. By the same token, just because they tell you they’ve hurt their back it doesn’t mean they haven’t got a kidney problem.

GP’s welcome the Health and Social Care Bill:
Some do. Many don’t. I shall be interested to see how many take early retirement over the next few years.

Orville Wright, the pioneer said – ‘If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance’

It would appear from my tale at the top of this blog that I’m not making much progress from the time when I was a young pharmacist, working in a retail pharmacy. A man came into the shop, asking for some cough mixture. I asked him to describe the cough, and he went into great detail, saying it was quite tight, worse at night and irritating during the day. I selected the best medicine and asked him if he would like to take a dose straight away. He shrugged his shoulders and said ‘ok’. After giving him the two spoonfuls, I joked, saying ‘there – you feel better already don’t you!’ Deadpan, he replied – ‘well not really – it’s my daughter who has the cough....’

Tuesday, 22 March 2011


The Health and Social Care Bill outlining radical restructure of the National Health Service was introduced to parliament on 19 January 2011. It still has to be passed through the House of Lords – so dear Lords and Ladies, if you read nothing else before you debate the Bill, please read this…

This blog outlines a time line of disappointment – these are some of the organisations who have so far spoken out in opposition to some or all of the reforms outlined in the Health and Social Care Bill.

17 January 2011
·                 British Medical Association
·                 Royal College of Nursing
·                 Unison (public service trade union)
·                 Unite (the UK’s biggest union)
·                 Royal College of Midwives
·                 Chartered Society of Physiotherapy

In a letter to the Times the above organisations stated  ‘The sheer scale of the ambitious and costly reform programme, and the pace of change, while at the same time being expected to make £20 billion of savings is extremely risky and potentially disastrous’

19 January 2011
·                 Royal College of Psychiatrists

Press release: ‘We are particularly concerned that in some areas the new structures will not have the skills or expertise to support mental health commissioning’

22 January 2011

·                 Lord Robert Winston Professor of Science and Society and Emeritus Professor of Fertility Studies at Imperial College,

‘I do not believe that handing a £100 billion budget to the staff of the health service, who are least qualified and interested in handling it, is a wise decision, GPs are really important. But what they should be doing is listening to patients and they will be increasingly distracted by running the service’

·                 Royal College of Surgeons (RCS)

John Black, president of the RCS said its members were concerned that hospital clinicians would not be consulted in the future, adding: “…The bill leaves the question of regional-level commissioning unanswered, with no intermediary structure put in place.  The legislation does not make explicit provision for secondary-care clinicians to input at the National Commissioning Board and local consortia levels. ‘

·                 Patients’ Association

Katherine Murphy, chief executive of the Patients’ Association, said: “Our members are deeply concerned by the lack of detail in the bill with regard to how the reforms will work. There are too many unanswered questions and too many loose threads….. Will GPs spend too much time being managers and not enough time with their patients? And how can we ensure that clinical decisions are made on the basis of what is best for the patient, rather than what is best for the consortium’s bank balance? 

1 February 2011

·                 Royal College of General Practitioners

RCGP Survey highlights GP concerns over NHS Reforms. More than half of GPs responding to a snapshot survey carried out by the RCGP ‘are concerned that the proposed health reforms will not lead to improvements in care for patients’

8 February 2011
·                 The Alzheimer's Society
·                 Asthma UK
·                 Breakthrough Breast Cancer
·                 Diabetes UK
·                 National Voices
·                 Rethink
·                 The British Hearth Foundation
·                 The Stroke Association.

In a letter to the Times, these eight leading health charities warned that the government's NHS reforms ‘could mean that patients end up with less say over services in their local area’ and ‘the proposed scrutiny arrangements - local authorities are being put in charge of monitoring GP consortia …… the lines of accountability would be too weak’.

17 February 2011
·                 Chartered Institute of Environmental Health

‘We …..have a number of reservations and concerns about certain aspects of the Bill. In particular, we are seeking clarification on funding arrangements for public health and are making the case – along with our partners – for a managed transition arrangement which avoids loss of expertise and a clearer idea of what goes where. We must also remember that over the past decade some excellent work has been done in the health care system, resulting in real health improvements and outcomes’

3 March 2011
·                 The Kings Fund (healthcare think tank)

 Services such as A&E, maternity, neonatal and specialist heart and stroke care needed to be run from fewer sites. without such steps patients could be put at risk’ and it warned ‘the NHS reforms could make it more difficult to get it right’

12 March 2011
·                 Liberal Democrats

At the Spring Conference the Lib Dems passed a motion criticising proposals to put GPs in charge of 89% of the annual NHS budget with Baroness Shirley Williams stating that ‘the changes are ‘lousy’’

15 March 2011
These seven leading organisations attacked the public health agreement between the government and the food and drink industry.

·                 Alcohol Concern
·                 Cancer Research UK
·                 Diabetes UK
·                 Faculty of Public Health
·                 Consensus Action on Salt and Health
·                 National obesity forum
·                 Sustain (children’s health campaign)

Also on 15 March - The British Medical Association passed a motion to ‘halt the proposed top down reorganisation of the NHS’

This is by no means a definitive list, but may be a useful reminder for Andrew Lansley when he states ‘nothing about me without me’. The organisations above represent a significant number of ‘me’s’.

I am still advocating reasoned and constructive debate on the NHS reform plans, in the hope that sensible and workable amendments will be made. Please circulate ‘THE LIST ‘ as widely as you can and let me know if you are aware of additional organisations or notable commentators who have voiced their concerns.

Thank you.

Sunday, 20 March 2011

Football and the NHS – in a parallel universe

Success in business (and life in general) often depends on ‘positioning’. Many a colleague/child/spouse/employee has been duped into action on an assumed premise which on further investigation may be misleading. By the same token, sometimes things aren’t nearly as bad as they are painted. A report in the Observer suggests that the government has ‘buried’ the results of a recent poll showing that ‘more members of the public than ever believe the NHS is doing a good job’ is a good example.

‘Positioning’ can certainly influence the way one could describe the current state, independently, of football and healthcare in the UK, two of my main passions.

I was at Old Trafford stadium in Manchester again this week. The game started with one minute’s silence as a mark of sympathy and support for the many thousands of people affected by the terrible events in Japan. Every single person in that stadium, all 75,000 of them, stood with heads bowed in respectful silence. You literally could have heard a pin drop and then, when the referee’s whistle blew to mark the end of the minute, the cacophony of cheering and clapping, again in support of Japan, was deafening and uplifting.

The same crowd, 80 minutes into the match were screaming abuse at the referee, questioning his parentage and disputing his decision to award a red card to a home player who had landed a dangerous tackle on an opponent, badly gashing his knee.

There you have the two sides to football – loud mouthed yobs or compassionate humanitarians (this could apply to the crowd, the players or even the managers!) One of the joys of football for people like me is the opportunity to be observer and participant, perpetrator and judge. In my defence, I tend not to shout abuse at matches, I don’t seem to be able to pull it off, but I have been known to loudly question a ref’s eyesight or a player’s sanity. I love putting my ‘ten pence worth’ in, acting as amateur pundit and enjoying the camaraderie that being part of a large group provides.

And so it is with the NHS. Our healthcare system and those involved with it can be positioned as saint or pariah, slovenly uncaring public worker or life saver from the Mother Theresa school of nurturing. Whether you are a ‘player’ (one of the 1.3 million employed in the NHS), or an ‘observer’ (patients, politicians and pundits), your view of the state funded system can be very different, fuelled by your personal experience and maybe even by what you read or hear. There are abundant pockets of excellence sullied by areas of inefficiency, lack of direction and wasteful practice.

To draw the parallel  further – the scrappy match on Saturday was dominated by the feeling that neither side were really clear on strategy, direction or commitment, until the home side scored a much desired goal, giving us the ‘right result’ two minutes from the end.

Let’s hope that this can happen with the NHS reform. That despite the heckling and abuse from the crowd, the support of the home team and commitment of the players (and their managers) will deliver the goods just in time, so we can somehow make these reforms work. Failing that – all we can do is hope for extra time and a change of tactics.

Tenuous link? Maybe – but I was determined to write about football this week….

Friday, 18 March 2011

How to really annoy people in business meetings

For my overseas readers – BBC question time is a prime time weekly debate discussing key political and social issues. The panel is normally made up of politicians and celebrities but usually deteriorates into political point scoring. Watching the programme last night and feeling myself get more and more agitated, I was reassured to note that many tweeps (is that the right word?) felt the same.

The panellists were displaying just about every ‘Don’t’ on how to behave at meetings. So I thought this aide memoire on how to annoy people in meetings may serve as a useful reference.

If you want to annoy people at meetings you should:

Dress inappropriately: Call me old fashioned but there is a saying ‘good clothes open doors’ so one can assume that bad clothes can close them! For women, if your décolleté is too low you will alienate other. less well endowed women and distract the poor hapless males. Either way – you won’t be taken seriously (well not for business anyway). The same goes for men – ridiculous ties, ‘loud’ suits or ill fitting outfits are just as bad.

Overdressing - looking as though you are going to a funeral/nightclub/birthday party can be as bad as under dressing (flip flops and shorts may be suitable for a brainstorming on dress down Friday but not so good for Wall Street)

Have bad personal hygiene:  If you notice you are sitting alone surrounded by empty space as others huddle together elsewhere there may be a problem..

Dominate the discussion or debate and interrupt people: Maddening! And people will eventually mentally phase out as your diatribe becomes white noise.

Be sycophantic: Publically sucking up to the boss, guest, object of your desire is nauseating

Miss the point: Politicians please note - answer the question! So often people will attend meetings with a very clear idea of the message they want to get across, disregarding the main point of the meeting and trying to steer the agenda their way. Very very annoying.

Don’t listen or concentrate: Gazing out of the window, at the décolleté (even if it’s your own), at your mobile phone, or any other distraction is not good.

Use jargon: A very good way to alienate the group. My absolute favourite is ‘with the greatest of respect’ – actually means – ‘I think you are a complete idiot but am too afraid to say so’. ‘Thinking outside the box’ was recently voted as the most annoying business jargon in the UK

Behave badly: Sideline conversations, giggling, releasing wind and a whole host of other unsociable activities are guaranteed to annoy. It’s not big and it’s not clever!

Use bad non-verbal behaviour: Watching MPs in the House of Commons is a marvellous example of how not to behave. As one of my fellow tweeps noted,  Andrew Lansley’s facial expressions during the health debate were pure pantomime. (Oh yes it was!)

Flirt: Only fun if you are the flirter or the flirtee.

And finally…

Be mean: being nasty is a very good way to annoy people in a meeting, but be warned, in the long run it doesn’t pay. At least that’s what my mother taught me…

Wednesday, 16 March 2011

Is the BMA missing the point?

The British Medical Association aimed to deliver another blow to the government’s NHS reform plans yesterday by voting against key elements of the reforms at a special representatives meeting. The body, which represents over 140,000 doctors, passed a motion to ‘halt the proposed top down reorganisation of the NHS’. A motion supporting clinician led commissioning was passed.

At one point during the debate the chairman, Dr Hamish Meldrum defended the BMA leadership describing the government claims that the organisation supported reforms as ‘mischievous’ saying ‘it’s a funny kind of support that produces highly critical responses to the white paper consultations, setting out 77 pages of detailed concerns and risks’

And there is the rub; although the BMA is a respected and influential organisation, when it comes to the Health and Social Care Bill, it is possibly a toothless tiger. Andrew Lansley, the UK secretary of state for health, has already ignored the ‘77 pages of detailed concerns and risks’ so why would he change his mind now?

Another speaker mentioned that there was ‘a smell of revolt in the air’. But who is revolting? (My legal advisers tell me I can’t answer that one). As Lansley is quick to point out – 177 GP consortia have already been formed - £ signs lighting up before their very eyes. It may have been helpful if the BMA had asked if GPs are managing £80 billion budgets – when are they going to find time to consult with patients? Hospital doctors are also going to need an enormous amount of support as they are in danger of becoming marginalised.

As Alistair McLellan, Editor of the Health Services Journal tweeted yesterday – ‘the limits of the BMA may become clear’ as a result of this debate. It’s laudable that the first special representatives meeting was called to discuss this bill but as to the efficacy of the meeting’s outcome - time will tell.

Those who still believe that the NHS restructure is deeply flawed can at best hope that as each public and professional body stands up to be counted with their views on these reforms, the government will take on board the comments and take action to reduce the risk of the planned changes.

In the meantime, I must confess that I am beginning to suffer from reform fatigue. This morning I turned on my car radio to hear Andrew Lansley, yet again, defending his plans with endless soundbites. At least I can find solace in football, and after another successful outing to watch Manchester United last night, may revert to posting another blog about the beautiful, or maybe not so beautiful game soon…

Monday, 14 March 2011

Is it just Spring or is there a sniff of U turn in the air?

So far, Andrew Lansley, the UK Secretary of State for Health, has been resolute in his determination for forge through the NHS reforms, giving control for 80% of the annual budget to general practitioners. He has appeared to suffer from an unusual form of selective deafness and maybe some word blindness too, by ignoring the verbal and written concerns by those in the know.

Earlier this year, in an unprecedented move, eight highly respected and knowledgeable leaders from organisations such as the British Medical Association (BMA), and the Royal College of Nursing wrote to The Times criticising the speed and scale of restructure using language such as ‘potentially disastrous’ and ‘extremely risky’. This, and many other pleas to reconsider have been ignored and as the weeks and months have passed, the momentum of criticism of the health bill has grown.

Lansley faces a vote of no confidence at a special representatives meeting of the BMA this week and now six major health bodies have rejected the government’s new voluntary ‘responsibility deal’ on alcohol. Organisations such as Alcohol Concern and The Royal College of Physicians say they were ‘brought to the table too late’ and that there needs to be a clear strategy on alcohol to replace the ‘lack of clarity’ with the recent initiative. Still, we get the feeling that these voices, growing in crescendo, will continue to go unheeded.

But now we have the Liberal Democrats, at their Spring Conference, voting overwhelmingly to pass a motion criticising the reform proposals. Finally, words are being spoken in a tongue that the government understands. No interpreter needed. The language of politics. But is this going to be too little too late?

GP’s and primary care providers HAVE embraced this change – some because they felt that they have no choice. Yes, some are enthusiastic and gearing up for the major change. Why wouldn’t a group of people given the opportunity to increase their influence and income be keen to give it a go? But secondary care and the hospital trusts are still in real danger of being disenfranchised.

And my point is? Now that it could be politically desirable, Lansley may have to reconsider some of his plans. But the wheels are already in motion – to try to unravel the changes so far could be even more damaging than allowing them to continue.

I am put in mind of the time I tried to teach my daughter to drive. I wasn’t very good at it and at one point we approached some traffic lights just as they were turning red. I wasn’t at all helpful and told her to stop too late, by which time we were in the middle of a busy junction – with the car blocking oncoming traffic as it started to approach. I wasn’t sure what would be best - to tell her to reverse and go back to where we were or to put her foot on the accelerator and try to speed our way out of trouble. I continued to dither and opted for neither and chaos ensued. She had told me that I needed to change my approach on instruction and I hadn’t listened. (Needless to say, after that episode all lessons were undertaken by an expert)

My advice to Andrew Lansley? Listen. Don’t just listen to GPs, listen to all interested parties. Then make a decision, stick to it and find a way to adapt your reforms to encompass what you hear. Give us some clarity on how commissioning will work. Reassure us with concrete direction to ensure that hospitals and secondary care will be protected and innovation nurtured. And then maybe, just maybe, you will start to like what you hear.

Today, the Prime Minister’s spokesman said ‘There are not about to be significant changes to the policy’ but then added that MPs and peers would have the chance to debate and ‘if necessary’ amend the Health Bill

If there is any type of U turn, we need a clear strategy, supported by those all along the patient pathway, with definitive plans and not just platitudes and soundbites.


Friday, 11 March 2011

NHS Expo 2011 - day two

I attended both days of the ‘Innovation for a healthier future’ event encompassing several alter-egos. As a healthcare commentator – anything to do with the future of the NHS is rich fodder. Innovation in health is an exciting and very necessary element of patient care. I was also researching opportunities for the likes of me – change managers and business consultants with health expertise. And last but by no means least, it was a great networking opportunity to catch up with old friends, including a university pal whom I hadn’t seen since Glam Rock first graced the airwaves!

This event has provided a wealth of material for my blog and I shall share much of this over the next few weeks but in the meantime would like to give you my overall impression resulting from the presentations, seminars and discussions.

This current spate of NHS reforms will stifle innovation: My view on this first conclusion is unequivocal. This could have short, medium and maybe even long term effects in reducing the UK’s capability to climb up the World Health Organisation’s rankings. There is no incentive for GP consortia to fund new treatment initiatives and in order to gain Foundation status, Health Trusts will be forced to cut costs. They may have to gamble on innovation in the hope that they can gain commercial advantage for their investment.

GP Consortia are in danger of becoming expensive versions of Primary Care Trusts: I attended some very interesting seminars regarding practice based commissioning and pathfinder GP consortia. The commitment and passion by these practices cannot be doubted, but they are the first to admit that they are on a very steep (and potentially expensive) learning curve. Many will need training in leadership, communication, pathway mapping, stakeholder engagement, bidding and negotiating to name but a few essential skills.

The patient pathway will become unbalanced. As GP’s make commissioning decisions, their default position will naturally to increase investment in primary care at the expense of secondary care. Yes, scalable services nearer a patient’s home in a community setting are an excellent idea. But we will still need centres of excellence for complex imaging (and interpretation) and surgical or medical interventions. One GP mentioned during his presentation that they had made some ‘quick wins’ with cost saving commissioning decisions which funded more equipment for their practice. I’m concerned that the hospital consultant voice may not be heard.

Patient ‘power’ must be very carefully handled. Andrew Lansley’s soundbite ‘no decision about me without me’ is becoming a very hackneyed mantra and is open to misinterpretation. I wonder whether we may face ‘healthcare by Wikepedia’ or even worse, newspapers like the Daily Mail (a right wing tabloid  in the UK) will direct patients to demand certain treatments which may not even be appropriate for them. Many presentations at NHS Expo concentrated on the patient voice and as one wise speaker noted – it must be a two-way dialogue.

All of these issues can be addressed. As widely reported, the speed of change is mind-boggling but somehow, thought leaders and change managers working with the NHS need to stop looking to the politicians for the answers and get on with implementing therestructure in a way that minimises these risks.

Wednesday, 9 March 2011

NHS Expo 2011 - day one

‘Innovation for a healthier future’ is the theme for the two day event which started today in London. The hottest gig in town though was the first keynote speaker, Andrew Lansley (UK secretary of state for health) and the title of his presentation was ‘How the modernisation plans will encourage innovation to drive up quality and value’

I have read many transcripts of Lansley’s speeches and viewed webcasts but this was the first time I had seen him perform live. (I was pathetically looking forward to this – must get a life).

I nurtured the vague hope (see previous blog) that this speech would be different. After all – the title wasn’t ‘My plans for the NHS’. Been there, done that, bought the T shirt. But after a promising but brief start, one minute and 56 seconds to be precise (as I said – I must get a life) Lansley launched into exactly the same rhetoric as the live webcast for the British Medical Association on Monday. The only difference was that every few minutes he incorporated the word ‘innovation’ into the text as a nod to the theme of the occasion.

He is an excellent orator and quite credible but as with so many politicians – didn’t actually answer a single question to my (and I suspect the majority of the audience) satisfaction. Several hospital consultants asked very pertinent questions about funding. One asked how to move forward with innovation if the GP commissioners won’t fund certain service initiatives. We didn’t really get an answer on that one. Another asked about quantifying patient feedback. Someone from a PCT asked about a telehealth innovation that the GP commissioners wouldn’t fund. Lansley suggested that a conversation between the PCT and commissioners would resolve that.

One audience member stood up and said he was ‘very excited’ about the reforms’. I shall let you guess – was this excited member of the audience:
a)     Hospital Physician
b)     Pharmacist
c)     Hospital Manager
d)     GP

No prizes for answer d)

But enough of the sarcasm. In Lansley’s defence – he spoke passionately about thrombolysis treatment for stroke but interestingly failed to mention that the national stroke strategy that initiated these improvements was created in December 2007 long before the word ‘coalition’ played a part in the political landscape in the UK.

He spoke very sensibly about the fact that change is uncomfortable and this is where I see the greatest opportunity for innovation. Innovation of approach.

As with so many events like this, it is the coffee break conversations that are so valuable. And my overwhelming impression was that healthcare professionals now accept that these reforms are going to happen whether they like it or not. This newfound ‘power’ for GPs could also be a huge burden and the real challenge will be to get everyone along the patient pathway to work together and agree best practice.

As I made my way home this evening I pondered that despite my well documented reservations about the reforms – as a facilitator and trainer in clinical pathway mapping – I think I’ll continue to be pretty busy for the foreseeable future.

Tuesday, 8 March 2011

NHS reform: plenty of questions – where are the answers?

Albert Einstein’s definition of insanity is ‘doing the same thing over and over again and expecting different results’

On that basis, my marbles are clearly under threat as tonight I tuned in to the replay of yesterday’s webcast of an interview with Andrew Lansley, UK secretary of state for health, at the British Medical Association. At least my grip on reality has not entirely escaped me as I had the good sense to choose dinner with friends last night rather than tune in to the broadcast live.

Did I really expect the sound bites to be different this time? I must confess I didn’t listen to the full recording as I heard nothing new. As far as I could ascertain, the very first question posed to Lansley ‘what do you think of the reaction to the bill so far? never actually got answered. He immediately launched into the mantra – ‘Patients at the heart of everything we do…nothing about me without me…focus on outcomes…..transfer of responsibility into the hands of front line physicians…… ‘

My concentration started to waiver. And yet, I kept the faith and carried on listening, still hoping for a real explanation of how patients making care decisions can possibly make sense, how outcomes are different from targets and how GPs can carry the burden of an £80 billion budget. The next question, apparently posed by a third of the listeners, was a particularly good one – ‘where is your evidence for going through with this reorganisation?’ I don’t think there was a definitive answer to that either.

So I gave up and watched the football instead. At least you normally get a different result each time you watch a game.

But I fear the men in white coats may well be coming for me soon. Alas tomorrow I am attending the Healthcare Innovation Expo in London and will be there, bright eyed and bushy tailed, ready to listen to the keynote speaker… Mr Andrew Lansley. And I’ll be hoping for some clarity and specifics.

Will I ever learn?

Saturday, 5 March 2011

The spirit of the NHS

Vince Lombardi, the legendary football coach once said ‘The achievements of an organisation are the results of the combined effort of each individual’

The combined efforts of the neuroscience departments of The Royal Free Hospital were very much in evidence on Thursday evening. A pub quiz was organised by the stroke coordinator, Kerry Thompson and her colleagues, to raise funds for Headway, a brain injury charity. Around a dozen noisy teams were very ably controlled by the master of ceremonies, a handsome TV star, Jeremy Edwards.

We occupied a private room in an old fashioned English pub, the food was good, the wine and beer even better and the atmosphere great fun. As I struggled to help my friends answer a range of challenging questions I realised a couple of things:

Firstly – I’m rubbish at pub quizzes. I thought that David Bowie was 62 years old (he’s 64), that Napoleon died on Elba (it was St Helena) and had no idea that dendrology is the study of trees! What makes me even more of a hindrance is that I give the impression that I know what I’m talking about so it’s even more annoying when people believe my wrong answers!

Secondly – and much more important – I felt privileged to be part of an event filled with such energy for a worthy cause. The quiz teams were made up with doctors, nurses, therapists, administrators, and hangers-on like me – all who are associated with the Neurosciences services at this NHS hospital that was founded in 1828 (another question I got wrong) ‘to provide free care to those of little means’.

These NHS employees had all done a full day’s shift and are passionate about their work, their patients and are clearly a cohesive, caring team, (who also know how to have a good time of course). The evening was a great success and several hundred pounds were raised.

Of course, the combined efforts of these teams amounts to so much more than organising a pub quiz. There were also representatives from other London hospitals and stroke networks and the progress made in Stroke care in the capital has been stunning. London now leads any other major city throughout the world for thrombolysis (life and brain saving treatment for stroke patients).

When I recently finished a project with the NHS, I asked one of the service directors what she thought would happen as a result of all the planned changes. Her reply was a touch wistful but held some optimism ‘I just hope that the good people will stay, and make these reforms work somehow’.

An evening with these fantastic people and the spirit running through the event is cause to believe this could be true.