Monday, 31 October 2011

Employer Healthcare Congress (3). Day two – some keynote notes

My apologies to regular readers and my new friends from the congress for the delay in this next thrilling instalment from Chicago.  I had some IT issues, resolved now I’m back in the UK so normal service is resumed.

There was a wide selection of sessions on the second day and I was drawn by three keynote presentations. I’ve never been sure of the meaning of ‘keynote  speaker’ and some quick research uncovered that the term originates from barber shop singers practicing a ‘key note’ before starting a performance. A good keynote singer sets the tone for the song as a professional speaker sets the tone for a conference session.

Another, and perhaps a little cynical, definition is that keynote speakers get paid..

Bill Rancic, Winner of the Apprentice. ‘Ability to achieve success in today’s healthcare and economic climate.’
I learnt a salutary lesson from the first keynote of the day. I have a pathological loathing for reality TV (Snob? Moi?) and found my brief viewings of the UK version of The Apprentice to be full of self-opinionated egotists. (Judgemental? Moi?). So I didn’t rush to attend Bill’s opening session of the day and missed the first half hour. Big mistake. I quickly discovered that Bill Rancic is a very cool guy. Softly spoken and yet successfully projects intelligence, charisma and humility.

Bill’s presentation was very well received and attendees afterwards told me of how he related the story of his first successful business launch – selling cigars online. His innovative, but simple sales techniques (‘stand out from the crowd’) and way he has seized opportunities throughout his life provided plenty of inspiration. He also had some interesting views on qualifications and felt that if you were already a proven ‘entrepreneur’ additional gongs such as an MBA were unnecessary but he did agree that good qualifications can provide ‘get you in but once you’re in it’s down to you’

A special mention is deserved for another entrepreneur, Liam Ryan from gethealth  (  who managed to find his way to the front of the queue for the microphone to pose questions to Bill. Liam demonstrated admirable ‘seize the opportunity’ and ‘stand out from the crowd’ skills, asking a question in his soft lilting Irish accent. What was his question? I’m not sure what he actually asked – but he did manage to mention that his company is launching an exciting interactive health proposition! It was the gentlest of business pitches to a large,  influential and benevolent audience. This young man and his business partner will go far methinks.

John Casey, Director of International benefits, Google. ‘Creating the healthiest employee in the world’.
John provided a fascinating insight into life within planet Google and the technology giant really does seem to provide an exceptional working environment. He was honest about the pressures of an ‘always on’ culture of a workforce with an average age of mid 30’s – employed by a company that receives 2 million (yes 2 million) job applications a year.

I was interested at the emphasis John placed on life stages within the Google population, recognising that many ‘Googlers’ (love it) are now entering a challenging phase in their lives – new marriages, commitment to long term relationships and young families, all happy events which can place pressures on a previously uninterrupted work focus. The organisation nurtures it’s ‘Nooglers’ (love that too) who join the organisation and a mouth watering suite of wellness options are available.

John admitted that a transparent culture and an obsession to listen can create its own problems in potentially delaying benefits decisions but these open channels also encourage creativity and innovation regarding all aspects of the business. He made a strong case for branding wellness initiatives with the Google choice of ‘Optimize your life’ providing a clear message of intent. The wellness programme adopts a global approach to health and wellbeing, covering the physical, emotional and financial health of employees. This may sound like Nirvana, but John also stressed that this frugal (his word) company questions every cent so each wellness initiative must provide a decent ROI.

The company is not afraid to experiment with new health initiatives and like so many speakers at this conference, John stressed the importance of robust benchmarking and regular monitoring of wellness programmes and health data.

I have no doubt that Google is well on its way to achieving its vision of ‘The healthiest employee on the planet’ - and good luck to them.

Mitch Joel, Author ‘How marketing connects in a connected world’
Key note speakers are like buses – you don’t see one for ages then three come along all at once!

There was something of the Halloween about this presentation – not intentionally I suspect. Dressed in black, Mitch also used monotone for many of his slides and even reduced Michelangelo’s beautifully coloured The Touch’ to stark black and white. A black background and white text in capitals used for much of the content came across as a bit aggressive which is a shame from an apparently charming man.

Mitch was keen to emphasise the speed with which our digital interactions are changing – and he succeeded. The tale of his 2 year old son trying to scan pages on the TV screen with his finger provided powerful imagery of the future. As Mitch said – keyboards will (not maybe – will -) become a thing of the past very, very soon.

Allowing customers to post comments, good or bad, on your company website is a compelling way to demonstrate transparency and YouTube was highly recommended as a dynamic interaction. I took on board Mitch’s advice that you should concentrate on liking your customers and not just focus on getting them to like you.

His summary of how to use digital marketing was, I think, excellent:
·         Accept it
·         Apply it with other marketing methods, not instead of
·         Be open and transparent with all your marketing transactions and communications
·         Your techniques must be shareable and findable
·         Treat written digital marketing as publishing – a blog is ‘published’
·         Let ‘why’ not ‘what’ define your tactics

Mitch also advised us to avoid ‘digital tumbleweed’ so for fear of my words being blown across an overcrowded digital landscape - I shall finish for now.

Thursday, 27 October 2011

Employer Healthcare Congress (2). Day one - A mixed bag

Day one of the congress provided a good selection of speakers and thankfully the logistics of finding the right educational seminar room and streamlining our individual schedules was much easier this year. Here is an overview of some of the sessions I attended.

Dr Cecil Wilson: ‘The future of healthcare and healthcare reform in America.
The keynote speaker, past president of the American Medical Association launched the event with a fairly lack lustre presentation which didn’t really live up to the hopeful title but did include some interesting facts and figures. We were subjected to a list of the rules and regulations of the Patient Protection and Affordable Care Act (PPACA), which will be no doubt be included in the certification workshops later in the event. What I really wanted to hear was Dr Wilson’s view of the political implications of the reforms, which are, according to surveys, understood by less than half the US population. (Unlike the UK where, according to my straw polls, 100% of the population do not understand the NHS reforms).

One interesting slide demonstrated the estimated cost of the governmental delay in clarifying the situations regarding SRG (sustainable growth rate payment formula for physicians). The dispute regarding the fixing of this rate could cost up to $600 billion by 2016. Andrew Lansley (UK Secretary of State for health who is still unclear on how best to proceed with the NHS reforms) – please note – dithering costs money!

The figures facing the healthcare system in the US are eye-watering for a Brit – we are used to talking in £ billions for our healthcare provision. But in the US, the estimated annual health care spend will increase from $2.2 trillion (16% GDP) in 2010 to $4.4 trillion (20% GDP) in 2018. Like the UK, the major issues are obesity and chronic disease. One additional burden for the US which has less impact than the UK is the cost of medical liability which contributes $70 – 126 billion annually.

All very depressing.

Steve Cyboran and Linda Spurlock: Investing in a health culture – achieving results via a healthy enterprise.
This was a fascinating presentation by a consulting actuary and a director of human health. In a nutshell – a healthy enterprise is defined as ‘creating an environment where employees can engage and thrive’. Personal and professional development of individuals should incorporate all aspects of ‘health’ – intellectual, emotional, social, spiritual and physical.

Steve Cyboran provided a scientific approach to this potentially woolly subject, including a workable framework for ‘vision driven solutions’.  The Sibson maturity model seems logical and practical, focussing on maturity from focus on treatment to focus on preventional management and finally focus on optimal behaviour. He stressed the need for robust metrics, so often the weakest link in any wellness initiative. I particularly liked his comment that ‘health is not just the absence of illness or issues’

Linda Spurlock spoke of the value of honouring businesses that take a leadership role in health and wellbeing. Wellness programmes that encourage employees to engage in community work were especially useful and this emphasises the importance of linking corporate social responsibility with individual input.

Denise J Holland: An introduction to Corporate Health and Wellness
I consider myself an ‘old hand’ at this particular game, but felt it would be useful to hear the views of the Director of Employee Healthcare at a major food production organisation

Denise was a lively and entertaining presenter and I agreed with most of her advice on how to set up a wellness programme. I felt that more emphasis could be put  on consultation in the process and the need to engage employees at a very early stage in the development of a programme.

I was impressed by her success in engaging not just employees but their families and thought the idea of sending postcards to female spouses encouraging male employees to have health checks was inspired. Another excellent tip was to remind employers not only of the value of benchmarking (as Denise said – this was a ‘duh’ point’) but to remember that vendors can provide valuable information and HR systems in a company will have already amassed some vital demographic data.

I liked her observation that a wellness programme is not just a collection of perks and her realistic approach to incentives. As she said – offering money doesn’t always work adding ‘I’ve done some crazy things just for a T shirt’.

Now that would be an interesting subject….

As with all conferences – the networking and socialising is a key part of the whole experience and yes, I am taking full advantage of this opportunity (it would be rude not to as my grandmother used to say)

The wine glasses are still oversized (I’m not complaining), the chatter thought -provoking and the company varied and entertaining. Like a little patch of healthcare heaven…

Wednesday, 26 October 2011

Employer Healthcare Congress (1) - the morning after the night before

The congress in Chicago kicked off last night with a cocktail reception and the networking, socialising and general healthcare chit-chat started in earnest. As I reflect on the evening’s activity and discussions I can summarise my conclusions so far..

Healthcare cost containment remains a hot topic for attendees at this conference: No surprise there. Providers, wellbeing strategists and employers are all seeking this Holy Grail. I am encouraged that it is recognised that just cutting budgets or cover levels is not the way forward – prevention and quality care are the most effective way to manage costs.

US Healthcare reforms are as emotive to American citizens as the NHS reforms are to us in the UK. Everyone seems, like last year, pretty much in agreement that the motives behind the reforms are good, but the practicalities of drastic change are creating logistical and economic mayhem.

Employee engagement has galloped it’s way to the top of businesses’ health and wellbeing agenda: This was a lively topic of conversation last night. Employers now recognise that ‘positive and measurable engagement’ is the way forward. Simply ticking the box with staff surveys and newsletters is no longer good enough to ensure that wellbeing programmes are on track.

There is something I still don’t quite get about the Medical Tourism Industry: I understand the theory but am not yet comfortable with many of the practices. And as if to validate my prejudices – I note again this year that representatives from this branch of the health industry have bigger exhibition stands, suspiciously more expensive giveaways and flashier suits than the health providers and wellness groups!

And finally – two undeniable truths..

I definitely have a penchant for charming men: And was fortunate to spend quality time with some fine examples yesterday!

Large wine glasses lead to overindulgence: Healthy eating/drinking initiative number one. Number two – portion control in general – even my glass of orange juice at breakfast held at least 500ml – with as many calories.

More tales of an Englishwoman abroad later..

Tuesday, 25 October 2011

The nutrition battle - time to get tough

As I waited for the Employer Healthcare Conference to start in Chicago this evening, I scanned the local news for health related stories and was immediately rewarded with the information that the first lady visited the city today with a healthcare agenda. The headline reads ‘Michelle Obama is bringing the nutrition battle to Chicago’ and the report went on ‘with a view to eliminating health deserts’.

The VIP guest opened a local Walgreen store, recently expanded to sell produce and grocery staples and took in a tour of an urban farm – 7 acres of inner city land producing health foods. These are both worthy examples of healthy eating initiatives so badly needed in a country with an estimated obesity rate of 40%  (and an ‘overweight’ rate of a jaw dropping 75%) within the next 4 years.

In the UK, we are, of course, facing the same side effect of our ‘civilised society’ and the government has been trying various approaches to not only educate, but also ‘nudge’ the population into healthy eating habits.

But what struck me about today’s story is the language - the ‘nutrition battle’. We are used to hearing about patients ‘battling cancer’ and we read stories about the ‘battling infection’ but this is the first time I have noted the nutrition battle. I think this is spot on. It is a battle. A battle to educate, advise, warn, coach, encourage, bribe, incentivise – do whatever is needed to reduce obesity rates and the dire personal and economic consequences of unhealthy living.

‘Health desert’ is such a new phrase that Google kept giving me results for ‘healthy desserts’ and struggled to come up with a decent selection of links. Part of the first lady’s ‘Let’s move’ campaign – retailers and communities are encouraged to provide healthy food choices within walking distance for all. Another interpretation of ‘health desert’ is the education gap across some sectors of the population regarding vital nutritional understanding.

So – let the war against obesity continue. Tough talking should lead to tough actions. I have no doubt that this battle will be extensively discussed during several sessions at the conference over the next few days and I shall be interested to see just how much, if at all, things have changed from  a corporate wellness perspective since I attended this event last year.

Sunday, 23 October 2011

Commerce has its part to play in keeping NHS costs down.

It is widely recognised that the biggest challenges facing the NHS are rising costs of medical innovations and care, and the ticking time bomb of a nation making unhealthy lifestyle choices. The population will live longer but in a less healthy state, due to increased incidence of diseases such as cancer, diabetes and heart disease, linked to inactivity, bad lifestyle habits and obesity.

As we all know, these challenges provide the context of the NHS reforms proposed by the UK Secretary of State for Health, Andrew Lansley and Public Health initiatives are key to the future viability of state funded healthcare.

This is where commerce and industry comes in. Employers face the same conundrum as NHS leaders - how can they keep their target population healthy, and reduce the costs of healthcare to their organisation. The costs to commerce include the effect of medical inflation on health insurance claims and premiums for their insured employees, the economic burden of illness-related absence affecting all staff and the impact of presenteeism, where an unwell employee stays at their desk often due to insecurity or work pressure.

This is a good reason to keep a close eye on the US health system. President Obama’s healthcare reform, The Patient Protection and Affordable Care Act (PPCA) puts the onus of health care costs for employees and their dependants squarely onto the shoulders of employers. Already motivated to keep their staff healthy for altruistic and economic reasons, this additional burden has certainly focussed employers’ minds on creating a healthy workforce with the aim of reduction in costs and increased productivity.

Motivating leaders to invest in wellness programmes and incentivising employees to adapt their behaviours is a high priority for all forward thinking organisations both sides of the Atlantic. I am attending the US Corporate Wellness Conference in Chicago next week to monitor the views and opinions of those tasked to tackle this major issue. The theme this year is ‘Progress in motion – creating a healthy culture’.  Sharing of this knowledge between companies and continents is crucial in bringing some control to the accelerating juggernaut of health inflation and a generation of individuals with destructive lifestyle behaviours.

In the US, companies are obliged to address healthcare costs thanks to the PPCA. In the UK, there are very good socio-economic reasons to do the same. Most successful workplace healthcare initiatives can be mirrored by public health leaders for the population at large. And every penny spent on improving health in the workplace will either indirectly or directly have a positive impact on savings for the NHS and the wellbeing of the nation as a whole.

Friday, 21 October 2011

That Friday feeling - from Health insurance to hanky panky..

I must confess to being a little jaded today after a very late night (or early morning) following the Health Insurance Awards last night. This is the annual black tie bash where the industry honours good work and, as importantly, an opportunity to dress up, enjoy the glamorous surroundings of the Great Room at the Grosvenor House Hotel and catch up with friends and colleagues.

This year, like every other, the chat didn’t just include personal gossip, there was also some debate (admittedly over a drink or two) about the state of the industry, the challenges facing healthcare businesses and the economic climate in general. I noticed one thing that was very different this year was that the NHS was mentioned with more frequency. Whichever part of the healthcare delivery or funding landscape they occupy, it is now crucial that everyone understands the current state of affairs in the public sector.

If last night’s chat was anything to go by, those working in the Health Insurance industry (and not just the policy makers) clearly have an appetite to get to grips with the Health and Social Care Bill, appreciate the threats and opportunities that reform may present and have an empathy for the challenges facing NHS staff and concerns of patients. This is a very good thing.

On a much lighter note – I had decided that, thanks to my delicate, post party state, I would try and keep the commentary a bit more cheerful. So I was happy to read an article in today’s Daily Telegraph entitled ‘ Frisky students at hospital warned’. The article tells of two medical students – how can I put this – ‘making out’ on a sofa outside a lecture theatre at Southampton General Hospital (SGH) Following a complaint from an unwilling spectator an associate Dean of the University sent an email to medical students advising them to ‘find a more comfortable place that it out of public view and off NHS property’

I would like to thank the frisky couple for providing that rare gem - an NHS story that actually made me smile. I also have a bit of advice for these frolicking medical students. In a few years you will be overworked, stressed, underfunded medics working in a profession under unbelievable pressure. So in the meantime - get your fun while you can, and I hope that SGH will hold many happy memories of ‘sofa moments’ for you.

Who knows what lies in store for you and your employer, the NHS, in the future.

Tuesday, 18 October 2011

Waiting times target manipulation - another tale from the front line

Since starting this blog, those involved with healthcare regularly contact me with tales from the front line – good and bad. One thing I always guarantee is anonymity and the other rule I have is, of course, to check authenticity as much as possible.

A young booking clerk, currently working for a Trust which aspires to Foundation status has told, with some distress, that she is about to hand in her notice. The reason for this is ‘I didn’t join the NHS to do this sort of thing – it’s wrong – I feel so sorry for the poor patients’

And what is ‘this sort of thing’?

The girl was told by her manager to phone up many of the people due for surgery this week and postpone their booking. These patients will all have had their pre-op checks, will have made personal arrangements for their hospital stay and will have been psychologically preparing themselves for the event. What is so unusual about cancelling operations you may ask? In this case – it’s the reason for the shuffle in operating list that caused this clerk some concern.

The patients who were being cancelled have all been on the waiting list for more than 18 weeks (exceeding the current target). The clerk was advised to call up a new group of people offering surgery to be undertaken in the newly vacated slots.
The new group of patients given the advantage of using these new slots have all been on the waiting list just less than the 18 week target. The motive quickly becomes clear. Those who have already exceeded the target will have been noted in the stats – those just about to reach the 18 week cut off will narrowly miss the deadline and avoid worsening the Trust’s waiting list figures.

I’m not sure if this tale is shocking or not, probably even old news, but it is certainly very sad. Presumably the motivation behind this action was to avoid further financial penalty and possibly aid the Foundation Trust application. Anyone involved with targets in any industry will do their best to present the figures in a favourable light but this must not be to the detriment of individual patients. I wonder what sort of pressure whoever made the decision to fudge the figures must have been under, especially as this will have caused considerable distress to some patients and maybe put them at risk.

The actions of this hospital trust in disadvantaging some patients to expediate targets shows that in the red mist of pressure, cuts and politics, hospital and healthcare providers may be losing sight of the core values of the NHS. Outcomes, targets, performance measures – call them what you will – these benchmarks will always be associated with healthcare. But we must not let the desire or need to hit targets distort the very heart of what we are here to do - help people to get better and keep them well.

Friday, 14 October 2011

Ministers behaving badly must go.

I try to keep this blog apolitical and would struggle if pushed to give an allegiance to one party. So I am writing this post as an independent observer disappointed with three of her majesty’s government ministers. I am also writing as a healthcare evangelist – and it is impossible to separate health and politics right now.

I won’t delve too deep into today’s resignation of Liam Fox, the Minister for Defence, as there is blanket coverage already available. At best – he showed very poor judgement - at worst, broke the mistrial code regarding conflict of interest. But either way – you don’t take your mates to work with you – do you? Ministers are, or should be, leaders. And leadership can be a lonely role. I must confess that when I was an employed director I would have quite liked to have a friend in tow – even my Mum sometimes! But it’s simply not done.

Then – even more bizarrely – we have the case of Cabinet Office Minister Oliver Letwin disposing of sensitive government documents in a park litter bin on five separate occasions. What?? I’m not a particularly over cautious individual but I shred any bill with my details on it and burn client information of it’s no longer needed. I would never, ever, ever dispose of anything remotely private in a public bin! Letwin is guilty of extreme stupidity. If his judgment is so poor on something as fundamental as confidentiality – Heaven knows what other imbecilic things he gets up to. He has to go

And finally – oh dear. Andrew Lansley – the beleaguered Health Minister. I have no doubt that Lansley is an honourable and intelligent man who genuinely believes that his reforms are the right way forward. But for nearly a year now he has consistently ignored the views of the experts in health – the consultants, nurses, GPs, therapists and managers who all tell him that the Health and Social Care Bill isn’t the way to solve the NHS woes. He is fixated on a solution that does not actually address the problem and this intransigence is now actively damaging the state provision.

But the killer blow for me was Lansley’s performance at BBC’s flagship discussion programme, Question Time. Questions are posed by a public audience to a panel of politicians and ‘thought leaders’ and the audience have an opportunity to join in the debate. With Lansley on the panel, of course health came up. The question logically enough was something along the lines of ‘when so many medical institutions and clinicians are against the NHS reforms, is it wise to go ahead?’ Lansley’s response was measured. Then a member of the audience, a health worker, very calmly and eloquently gave her opinion, finishing with ‘Mr Lansley, I don’t trust you’. I’m not sure if Lansley knew the camera was on him – but he sneered at this woman with undisguised contempt.

It was actually quite chilling. Twitter went ballistic demonstrating very clearly that I wasn’t the only person to notice that the one thing NHS staff and Andrew Lansley have in common is a mutual and reciprocal dislike and disrespect. In that split second, 8 million viewers saw what Lansley thinks of many of the 1.5 million NHS workers for whom he has a responsibility. He is so disconnected from this population and apparently dismissive of their views that he didn’t even hide his feelings.

If a CEO of a large corporation loses the respect of his staff and ploughs a furrow not in the best interest of that organisation – the board would normally dismiss him. And so it is with the UK Secretary of State for Health.

It’s time for Andrew Lansley to go.

Wednesday, 12 October 2011

The Lords have failed the NHS today.

I am now well and truly off the fence and must record my deep disappointment with the House of Lords vote today.

Like so many associated with the NHS, I judged the Health and Social Care Bill to be a badly constructed piece of legislation – emanating from the world of Andrew Lansley – not a world that most clinicians and healthcare workers understand.

Then as time and debate continued, I started to accept that in spite of coherent and intelligent opposition from literally thousands of highly knowledgeable experts representing millions of people, the Coalition intended to forge forward with the reforms. Ever an optimist, I even believed that the amendments to the reforms could be workable and thought that maybe a point of no return had been passed where maybe it would be better for the NHS to live with this difficult Bill rather than continue to operate in the current no mans land.

But as the House of Lords debate started, like many of us watching this political saga, I began to hope that cometh the day, cometh the Lords. The Lords have the power to send the Bill to a select committee that would further delay the legislation which could have effectively derailed the reforms. 

Despite some excellent argument to the contrary, the learned gentlemen and women took the easy way out. 354 peers voted against an amendment calling for the Bill to be further amended versus 220 who voted for the amendment. It was embarrassing to note that several speakers spoke of Lansley’s ‘good intentions’ with his reform. A bit like saying ‘bless’ as you watch an inadequate and mortifying performance by someone not quite in control of their faculties on The X factor.

As Lord Hutton said ‘Good intentions do not make good legislation…. The white paper has become a white elephant and all we hear is white noise..’

Lord Tugendhat spoke in praise of the managerial staff who have borne the brunt of implementing already challenging budgets as they face their own redundancy. He also made the very good point that the ‘Nicholson Challenge’ (to reduce costs in the NHS by 20 billion over 4 years) was enough of an incentive for reform without cumbersome, complex and expensive legislation. But he felt there was ‘no going back’ as ‘too many eggs have be broken and no omelette made’

One of my Twitter friends (@Scoobydoc) made the very good point that ‘there will be no omelette with these proposals – just mushed egg on the floor’

Another tweet (@mulberrybush) said  ‘what an appalling position – going ahead with the wrong thing just because so much damage already done’

They are right of course.

So… we have 75% of GPs calling for the Health Bill to be withdrawn. We have leading clinicians, medical organisations and Britain’s Royal Colleges of Medicine calling for ‘substantial changes’ to be made to the reforms. Non–politically motivated supporters to this radical reshuffle are as rare as hen’s teeth.

And yet the Health and Social Care Bill has cut a swathe through good sense and expert opinion. Top down re-organisation of the NHS was not part of the Conservative or Lib Dem manifestos. Opposition to this reform is widespread, real and heartfelt.

It’s not just the NHS I fear for today. My belief in democracy is shaken too as a piece of incredibly unpopular legislation comes closer to implementation.

Monday, 10 October 2011

Will NHS reform really get an old lady the help she needs to eat her hospital meal?

Two stories in the Sunday papers yesterday demonstrated very clearly the state of play on NHS Reform.

A front page story in The Observer reported ‘Ministers fear the Lords will kill off controversial reforms’. If the bill is ‘so badly stalled it would fail to get Royal assent by next Spring – meaning it would fall’. It doesn’t take a rocket scientist to work out that if the bill founders, the NHS will continue to sail in unchartered waters without maps or GPS.  Sir David Nicholson has gone on record as saying that more delays would be ‘hugely damaging’ I agree with his view that the ‘NHS needs clarity and consistency, particularly about the timetable for modernisation’. But did he mean hugely damaging for savings initiatives or hugely damaging for patients? Or both?

The Sunday Times focussed on the scandal of inconsistent nursing care with ’20 hospitals break the law with unsafe care’ The article makes for very distressing reading, with reports of patients’ calls for help being ignored as nurses get on with their paperwork, and meals and drinks being left out of reach of the elderly. Spot checks by the CQC (Care Quality Commission) have resulted in a painful and embarrassing catalogue of bad care, and lack of caring (two different things). It is truly shocking that patients should be left wanting for the most basics of care.

So what should be the priority here?

The passage of the Bill through the House of Lords makes for interesting political commentary. This may be an opportunity for the Lords to really demonstrate the value of their institution and halt some badly thought out reforms. But will this really help? What about the frail old lady who can’t eat her meal because the nurse or care assistant simply can’t be bothered to remove the cling film. Does she need to understand who commissions her care? Is she really interested in outcomes? Probably not. She just wants to get better and receive some gentle help and care along the way.

And please, ward staff, don’t give me you are ‘too busy’. It’s basic human kindness and good sense to notice if a patient needs help with their meal. Another example was of two nurses having a conversation between themselves while assisting patients to eat their meals. That’s just plain bad manners – and how mean, considering that may have been one of the few opportunities during the day for some interaction by that patient with another human being.

To bang my old drum again. While the argy-bargy of political bartering continues, patients are not receiving the care they deserve. Leadership, training, a caring culture and performance management do not need a Bill of Parliament. Good, strong management in all NHS facilities is a must. And it’s needed NOW.

Many commentators, me included, have quoted ‘shuffling deck chairs on the Titanic’ and ‘fiddling while Rome burns’. But sadly – these metaphors still apply.

I am put to mind of one of my favourite, silliest of films – Airplane. There is a very poorly passenger, with a naso-gastric tube and IV drip and a well meaning person starts to play the guitar and sing to try and raise her spirits. A jolly sing song ensues, with everyone on the plane ‘engaged’ (although that buzz word didn’t exist in the 70’s when this film was made). What the group fail to notice is that, in her enthusiasm, the songstress has disconnected the patient’s drip. The patient goes into convulsions, unnoticed as everyone else on the plane sings and claps, believing they are doing a good job.

Luckily – another passenger notices just in time and reconnects the IV before the patient expires. Perhaps the most appropriate and uncomfortable metaphor for the NHS so far…

Thursday, 6 October 2011

Blurring of lines? GPs must operate within clearly marked boundaries

A story uncovered by the BBC earlier this week is a classic example of a good reason to have concerns about handing a large proportion of the NHS budget to GPs.

A GP practice in Yorkshire has apparently written to some of its patients advising them that certain minor dermatological procedures will no longer be available at their local NHS Trust and offering the treatments privately.

If this is true – it is wrong on so many levels.

I support any GP who takes proactive steps to maintain the health and wellbeing of their patients. But removal of skin tags? (£56.30). Is this a public health issue?  I’m aware of the obesity epidemic and the ticking time bomb of diabetes – but an  Armageddon of skin tags? A massacre of benign tumours (£243.20)?

I wonder what the cost of this mail shot was in terms of time and postage. And what was the motive behind it? Giving these GPs the very best benefit of the doubt and assuming they are concerned for their patients’ welfare – one cannot nevertheless deny that that one of the private options offered was a Clinic ‘wholly owned and operated’ by the GP practice.

So – here we have a private company potentially benefiting from a mail shot that is apparently generated using NHS patient details to promote its services. Can you imagine the outcry if a private hospital used an NHS GP practice’s database to promote cosmetic services in the local area?

Clare Gerada – chair of the Royal College of General Practitioners shares the concerns of many, saying ‘We believe that the boundary between what a GP offers under their NHS provision and what is offered for a private fee, is in danger of becoming increasingly blurred’

David Cameron at the Conservative Party Conference said ‘It is our policy to protect the NHS…’ I have no doubt that the coalition genuinely has no intention of privatising the NHS and I support competition for the delivery of some services from the private sector, especially if commissioning decisions are based on quality and price.

But let us not forget that most GPs are self employed, private contractors. I fear that Andrew Lansley, the Health Secretary still doesn’t fully understand that by  handing the lion share of the NHS budget to GPs there is a real danger that in some cases the lines may not only become blurred – in some cases they may disappear altogether.

Tuesday, 4 October 2011

Andrew Lansley fails to ignite the Tory Party Conference

Lansley fails to ignite the conference.

Sad as I am, I sat in front of the TV in rapt anticipation for Andrew Lansley’s Tory party conference speech. I wrongly assumed that the contentious Health and Social Care Bill would be high on everyone’s agenda but the conference hall was only half full as the audience awaited the Health Secretary’s appearance.

The choice of music just before the start of the session was bizarre – Shawn Mullins’ song ‘All in my head’ with the lyrics:
‘Is it all in my head?
Is it all in my head?
Could everything be so right without me knowin’?’

The song goes on:
‘Everyone needs a little love – to make it all work out..’

Was this a subliminal plea to the Tory faithful to be kind to their beleaguered reformer?

Lansley gave, as usual, a polished performance. Quoting many of the good work going on in the NHS and it was notable how often the N word was mentioned. Nurse. Lansley has realised that bigging up GPs as the only clinicians who count with the initial draft of the bill was a fundamental error.

The audience was as lukewarm as a cup of tea left by an old lady’s hospital bed. Ripples of polite applause interspersed the usual sound bites but to be fair, I found the Health Secretary more convincing that normal, especially when discussing outcomes and integrated care.

He received the mandatory standing ovation, albeit very muted – and I couldn’t help wondering if the delegates were stretching their legs after a long day sitting in conference rather than getting excited about a Bill that could cost them a second term.

The panel who joined Lansley were actually more convincing. An amazing nurse called Vicky Bailey spoke with great authority about practice based commissioning and the excellent work that her organisation, Partners in Health, had achieved with integrated care.

The next speaker, Neil Bacon, was billed as ‘a doctor and entrepreneur’. Yes. I’m judgmental and yes I mentally switch off when anyone refers to themselves as an entrepreneur.

Another nurse, Sylvie Hampton spoke with true passion about her wound healing social enterprise, while turning a few gills green by showing an explicit slide of a nasty wound. This speech described a great example of the value of private providers as she demonstrated the high quality cost saving treatments her organisation offer. Sylvie is a powerful advocate for ‘any qualified provider’ and went on to say that her team were ‘a new breed of private provider to the NHS – anyone who thinks this is privatisation is nuts’

And then it was business as usual as Simon Burns, huffed and puffed his way through his presentation. There is always something of the pantomime about this health minister and he didn’t disappoint as he raged about how the reform plans have been ‘discounted by those with an axe to grind’

It was interesting to note that the most positive and memorable messages came from the two nurses who described the success of their services so effectively. More interesting was the fact that both these initiatives were in place long before the Health and Social Care Bill was a twinkle in Andrew Lansley’s eye.

Vicky Bailey’s initiative was in her words ‘nothing new – we’ve been doing this since 2006’. And Sylvie Hampton’s company first did business with the NHS in 1999.

The words of Shawn Mullins song, played just a hour earlier sprang back into mind..

 ‘Could everything be so right without me knowin’?

Monday, 3 October 2011

‘Employee Benefits Live’ conference and exhibition

‘Employee Benefits Live’ has become an essential part of the calendar for the UK Employee Benefits Industry. This is an excellent opportunity to meet potential clients – reward and benefits professional flock to the event – it’s also a great networking forum. This year was no exception – The London Design Centre was buzzing with representatives from every aspect of the industry for two full days last week.

The exhibition hall with packed with stands from 100 organisations, plying their wares and this year three major themes caught my attention. The first two came as no surprise.

Firstly - as expected, the staged introduction of the new auto-enrolment regulations for pensions is a huge issue for employers. What started as mild interest a year or so ago has now become harsh reality – this reform is coming whether we like it or not and fines for non-compliance will be levied. This came out as the major concern from my straw poll of the reward and benefits professionals who attended.

Secondly – employee engagement. Whether firms need to educate their staff on health and wellbeing, help them to appreciate their benefits packages or simply to engage them on a wide variety of issues, this is now an essential element of an employee benefits strategy. Online solutions, engagement events organisation and sophisticated flex benefits platforms were all well represented.

Thirdly – and more of a surprise for me. Bicycles. I’ve never been very good on a bike since falling off in front of the postman’s van at the tender age of 9 (the memory still lingers – probably wasn’t great for the postman either). Bicycles seemed to dominate the exhibition space. I guess this shouldn’t really come as any surprise as a Cycle to Work scheme ticks so many boxes. Corporate Social Responsibility – keeping your staff fit and making your contribution to reducing the company carbon footprint. Cost saving – with rising costs of petrol and the inconvenience of public transport, funding a cheaper method of commuting for your staff is a no-brainer. Cost effective and tax efficient - a low cost benefit with high value returns. One exhibitor has reported a 40% increase in uptake already this year.

I always come away from this exhibition laden with information and goodies and this year in these economically restrained times I expected there to be a toning down of the corporate offerings. Far from it – champagne and cocktails flowed from several stands, and had I not been driving home, I could have floated back! Cloth bags, rucksacks, stress balls, pens, sweets and usb sticks were in abundance. Apparently the Boots Opticians goodie bag was exceptional and was even described as an object of desire in a discussion thread on Linkedin…

As Mark Twain said a century ago:

‘Many a small thing has been made large by the right kind of advertising’