Monday, 31 January 2011

NHS Reform – Has Lansley been reading ‘The art of war?’

As the Health and Social Care bill passed its first test through a six hour debate in the House of Commons, I continue to wonder at Andrew Lansley’s tactics as he forges on with his restructure plans.

Sun Tzu, the Chinese philosopher and author of the seminal work on strategy, ‘The Art of War’ advises:

Be extremely subtle, even to the point of formlessness.
Be extremely mysterious, even to the point of soundlessness.
Thereby you can be the director of the opponent's fate’

Listening to the debate in parliament today, ‘formlessness and mysterious’ is an accurate description of Tory MPs attempts at supporting the bill. One MP stood up and stated that none of his constituents had ever complained about their GP. That’s alright then – let’s give them £80 billion to run the NHS.

Another had an equally ‘formless’ contribution – ‘I can’t say that I have a medical background, but my wife worked in the NHS and I do have background as a patient and my family have background with the NHS’ Great credentials – thanks for the powerful oratory – very persuasive.

And so the debate meandered on – sound bite after sound bite. Actually more of a nibble than a bite, as we heard yet again about patient choice, more openness, but no substance or explanation as to how GPs, already stretched, will suddenly find time to ‘listen more to their patients.’

If you have been reading Sun Tzu, Mr Lansley, as you plan to reshape and maybe dismantle the NHS – can I ask you to follow one piece of advice from the great strategist….

‘In the practical art of war, the best thing of all is to take the enemy's country whole and intact; to shatter and destroy it is not so good’.

Thursday, 27 January 2011

Sexism in football – Neanderthal man is alive and kicking in the workplace.

I have been trying to avoid talking about the agony of the NHS this week, as there is only so much pain that my readers should have to suffer. So the very public sacking of Andy Gray, the football pundit for sexist and offensive remarks, has been a welcome, but troubling distraction.

For those of you living outside the UK, Andy Gray is a well known football commentator working on Sky Sports TV channel. At the weekend he was overheard, thinking he was ‘off mike’, suggesting that a female lineswoman officiating in a Premier League match would probably not understand the offside rule. These comments were embellished with a rant about women in football and Gray’s position became even more untenable as some old footage of him making lewd remarks to a female presenter was released on You Tube.

Enter pages of newsprint, hours of commentary and headline TV news discussing sexism in football. Interviews with fans, officials, and equal rights campaigners followed, all focussing on the national sport.

This isn’t just about football. Of course sexism, along with racism and general bigotry, is alive and kicking in many workplaces. In fact it was Gray’s undermining of a very capable woman’s ability to do her job which, in my opinion, was his major faux pas.

As a woman who has spent many years working in male dominated environments, I have always been grateful for the fact that I love football, and like to think that I can talk with reasonable knowledge about this favourite subject. (Although I’m sure Andy Gray and his fellow cave-dwellers would disagree). Back in those heady days of corporate hospitality, when I was the director of a team of consultants at a major broking firm, I noticed that although many of my male colleagues were taken to major sporting events, I didn’t seem to be getting any such invitations. I then realised that our clients and business partners simply assumed that because I was female I wouldn’t be interested in going to Paris for the Rugby world cup or Wembley for a football international.

Evenings out with my fellow (male) directors were not for the faint hearted and however much I may want to be treated like one of the boys, the conversations often went, in my opinion, well beyond the boundaries of good taste.

On a more serious, day to day level, sexism exists in the workplace and in life in general. And of curse, any sexual harassment, or implication that a person’s gender can have a negative impact on their ability to do a job for which they are trained, is unacceptable. But it isn’t always a one way street. A friend of mine runs a high street branch of a recruitment agency. If a handsome man comes into reception, the girl at the reception desk immediately sends an email to the rest of her team in the back office, subject matter – ‘Hotty alert’. It’s amazing how, one by one, each team member finds a pressing need to go to reception and surreptitiously check out the talent. Boys will be boys and girls will be girls.

I support Sky’s decision to sack Gray, who has behaved like an ignorant bigot. The fact that he and his colleagues felt comfortable in following this very non politically correct line of banter suggest that the sexist attitudes could be endemic in the Sky Sports Studios. But let’s not pretend this is about football. It’s about corporate emotional intelligence and the need for cultural change in many organisations.
The whole affair is rather sad– because despite his bad behaviour, Gray was a good football pundit. But even more importantly, the lineswoman, Sian Massey, performed at a very high standard at the match and proved, without a shadow of doubt that yes, women DO understand the offside rule.

Sunday, 23 January 2011

Plenty of change – but not so much change management

If you are a healthcare professional, manager or support staff, working in the NHS right now, I can’t think of anywhere along the patient pathway that is a comfortable place to be.

I’m not aware that any of the uncertainty, fear and general conclusion is yet impacting directly on patient services, but of course it won’t be long before it does.

Behind the scenes, the butterfly effect is poised to wreak its worst. I looked up chaos theory and found this definition (Wikipedia)

Chaos theory studies the behavior of dynamical systems that are highly sensitive to initial conditions; an effect which is popularly referred to as the butterfly effect.

The well known concept is that if a butterfly flaps subtly her wings somewhere far away, there will be a breeze felt the other side of the world.

How can we define the effect of mammoth change affecting 1.3 million employees, implemented with indecent speed and apparently little management guidance, or preparation for the way forward?

We can be sure that the frantic flapping of wings emanating from Andrew Lansley (UK secretary of state for health) will be creating some serious turbulence somewhere along the line.

So far, rather than a tsunami of activity – there is an eerie silence, as bewildered people struggle to perform their daily tasks, unsure if they will have a job by the Summer, and if they do, wondering what the framework for that job will be.

At the headquarters of one major Primary Care Trust, staff have been advised that it will not be possible to book meeting rooms for the whole of March. Why? Because the rooms will be used for over 300 people to be re-interviewed for their jobs. How much constructive work will be achieved by those weary souls between now and then I wonder? This will not be an unusual scenario throughout the UK.

On an individual basis, some managers are doing their best to guide and support their staff. But what about organisational change at the highest level?

Yet again I find myself in the uncomfortable position of making a political point. Like many others I suspect, I am bitterly disappointed that the coalition government  seem to be adopting change management methods with the subtlety of a vampire in a blood bank.

Wednesday, 19 January 2011

NHS reform – The Titanic has now hit the iceberg

As the NHS Reform Bill is published today, the growing sense of foreboding is translated into stark reality. Those within the NHS (aka the SS Titanic) have felt like the hull has been scraping along the edge of this iceberg for some time – but now it is taking on water.

David Cameron helped to steer the national treasure towards its icy grave on Monday with his Freudian slip – calling the NHS ‘second rate’, and quickly trying to cover his gaffe up by saying he meant ‘second best’.

The charm (?) offensive has started in earnest. The UK Secretary of State for Health, Andrew Lansley is appearing on a prime time radio programme every evening this week to answer listeners’ questions. The Prime Minister has been making speeches daily, stressing his belief and commitment to the NHS ad nauseam. (apart from his little slip of course). Rather than reassuring the public and NHS staff with this PR offensive, it is having the opposite effect. Confidence is falling and we are rushing for the lifeboats as the deck starts to tilt.

When I started this blog, it was intended to focus on health reforms and wellbeing in general and I amazed at how often I find myself drawn into political commentary, but as I have said previously, you cannot separate health from politics.

There are, of course, some good elements to the health bill. Yes the NHS does need a cull of wasteful and expensive layers of beaurocracy. We do need to improve our patient survival rates and public health. I am not entirely against the private sector’s involvement. If well managed, this could introduce some badly needed lean practices within the NHS. But it is the speed of change and blinkered approach which worries the great and the good, such as the British Medical Association, Royal College of Nursing and Public Sector unions. 

As the wise, the smart and the experienced reach out for new jobs away from the NHS, and the less able and confused batten down the hatches, the NHS is being steered through troubled waters towards serious damage.

As redundancies increase, I truly hope that the people we need to keep this ship afloat will stay. There are hundreds and thousands of dedicated, talented and bright clinicians and administrators (and interims)  currently doing their level best to man the pumps as the water levels rise and I have faith that they will not let this institution founder. But I fear that they are rushing for the lifeboats right now, while Cameron and Lansely, with all good intentions, play their violins on the sloping deck.

Sunday, 16 January 2011

Reform anxiety – the pandemic we should really fear.

Forget swine flu – the pandemic that is slowly worming its way into the collective consciousness in the UK is a growing sense of nervousness about the NHS shake up.

The BBC appeared to have, at least for now, ceased to be the mouthpiece of the Department of Health, and have just reported that the NHS Confederation feels that some of the changes are ‘extraordinarily risky’

Even the chosen ones – the Royal College of General Practitioners have stated publicly that ‘some government suggestions on providing more choice in the NHS will cause long-term harm to patients and the NHS, particularly for vulnerable adults and at-risk children’

As news coverage seems to echo the fast pace of these reforms, anxiety is increasing in parallel.

I have experienced reform anxiety first hand, working on projects with NHS staff across the patient pathway. Most of those ‘embedded’ in the NHS are nervous about their jobs, their future, patient care, their organisation or department and without exception, the pace of the changes.

This anxiety and concern is natural – many of us don’t really like change, especially if we feel it’s out of our control. But the effect of this uncertainty on patients had escaped me until today and I thought I would share this story with you.

A friend if mine is a fit, healthy young woman. She is intelligent and confident, and very rarely needs to see a doctor. Earlier today the symptoms of what appeared to be a chest infection suddenly became much worse and started to cause her severe pain when coughing. So she called her GP practice out of hours service and was very pleased to get an appointment to see the emergency doctor at a nearby clinic. When she walked into the consulting room, the conversation with this GP was virtually verbatim as follows:

GP: ‘So what do you think is wrong with you?’
Patient: ‘I think I have a chest infection’ – she then described her symptoms
GP:’’Do you have a temperature?’
Patient: ‘I feel very hot but I don’t have a thermometer so I don’t know’
GP then takes her temperature and listens to her chest with a stethoscope
GP: ‘Your chest sounds clear’.
Patient: ‘It hurts when I breathe and I have a painful hacking cough and I have felt ill for nearly two weeks’
GP: ‘So you think you have a chest infection?’
Patient: ‘I rather hoped you might be able to tell me the answer to that’
GP:’ What would you like me to do about it?’
Patient: ‘Again – I thought that was for you to decide – I’m not medically trained.’
GP: ‘Would you like some antibiotics?’
Patient; ‘If you think that’s a good idea’
GP: ‘I’ll give you a prescription and then you can decide whether to take them or not’

I won’t presume to comment on the doctor’s bedside manner (especially as his parting shot to my friend was – ‘perhaps you shouldn’t be quite so quick to see a doctor next time’). And I know that there are thousands of excellent GPS currently practising in the UK. But what shocked me is what happened next.

My friend called me and asked me if that was the way it now had to be in the NHS – ‘do patients really have to decide their own treatment’? She has read so much in the press about patient power that she genuinely believed that this GP’s crass behaviour was going to be the norm

Andrew Lansley, the UK Secretary of State for Health says that the NHS reform will result in ‘the power in the hand of the patient and their GP’

Has it occurred to him that every time he uses that statement – he actually undermines public confidence in the professionals in whom we have been trusting our lives?

I would like to say something soothing and reassuring to any potential patients who may be reading this.

But I don’t think I can.

Thursday, 13 January 2011

NHS Reform – who are the heroes and who are the villains?

I was just settling down to write a short missive on the quandary of a parent contemplating flu vaccination for their young child when the BBC news started.

I was shocked to see that the headline story was about some hospital Consultants earning in excess of £100,000 annually in overtime. This was heavily criticised by various commentators on the news piece, with the reporter saying that these consultants were playing the system, and Professor Alan Maynard, an expert in health policy and former chairman of a hospital, said NHS trusts often faced a "challenge" managing consultants. ‘They don’t always keep to their job plans and then get to do overtime. I think there needs to be much more transparency about consultants pay’

Is this story politically motivated I wonder?

All this in the same week that the government’s plans for improving cancer outcomes announced an additional £750 million over four years by giving GPs powers to ‘save an additional 5,000 lives’ each year.

Health is always political, and none more so than now (both sides of the Atlantic), but I don’t understand why the spin appears to be so biased in favour of GPs who are being handed 80% of the healthcare budget in the very near future.

Have GPs suddenly become some kryptonite-challenged superheroes, snatching control of patients from the grasp of failing hospitals and greedy consultants? I really don’t think so.

Do GPs have blue tights and red underpants under their business suits or do they change in handy telephone boxes to save the NHS, give patients choice, cure cancer, control maternity services, keep the nation healthy and maybe morph before shimmying up some buildings at the same time? Mmm – not convinced.

Does there have to be goodies and baddies in the NHS and how come the GPs are the heroes and hospital staff the villains? Andrew Lansley, the UK Secretary of State for Health has decided to put all his NHS reform eggs in the primary care basket and I hope he won’t be disappointed with the outcome.

Effective and well planned clinical pathways are crucial to patient care and recovery. These pathways often include a GP, maybe a trip to the emergency department, a hospital stay, surgery, then nursing and maybe therapy to aid recovery. Each healthcare professional is equally key along this pathway.

How fascinating that The Health Services Journal, the publication most likely to have a really accurate finger in the NHS pulse, published the results of their analysis today, reporting that nearly 1 in 5 GP practices are underperforming across a significant number of quality and performance measures

I wonder why that little nugget didn’t make headline news today?

Monday, 10 January 2011

Organ donation and medical research – the ultimate patient choice

This weekend the UK Times newspaper published a thought-provoking article entitled ‘The NHS needs our bodies as well as our cash’ by Colin Blakemore, a Professor of Neuroscience.

Blakemore feels that as there is a ‘crisis in the development of medical treatments’ some ‘regulation is strangling medical research’ and goes on to say ‘surely, unless patients opt out, it should be assumed we all want to help’.

He presents a feasible argument that patients should ‘opt out’ rather than ‘opt in’ to allow their records, tissue and blood samples and scans to be used. He also suggests that as 90% of people when surveyed were willing to donate their organs to a stranger after their death, consent should be assumed. The current system dictates that patients must ‘opt in’ by joining the organ donor register prior to their death – or the next of kin can also be asked to consent to the removal of organs from their deceased loved one.

The NHS is, of course, a rich source of such organs and tissue samples and if those with similar views to Blakemore had their way, there would be a massive increased availability in organs for transplant and research.

Blakemore reminds us that the NHS is a social contract, providing care from the cradle to the grave. He suggests that in order to qualify for that care, we should, in return, offer assumed consent for organ donation and medical research

I am very uncomfortable with this point of view, even though I will admit that if someone close to me needed a transplant, I would be the first to beg for an organ on their behalf. I have opted in to the organ donation register and would be happy for my organs to be used following my death. But that’s the point – it is my choice.

All civilised societies not only care for the sick and explore ways of improving treatments and outcomes, we also treat the dead with the greatest of respect. We entrust their bodies to people who will undertake the appropriate duties with dignity and sensitivity. We ensure that their wishes for their funeral are followed, that their memory is honoured. Surely we should also respect their choice as to whether their organs are harvested? I believe that to assume consent is to deny an individual or their next of kin of the last but arguably one of their most significant, choices.

Yes, we do need more organs for transplant – it is a telling measure of the success of the seat belt laws that the resultant drop in fatal traffic accidents caused a transplant crisis.  But let’s increase education and prompts to encourage such philanthropy. A form to join the organ donor register is to be included with driving licence applications. This is an excellent idea and certainly works as my daughter joined the register following such a prompt. By all means, continue to allow doctors to have that difficult discussion with the next of kin if a deceased patient could provide a vital route to life for others. But we must accept that the answer could be ’No’

I am fully supportive of a national campaign to encourage us all to join the organ donor register. If you live in the UK and you wish to join – opt in:

But we should not have the choice taken away - this is too big a decision to be left to assumption. 

My thoughts and warm wishes are sent to all my American friends as you come to terms with the tragedy in Arizona

Friday, 7 January 2011

2022 World Cup – a spot of goalpost moving?

Sepp Blatter has announced that the World cup, to be staged in Qatar (that well known footballing nation?) will probably be held in January, due to the adverse weather conditions in the summer (i.e. 50 degrees Celsius)

Of course for the British football league, this poses a potential nightmare. Bang smack in the middle of the football season, when the top flight teams will not only be battling for the Premiership titles but may also still be involved in the Champions League and two other domestic cup competitions. There is already pressure to create a winter break to align the UK Premiership teams with their European counterparts – so how will a winter World Cup fit in?

Oh dear – the World cup farce continues. So Sepp Blatter (when IS he going to retire?) – will not only be embracing goal mouth technology (it will be a very long time before we forget our disallowed goal against Germany last year)…

…He is now also conceding that goal posts can be moved too.

Level playing field for all those nations that bid for the World Cup? Clearly not.

Wednesday, 5 January 2011

Flu vaccination for children – since when was quality negotiable?

As concern over a possible swine flu epidemic in the UK grows, apparently doctors and the Department of Health (DOH) are suggesting that flu vaccinations for children can be obtained privately from pharmacies.

Children and young adults appear to be most at risk from this strain of flu and vaccinations are provided free to the vulnerable among these groups, such as asthma sufferers and pregnant women. But if a parent wishes to arrange vaccination for healthy children, the DOH suggests that patients should receive the vaccination privately from, for example their local pharmacist, despite guidelines to the contrary from a public sector quality regulator.

A government spokeswoman has stated ‘There are no restrictions on who pharmacies give vaccinations to in a private capacity. If they decide they don’t want to do it, we cannot force them to do it’ She continued, ‘…There is nothing to stop pharmacies from giving it to healthy children under the age of 16’

The Telegraph also reports that Dr Prit Buttar, who is on the general practice committee of the British Medical Association said that rules that pharmacists must have undergone child protection and resuscitation training, imposed by the regulator, The Care Quality Commission (CQC) were ‘overly cautious’

So now it would appear that the Department of Health and some GPs are suggesting that it’s fine to ignore quality and safety guidelines for political expediency. How interesting that in the white paper ‘Liberating the NHS’, Andrew Lansley, the UK secretary of State for Health states:
We will strengthen the role of the Care quality Commission as an effective quality inspectorate across health and social care’

Quite rightly, in my opinion, the major pharmacy chains and many independent pharmacists are sticking to their guns, following the CQC guidelines and refusing to allow vaccination of children under 16 by pharmacists.

I wholeheartedly and passionately support them. I am a qualified pharmacist and practiced in hospital and retail for several years. Like medicine and any other health related profession, the training is rigorous and detailed. Throughout this part of my education and subsequent career, every bit of training and experience constantly reinforced that patient safety is paramount. Doses and formulae are checked and re-checked, patient understanding confirmed and a robust clinical audit trail applied at all times.

How can you be 'overly cautious' with the safety of children?

Tuesday, 4 January 2011

UK health hot spots for 2011

Happy New year to you all!

Here are my predictions on the hot topics that will be at the forefront of healthcare in the UK this year.

Swine Flu: Is rearing its ugly head again in the UK and is spreading faster here than any other European country. The government is revitalising an advertising campaign encouraging the most at-risk groups to have the vaccination.

State of flux for the NHS: Will be the overriding theme in the public sector. Just before Christmas (nice timing), many employees received their notice of consultation period (meaning that their jobs have been officially placed at risk). This period of uncertainty is like a creeping interloper invading every branch of the NHS. As people fear for their jobs and managers are tasked with increasing cuts, their effectiveness is sure to be reduced. My main concern is that it is not the talented, effective and efficient who go.

GP Consortia: This will be a particularly fascinating element of the healthcare landscape in 2011. I wonder if there will be enough GPs wanting to take on the extra burden of commissioning and whether there will be any cost savings or increased efficiencies to be made.  Especially as I suspect that they will need to buy in expertise from commissioners currently working in Primary Care Trusts, and source additional administrative support from the private sector.

Incentives: The Department of Health will continue to look for ways to encourage the general public to lead more healthy lifestyles. Corporate wellness incentives will also be used to help reduce private medical insurance premiums.

Private medical insurance: Will continue to be perceived as a highly valued employee benefit and companies will be working more closely than ever with their providers and brokers in efforts to reduce premiums. This will include creative ways of limiting benefits packages, wellness incentives designed to reduce risk of claims and higher levels of employee contribution. Self funded healthcare trusts will remain the option of choice for many large corporates.

Public private partnerships: As the private income cap is removed from NHS Foundation Trusts, independent providers will be exploring opportunities to expand the services they offer to patients in the public sector

Bariatric medicine: Specialises in the treatment of obese patients and health conditions associated with obesity. As the obesity epidemic in the UK grows, we will hear far more about this branch of medicine and the special challenges faced in treating massively overweight patients. Just the logistics of transporting them have significant cost implications – a bariatric ambulance must be expensively adapted to carry patients over 20 stone, and patients weighing over 35 stone require special CT scanners with extra wide bores.

‘The five domains’: ‘Liberating the NHS’ white paper outlines five key domains where transparency in outcomes are expected. These are:
1. Preventing people from dying prematurely
2. Enhancing quality of life for people with long term conditions
3. Helping people to recover from episodes of ill health or following injury
4. Ensuring people have a positive experience of care
5. Treating and caring for people in a safe environment and protecting  them from avoidable 

Long tern conditions - Dementia and Diabetes: As life expectancy continues to rise, Dementia and Diabetes will be the long term conditions at the top of a packed agenda.

Political posturing and professional protectionism: Where there is health there will always be politics.

It’s going to be a busy year….

Sunday, 2 January 2011

Vouchers to promote healthy eating - Don’t look a gift horse in the mouth

A new scheme is to be launched in the UK, offering £50 ($75) of vouchers and additional discounts to families to encourage them to buy healthy foods and health related products such as Nintendo Wii fit and trainers.

This £250million ($375m) scheme is being funded by industry, with food giants such as Nestle and Mars underwriting the distribution of around 4 million voucher books offering money off some of their health food products.

There has already been some debate about the desirability of industry funding a department of Health initiative and Tam Fry, a trustee of the National Obesity Forum was quoted in The Sunday Times that the scheme was ‘little more than a marketing opportunity’ for the companies taking part.

But the point is – it is a well know fact that incentives can affect behaviour. I have built many a sales and marketing plan based on this premise. If these vouchers encourage the target audience (a fifth of the adult population according to the National Obesity Forum) to try some healthy foods then surely this must be a good thing? One of the vouchers is for alcohol free lager – perhaps some heavy drinkers who would like to try to limit their intake may be pleasantly surprised at this alternative.

I agree that the impact of this initiative may be small and if this was a government funded scheme I would probably be among the detractors. But I applaud Andrew Lansley (UK Secretary of State for Health) for looking to industry for sponsorship. Of course, the sponsoring companies expect to see increased sales as a result of this marketing exercise. But if even just a few unhealthy or overweight families start to change their behaviour then this is clearly a win win situation.

Obesity related disease will continue to have a significant impact on the health and wellbeing of people in the UK and every health promotion initiative should be subjected to a rigorous cost benefit assessment. But where there is no cost to the tax payer and the initiative can at worst make little impact but at best promote some healthy habits, then it’s a no-brainer.