Wednesday, 26 December 2012

Christmas 2012 - business as usual?

So how was it for you? I hope the festivities went well and you had a happy time with friends and/or family. My day started well – just the way I like it – some peace and quiet before the hoards arrived. The halls were decked, table was looking beautiful – fitting of any stylish home magazine, the log fire burning, carols playing, turkey safely nestling in the oven as I prepared the vegetables.

And then disaster struck. Careless as ever, and not concentrating on the task - and sharp knife - in hand, I managed to gauge a deep wound between my thumb and forefinger. Ow! And then the blood started to flow. And flow. And flow some more. As various scenarios played in my mind, typically more worried about the mountains of food that threatened to spoil rather than the injury temporarily slowing me down, I suddenly realised that wasn’t sure what to do next. I knew this wasn’t a 999 (or on the US, 911) job. My life wasn’t hanging in the balance, but I did have an injury that may need medical attention. Should I go to casualty (emergency room)? I seemed to remember that my local Accident and Emergency unit was closed and I thought I knew where the nearest one was. But I also had a vague recollection of a leaflet coming through my letterbox mentioning a minor injuries centre that had recently been opened. But where was it? Was it open on bank holidays? Should I ring NHS direct – the free health information line? But where was the  number for that? Or how about my GP out of hours service? Where was that damned leaflet?

Luckily by the time all options had been fairly unsuccessfully explored, vast amounts of kitchen roll and pressure stemmed the flow and the mini crisis over.

But now as I reflect on these events on Boxing Day I realise several points. Yes, I must be careful with sharp implements. But as importantly – how come a healthcare geek like moi, who professes to live and breathe the business of health – failed so miserably to understand my local health services? Some quick research on line demonstrated that it is easier to find out where to recycle my Christmas tree (2 clicks) than to find out where to go with a bad cut (7 clicks and to be honest I’m still not clear and I still don’t know if it’s open 24/7). One thing is clear – the NHS needs to up its game on the information stakes. Minor injuries services are only effective if people know how to access them.

One thing I didn’t have to worry about was ’where’s my credit card? will my insurance cover the bill?’ I knew that if I needed it and once I could find it, the treatment would be available at no direct cost. The NHS is still ‘free at the point of delivery’ and this is something we should continue to cherish as another stressful year in healthcare draws to a close. Some things never change, the concept is still great, the majority of services excellent but stratgey and clarity still lacking.

And the leaflet? I found it wedged between two books ‘Excel for Dummies’ and ‘Communicating Effectively’. Go figure….


Sunday, 2 December 2012

Pat on the back for the Aussies and their anti-smoking initiative

Australia and Australians are a bit like marmite or republicans – you either love ‘em or hate ‘em. I am firmly in the middle – admiring their weather, their positive attitude, their sportsmen and their wide open spaces but not so keen on the fact that my step daughter has been lured to sunnier climes and now resides in Brisbane.

But this weekend I salute the Australian government and their health ministry in sticking to their guns with their anti-smoking strategy. Australia is the first country to make it compulsory, by law, to sell cigarettes in plain packaging. Except it’s not actually plain packaging – the lethal drugs are now being sold in packs emblazoned with gory pictures representing the various diseases caused by smoking. A supermarket’s cigarette cabinet down under now looks like the horror section of a DVD rental store. Manufacturers have no choice but to place these graphic images on their merchandise and they have no choice of colour for their packs either – they must be green. The only nod to brand is the ‘brand variant’ being listed in small print at the bottom of the front of the pack.

Will this work and should a country seek to restrict industry in this way? In my opinion the answer to both is yes.

The tobacco industry is vehemently against this initiative, saying that it won’t work and will increase tobacco smuggling, forcing them to decrease their prices in order to be more competitive, hence leading to increased smoking. Mmm – a rather tenuous argument methinks. Of course they are against this move because it is bound to have a detrimental effect on the glamour associated with smoking by the young. Maybe there is an odd approach to smoking in Australia. My step daughter has told me how surprised she is that many of her peers, mainly young(ish) housewives smoke – usually in secret – to the extent that they wear rubber gloves when they nip outside for a quick fag so there will be no tell-tale marks on their fingers – bizarre!

I suspect that the immortal youth who already smoke will mentally distance themselves from the upsetting images on the packs, believing that such health nightmares could not happen to them. But maybe the horror pics will stop the next generation from starting in the first place – it’s got to be worth a try.

The pictures on packs in the UK do have some effect – a young friend of mine who used to smoke said he was tempted to ask for a pack not by brand but instead he would try to pick the pack with the least upsetting picture! I wonder in the future whether Australian smokers will ask for ‘the pack with the rotting teeth and ulcerated mouth’ rather than ‘the one showing a young women in an oxygen mask’.

It will be very, very interesting to see if this bold move makes any difference in the number of cigarette packs sold in Australia, and hopefully a long term study will prove that this has gone some way in reducing the number of smokers in the next generation. If this does work, and Australia reach the targeted reduction in smokers from 16% of the population in 2007 to less than 10% by 2018, then here in the UK we should take note of hard evidence and follow their lead.

And to the pro-smoking lobby and accusers of a ‘nanny state’ regime I have one thing to say – carry on smoking if you must, but don’t expect anyone to make it easy for your peers, or more importantly your children, to take up this lethal habit.


Friday, 23 November 2012

Whither procurement?

Or should I say wither procurement?

It was always going to happen – those ‘I told you so moments’ as top down NHS restructure led to cracks in the system. Alas, however well-meaning Andrew Lansley’s Healthbill was, the execution and interpretation of the changes were always going to lead to trouble as the NHS struggles to achieve savings of £20bn over the next four years.

A good example is procurement. As I witness changes in procurement strategy and behaviour I can’t help thinking of that hilarious scene in the iconic 60’s movie, The Italian Job. The incompetent would-be villains have a practice run to open a bullion van but overdo it with the explosives. As the van is blasted to smithereens, the head honcho says  You're only supposed to blow the bloody doors off!"

Some trusts and Clinical Commissioning Groups (CGGs) are viewing procurement as a blunt instrument of torture, aiming at sweeping cost cuts without considering the implications of squeezing suppliers till they, at best, bleed, at worst, expire. I was passed a document recently from a Hospital Trust advising a supplier that ‘in addition to and savings initiatives driven by our procurement department, we are also applying a 2% settlement discount on all invoices presented during 2012/13’.Take note – this isn’t an early payment settlement, this is basically chopping 2% of the bill, and it’s quite likely that the bill will be paid late too. Hardly ethical practice. This supplier, like many others, had also been advised that there will be an additional 5% reduction in terms or no deal. Like many independent suppliers working with the public sector, this supplier’s margins are virtually zero so what can they do? Operating in a specialist clinical device sector, this company could go out of business and the NHS will lose access to some exceptional intellectual property and equipment vital to enhance some patients’ quality of life.

The procurement mantra should be ‘value’, not ‘cheap’, and short term savings are not necessarily translated into long term value.

Effective procurement needs a robust strategy, experienced operatives and clear tender process. The ‘various procurement organisations and initiatives’ (to quote a recent procurement conference promotional literature) do not generate the clarity needed. It is highly time-consuming and expensive to complete an NHS tender process and if each Trust or CGG uses a different document, suppliers are at risk of re-inventing the wheel with alarming regularity.

Speaking of experienced operatives, a quick glance of the interim job ads display an air of desperation. As the disassembled Primary Care Trusts created an unprecedented brain drain, the newly formed procurement teams are, in some cases, sadly lacking essential expertise. Here is one of many of those ads:

I am urgently seeking a Commissioning Project Manager for a 4 month contract in London. Essential skills include:
- NHS experience
- Masters degree or equivalent managerial level experience or qualification
- An understanding of the NHS policy framework
- Understanding of procurement and contracting rules in the NHS
- Experience of working successfully with clinicians particularly GPs
The ad continued with other worthy attributes such as stakeholder engagement, bla bla.

But where would such a candidate have gained such experience? In the NHS. So this organisation will either be re-employing someone who was made redundant earlier or they will be pinching an expert from another procurement body. Same old same old.

No-one can argue that savings must be made for the NHS to remain a sustainable, free to all, health service. But efficiency savings should be as the name suggests – efficient. Working smart, not just cheap, is the way forward.

Sunday, 4 November 2012

Liverpool Care Pathway – one man’s meat is another man’s poison.

This is a debate this isn’t going away any time soon. And now the government is including a change to the NHS Constitution which will, in effect, change the law regarding the way that the Liverpool Care Pathway can be applied.

The suggestion is that relatives must be involved in decisions regarding ‘end of life’ care for terminally ill patients. I have a strong personal view about this having nursed my beloved husband through to what I would describe as a ‘good death’. Peaceful, without pain and in my arms. You could say that we were fortunate, as a pharmacist and stroppy mare, I was intimately involved with every decision about pain relief and care and no, the Liverpool Care Pathway was not included.

The regime is designed to relieve suffering and of course includes pain relief but controversially may involve the withdrawal of food and water. This sounds horrific but must be viewed in the context of a terminally ill individual who may be incapable of taking on board sustenance.

As the news of this proposed change in the NHS constitution was announced I listened to an interesting radio debate on the subject. Two callers, both recently bereaved, spoke with passion and knowledge about their recent experiences of supporting a much loved relative through their final hours, one with a highly positive view of the LCP, and one vehemently against. They both spoke angrily about ‘dying with dignity’ – a phrase that makes my hackles rise at every mention. How can anyone describe what dignity means? Surely a ‘good death’ – i.e. – at peace, in comfort and hopefully without pain – is what we should want.

I remember a recent news item about an old lady suffering from pneumonia. The nursing home advised her niece that there was little chance of recovery and they would adopt the LCP to ‘ease her passing’. The niece was having none of it and knowing what a feisty lady her aunt is, insisted that antibiotics should continue and there should be no talk of dying. Two years later, the sprightly old dear was enjoying a game of scrabble as she celebrated her 90th birthday.

Discussing care of a relative who is unable to speak for themselves doesn’t always work in the patient’s favour. There is a real risk (and no doubt plenty of examples can be found) where an elderly or infirm individual may be seen as a burden and a terminal care pathway seen as a blessed relief, not for the patient, but for their beneficiaries. Harsh but true.

So to get off the fence, what is my view of the LCP and a change in the constitution? Care pathways for terminally ill patients are normally designed specifically for that patient, discussed with the patient, or if that’s not possible, with their relatives. The LCP is one solution in a complex tool box full of options for a clinician to do their best for the patient. To focus this debate on only one method of terminal care is unhelpful and confusing.

As the former secretary of state for health famously kept saying – ‘nothing about me without me’ – in a perfect world, these life changing, and possibly life ending, decisions must be made with an informed balance. Doctors, nurses and therapists can only do what they believe to be best for an individual state of circumstances. The views of a patient and/or relative must be sought and the discussion must be recorded on the patient’s notes along with the way forward which has been agreed.

This will protect not only patients, but their clinicians too.


Sunday, 21 October 2012

Science vs. religion? – sounds a bit like the politics of healthcare

I should be heartened by the recent statement from the new Secretary of State for Health that he will be guided by science. Jeremy Hunt is on record as saying that his decisions would be ‘evidence based’. I fail to be convinced as one of his most publicised statements endorses abortion at 12 weeks and another supports the efficacy of homeopathy – neither of which preferences are ratified by the accepted wisdom of current scientific research.

His predecessor, Andrew Lansley seemed to be oblivious of much evidence based research and designed his reforms not based on science but his own form of religion – strongly held beliefs but little evidential back up.

And so it is with the politics of health. Good medicine is based on current scientific evidence balanced with the needs of the patients and available funds. I cannot exclude money from this definition as in the real world, cost benefit analysis will always be key. The politics of health, I believe, has a different definition. It is the balance (often unequal) of science and religion. The religion in health politics is the beliefs and possible bias of the decision makers, moved even further off-kilter by the colour of the party politics involved.

But one must have sympathy for the holder of the heavy and potentially poisoned chalice of the health ministry. I carefully included ‘current’ science in my definition of good medicine. I still shudder when I consider that 26 years ago I used to settle my precious baby on her front to sleep – luckily without ill effect. That was the advice at the time, even though now there is irrefutable evidence that cot death has significantly reduced since parents have been advised to lay their babies on their backs.

We are constantly bombarded with new pearls of wisdom from health researchers, especially when it comes to lifestyle and surgical options.  Working in both the public and private sectors, I am familiar with the anger experienced by patients when a treatment they believe to be essential is not offered by their NHS trust or approved by their particular medical insurer. Hysterectomies used to be ‘ten a penny’  but now there are other, less invasive and more cost effective ways of treating the symptoms that sent women in their droves to the surgeon’s knife.

Times change, health knowledge changes, scientific evidence changes. But all that any medical practitioner, and for that matter health minister can do – is to work within the accepted scientific guidelines of the time, study evidence not hypothesis, and make a decision based on here and now and not hearsay.

And please, whatever you do – leave religion and politics out of it.

Ah well – a girl can dream…

Thursday, 11 October 2012

The cost of silence – a high price to pay

The fallout from the sound of silence is being demonstrated with dramatic effect either side of the Atlantic right now. Two very high profile cases have shocked the health, sporting and corporate establishments where a catalogue of wrong doing is finally being exposed.

The world of cycling is finally accepting (or should I say admitting) that the iconic American cyclist, Lance Armstrong was probably at the head of a global doping cartel, cheating his way to world dominance of his chosen sport.

Here in the UK, the late Jimmy Saville, the legendary presenter, DJ and benefactor is being exposed as the predator of the worst kind, abusing the privilege of his status and taking advantage of vulnerable young girls. This abuse took place on BBC premises, at schools and within hospitals possibly over 5 decades. Truly shocking. I’m not sure which is most shocking, the multiple acts of abuse or the conspiracy of silence.

Like the first tentative spray of water fighting its way through the flawed concrete of a failing dam producing an unstoppable and highly destructive torrent, so the victims and silent enablers have started to come out in the open.

Of course, the highest priority for the authorities here in the UK is to provide appropriate support to the victims of Saville’s excesses, and finally help them heal.  Putting the human tragedy of these individuals aside for a moment – what about the corporate conspiracy of silence? What about those who shunned the victims who turned to them for support? The BBC, a highly respected organisation which appeared to support the culture of a blind eye. The teachers who chose to disbelieve a troubled teenager. So many observers, complicit through their silence, must take some responsibility for not speaking up. Or should they? Is it organisational culture that is the real culprit here?

The victims of abuse were not just failed by the TV personality, they were let down by those they trusted to know better.

In the corporate or organisational environment, people tend to stay quiet about bullying, abuse, inappropriate behaviour, bad practice or fraud for one of two reasons. Fear or gain.  I suspect that currently in the workplace it is fear that is the driver to silence.

I am aware of no figures available to quantify the number of excellent employees who leave an organisation because of the conspiracy of silence.  Not speaking up because you know your concerns would be ignored is a damning indictment of any employer. What is the point of exposing bad behaviour if you know that at best you will be ignored, at worst your career prospects will be damaged or you could lose your job.

When I was much younger, I learnt the hard way that speaking up must be carefully managed. I discovered that my immediate superior was using company funds to pay for furniture for his family home. Even worse, I discovered that some of the ‘patients’ on the clinical trials we were setting up were in fact this doctor’s relatives, enrolled for juicy fees and results were being fabricated. Horrified, I challenged the perpetrator and was summarily fired (you could in those days). Our paymasters were in the US and when I called them to warn them of the irregularities, my comments were understandably viewed with some suspicion as an aggrieved ex-employee. Luckily, they trusted my word enough to embark on an investigation which proved my allegations. Had there been a suitable whistleblowing policy in place, the human and economic cost of my discovery would have been significantly lower.

Employee engagement is a much vaunted corporate value – and this should include the knowledge that your voice will be heard. Easier said than done. Which is where a whistleblowing policy comes in.  

As the Chartered Institute for Personnel Development (CIPD) states:
'A clear procedure for raising issues will help to reduce the risk of serious concerns being mishandled, whether by the employee or by the organisation. It is also important for workers to understand that there will be no adverse repercussions for raising cases with their employer.’

 Legislation is in place to protect whistleblowers – the CIPD summarises:
‘Employees and workers who make a ‘protected disclosure’ are protected from being treated badly or being dismissed. The key piece of whistleblowing legislation is the Public Interest Disclosure Act 1998 (PIDA) which applies to almost all workers and employees who ordinarily work in Great Britain. The situations covered include criminal offences, risks to health and safety, failure to comply with a legal obligation, a miscarriage of justice and environmental damage’
Whistleblowing is particularly vital in protecting the vulnerable such as those in care homes and hospital patients and the government funded Whistleblowing Helpline, offering ‘free advice to the NHS and social care’ has been created to enable staff to report ‘malpractice, wrongdoing and fraud’ (tel: 08000 724 725)

A similar helpline for all public and private sector employees is  a must- have to support health and wellbeing in the workplace, whatever your job entails – whether you are a bean counter or brain surgeon. To speak out is best for you, your mental and physical wellbeing and ultimately for the good of the organisation that employs you. Sporting bodies could clearly benefit by offering a safe environment to report drug abuse.

All NHS hospitals and care homes now have access to the whistleblowing helpline. I hope the BBC now has a similar facility at their disposal and strongly recommend that all organisations get cracking to introduce and implement an appropriate whistleblowing policy for the common good.

This should help make these scandals a thing of the past.

Friday, 5 October 2012

Ward rounds are all about leadership, responsibility and team work

‘Make ward rounds the cornerstone of care’ is the title of a recent press release issued jointly by the Royal College of Physicians and royal College of Nursing. The statement goes on to call for ‘a concerted culture change with clinical staff, managers and hospital executives engaging with, and focusing on, improving the quality of ward rounds’

Hear Hear!

Why are ward rounds so important? They are a tangible representation of responsibility, communication and team work. They are a classic example of an entity equalling more than the sum of its separate parts. Sometimes the old way is actually the best way. Routine may be the enemy of creativity but it is the lifeblood of consistent care. In a traditional hospital setting the ward round really was the heartbeat of ward life.

Progress into the 21st Century and shifts in hospital hierarchy at least means that the consultant is no longer (at least not usually) the pompous omnipotent demigod portrayed as Sir Lancelot Spratt in the comedy films in the 1950’s. A vast improvement in cross disciplinary respect, a growing understanding of nursing, paramedic, therapy and support roles and hopefully a regular dose of good manners means that each professional along the patient pathway has a valued part to play in patient care.

An uncomfortable thread that runs through iatrogenic (literal translation – ‘physician-induced’) tragedies is poor communication and blurred lines of responsibility among the medical staff. In the same way that team meetings keep commercial departments on track, so patients can benefit from regular contact and review with their medical team. Switched on patients and their relatives can also gain additional insight and feel more in control of their destiny if they can see and speak to their medical team as one entity.

The press release offers recommendations for a well-run ward round which make remarkably good sense. Such good sense in fact, that it seems shocking that many hospital wards do not currently follow this good advice:

·        Preparation for the ward round should include a pre-round briefing.

·        Consultant-led ward rounds should be conducted in the morning to facilitate timely completion of tasks during the working day.

·        A nurse should be present at every bedside as part of the ward round.

·        Patients, carers and relatives should be provided with a ‘summary sheet’ clearly presenting information discussed in the ward round.

·        Patients with dementia and learning disabilities should be supported as far as possible to make decisions about their care.

·        Patients’ records should be kept centrally to promote effective communication and team working.

·        Ward-round teams should utilise locally adapted checklists to reduce omissions, improve patient safety and strengthen multidisciplinary communication.

As our previous Secretary of State now famously said of the health reforms ‘the patient should be at the heart of everything we do’ and ‘nothing about me without me’. Worthy sentiments even if you are not a fan of a top down reorganisation.  It’s at the coal face of care where improvements are most important.

Regular ward rounds are a very good place to start.



Tuesday, 25 September 2012

What does innovation mean for the NHS?

One of the things I love about twitter is the way that random tweets can spark a thought process that leads us to look at things with an alternative eye and challenges the hitherto underutilised recesses of my mind.

The other day I noticed that Clare Gerada, Chair of the Royal College of General Practitioners tweeted ‘Can someone give me a clear definition of innovation in the NHS’?

I then had the luxury of a three hour train journey to Liverpool to contemplate this conundrum. Two diametrically opposite quotations sprang to mind. The first by Bill Gates 'Never before in history has innovation offered promise of so much to so many in so short a time' celebrates newness and change in all its glory. The second, by Coco Chanel 'Innovation! One cannot be forever innovating. I want to create classics'  honours the tried and tested.

Of course both of these quotes are applicable to the NHS in the 21st Century and maybe an appropriate combination of the old and the new is the Utopian vision we should aspire to achieve. Innovation in any context can be the excuse for a multitude of sins or a cacophony of excellence, but here is my personal view of where innovation should sit within the context of an NHS struggling with reform.

Innovation should NOT be…
The new buzz word! Yes the irony does not escape me. I have recently written a piece in Health Insurance magazine pleading for providers to stop using the ‘I’ word unless they really are coming up with something new. Whether it’s products, services, care pathways or medical techniques, please don’t say they are innovative unless they really are. The rehash and repackaging of old ideas achieves little and can cost much.
Change for change’s sake: Secretary of State for Health (whoever you are) please note. Change, such as radical restructure, rebranding or even just changing titles, must comply with measurable governance and provide a real opportunity for improvement. Change should not have a political expediency or be created on the basis of a need for heightened publicity.
Re-inventing the wheel: Same job, different title. Same function, different department. GP commissioners and disbanding  PCT’s. Enough said.

Innovation in the NHS SHOULD be:
Ways of working smarter: Needed at all stages of service delivery. This is innovation in the improved outcomes sense of the word– streamlining, service improvement, efficient pathway mapping, resource planning and possibly most important of all – robust leadership.
Looking at sustainable means of funding care: The public purse is not like the fabled magic rice bowl that refills on demand. Public private partnerships, patient contribution, increased taxation, improved use of voluntary resources – all must be considered to meet growing cost of healthcare.
Creating a system to not only educate the public but to generate changes in behaviour: The western world seems to be on a path of self-destruction with unbelievably unhealthy habits, from smoking to drinking, over indulgence and lack of exercise. Changing this self-harming way of life would not only be innovative, it would prolong healthy life and save the NHS billions.
Research and Development: Whether this is funded by commercial enterprise, charities or academic institutions – the unimaginable has already been achieved through innovation within the NHS and through strategic partnerships. Reform and cost cutting must not be allowed to halt this progress.

A crystal clear definition of innovation in the NHS? Not possible. But I can have a stab at defining the golden rule that should apply to all such innovation. It works for clinical research, and applies to basic management techniques, service redesign and lean consulting. What is the true cost of a planned innovation (in financial and human terms) and what is the potential, measurable benefit? Is there sufficient evidence or theory to justify the risk associated with the innovation (clinical, emotional, physical or fiscal). If these questions produce unsatisfactory answers then you should only proceed, if at all, with caution.

And one last quotation – accredited to ‘anon’  perhaps provides the closest to crystal clear I can manage..

‘Innovation is not the same as reform.’

Tuesday, 11 September 2012

The NHS - new term, new headmaster, same curriculum.

I’m sure that the coalition government has been exceptionally grateful to the Queen, our Olympians, our Paralympians and even US Open tennis champion Andy Murray for a wonderful summer of distraction – helping us to overlook the tricky issues facing the UK.

Well kiddoes – the summer holiday jollies are over and the new term has started. Back to the serious business of the economy, and more specifically for me and my readers – health. This time last year I posted a blog entitled ‘new term, new habits’ and made a request for all those involved with healthcare delivery to do the following: be nice, respect each other’s profession, acknowledge that others don’t know what you know, stop using jargon, make your meetings count, take pride in your environment and think integrated. It was a worthy wish list and when you think about it – all of the above was applied with incredible success to make our Olympic and Paralympic dream a reality.

But speaking of reality - as the children go back to school and we drag our eyes from the TV screen back to our p.c.s - what is in store?

NHS Reform is still happening and it’s no good pretending it’s not real. The new term brings  not only the same day to day challenges of delivering cost effective safe care,  but the NHS must start to get used some of the major changes. Yes – we have a different headmaster, but the curriculum is the same.

I see the only major significance of a new Secretary of State for Health is that now it will be Jeremy Hunt and not Andrew Lansley to face the barrage from the public sector unions and medical professionals as they continue to make their feelings clear.  

So – what I am hoping for this term? I hope that everyone involved with trying to make these reforms work accept that this is now law and whingeing won’t get them anywhere. I hope that the commissioners do the job they are supposed to do and that the balance of power does not rest as heavily on GPs as originally planned. I hope that hospital and community based health professionals have a significant say in patient pathway planning. I hope that the brain drain from Primary Care Trusts is not as bad as I fear it will be and that managers will provide robust leadership. I hope that the general public will understand that healthcare doesn’t come cheap and the NHS cannot pay for everything.

And most of all, I hope the new Headmaster will watch, listen and learn.

Tuesday, 4 September 2012

How will history judge Andrew Lansley?

As predicted, the Secretary of State for Health has been moved out of harm’s way in David Cameron’s government reshuffle.  Also as predicted there is a dearth of wise cracks about Andrew Lansley’s departure and muted celebration among NHS employees at the end of tenure for an unpopular minister.

But there have also been some kinder words – such as the Health Services Journal editor, Alistair McClellan who delivered the veiled compliment ‘…by a long shot – not the worst health sec of modern times..’ 

The Royal College of Nursing have hedged their bets – saying ‘In challenging times, the RCN has not always seen eye to eye with Andrew Lansley on the government’s health reforms. However, we have welcomed the continuous dialogue….’

The BMA's official statement was a little less tactful with 'The appointment of a new health secretary provides a fresh opportunity for doctors and government to work together to improve patient care and deal with the many challenges facing the NHS

And what exactly do I mean by ‘out of harm’s way’? Has the harm already been done? Or is moving Lansley to the new post of Leader of the House of Commons effectively taking him out of the firing line as problems with the Health and Social Care Bill inevitably escalate. He may well appreciate the relative calm of organising the government business in the House as the £20 billion savings target for the NHS becomes reality and the new Health Secretary, Jeremy Hunt sticks his head above the trenches to face heavier, and better targeted fire.

I wonder how the unbiased should view Andrew Lansley’s ten years’ devotion to the cause. And be assured that devoted he has been. Misguided, intransigent, short sighted,  tunnel-visioned – Lansley meant well but got it wrong. He is a politician with ill-conceived strategy who used flawed benchmarks.

I don’t believe that the Health and Social Care Bill will destroy the NHS – there are too many good people within the system to let that happen, but Lansley was the architect of much confusion who handed the mantel of power to, in the main, unwilling recipients as many GPs’ retirement has been hastened. His reforms will probably waste more money than they will save and his unsustainable sound bites outweighed his good ideas.

I wish Andrew Lansley all the best in his new role and who knows how history will ultimately judge him. But for now, he’s the Health Secretary who just didn’t listen.

Friday, 31 August 2012

NHS reform doesn’t come cheap

A good way to assess the state of any large organisation is to look at their current vacancies. Are they recruiting high calibre people? Are there many current vacancies? If so - why?

There is no easier way to feel the temperature of the NHS than the Health Services Journal, an industry publication that always prints the most up to date news and opinion but is also the first port of call for management and senior clinical posts within the public healthcare sector.

So it was quite an eye opener a couple of weeks ago to see 9 posts advertised by the NHS Commissioning Board (NHSCB). The title of each regional post is Local Area Team Director. The salary? £140,000 p.a. Alongside the ten regional director posts there are an additional 10 senior posts advertised with annual salaries ranging from £102,500 to £140,000 p.a. These jobs included ‘Director of Insight’ and ‘Director of Intelligence’

The adverts all start with the same introduction With a passionate commitment to secure the best possible outcomes for patients, the NHS Commissioning Board (NHS CB) will play a critical role in the modernisation of the health service driven by a new clinically-led commissioning system’

The invitation to apply continues with. Priority will be given to applications from employees in the NHS, Department of Health and Arm’s Length Bodies (ALBs) who are affected by change or who are at risk of redundancy’

A quick calculation to include employment costs shows that these 19 posts alone will be costing the NHSCB over £3 million every year.

Yes one could argue that it is commendable that the NHS is aiming to recruit high calibre individuals for a very responsible job. Yes, you could argue that it’s right and proper to employ those who had held similar posts before. Yes it’s good to give people who have been made redundant due to the disbanding of Primary Care Trusts and other organisation previously involved with commissioning.


As so many of us have been saying all along. The reform of the commissioning process means that the same people will be doing similar jobs but with different paymasters. Many of these may well have enjoyed generous redundancy payments and can now walk into another, similar job. The other, not so lucky individuals who have been earning considerably less, but are knowledgeable, competent and experienced will have left the NHS for good, taking their intellectual capital with them. A costly excercise all round.

It’s all nonsense really isn’t it?


Tuesday, 21 August 2012

There is still good news to be found about the NHS...

….You just need to look in the right place.

A close friend of mine, I’ll call her Jane, is currently undergoing treatment for cancer. She’s had a tough time of it – with chemotherapy, radiotherapy, surgery and now another course of chemo. Jane’s prognosis is excellent and she has approached the past year with remarkable pragmatism and calm.  I commented on her bravery and she said, ‘well I get a bit worried before some new treatment, but when I’m at the hospital – there’s no need to be frightened – after all, the doctors and nurses know what they are doing so I don’t have to be scared’.  A simple view but what a precious aid to recovery this confidence must bring. I am very familiar with the unit where Jane is being treated and it is a fantastic collaboration between the charity, Cancer Research UK and an NHS trust. A powerful mix of personally tailored treatment regimes, focussed care, innovation and even carefully controlled experimentation are all designed to give each patient the very best chance of survival or extended life expectancy.

The reason I know the unit well because my late husband Bob was treated there for several years.  Although he suffered from an incurable cancer, he took part in four clinical trials with the equally important aim of helping others and staying with his loved ones for longer. I shall never forget the kindness and professionalism of the Oncologist who looked Bob straight in the eye, without a hint of pity but with plenty of determination and said ‘we will do everything we can to keep you as well as possible, for as long as possible’. You can’t ask for more than that can you?

But back to the good news. The results from a recent National Cancer Patient Experience Survey have just been published by the Department of Health. Cancer Research UK welcomes this survey as a useful barometer of patient views and the results are encouraging. Questioned about treatment choices, information, and access to specialists, 88% cancer patients rated their overall care as ‘excellent’ or ‘very good’ and 98 Health Trusts improved their scores over last year.

I’ll say that again 88% of cancer patients surveyed rated their overall care as ‘excellent’ or ‘very good’. How come this doesn’t make a headline in the UK press?

Cancer Research UK states that the two key issues of greatest concern are research and early diagnosis. 20% of cancer patients surveyed were taking part in some sort of research study so the good news goes on, but the weak link in the chain is early diagnosis. The survey results show that nearly half of the patients still see their GP several times before seeing a specialist and 1 in 5 ends up at a hospital without even seeing their family doctor first.

I dearly hope that new commissioning practices as outlined in The Health and Social Care Bill will encourage GP commissioners to reduce the time lag between first presentation of a patient with potential cancer diagnosis at a GP practice to onward referral. Sadly I’m not convinced that this is the case. But in the meantime, let us celebrate the good news that this survey provides and give thanks that Jane’s confidence is well founded.

Monday, 13 August 2012

Our Olympic legacy isn’t just about sport and fitness

As life gets back to normal and we learn how to live without the sports fest, general bonhomie and national pride generated by London 2102 there is much talk about ‘Legacy’.

There are numerous articles in the national and specialist press about how we should use the impetus started by our elite athletes to encourage increased physical activity and fitness in the population as a whole. As the Health Services Journal states in this week’s issue, ‘we all know that participation in sport and physical activity is good for health and reduces healthcare costs’. The article refers to the NHS London document published in 2009. ‘Go London: An active and Healthy London for 2012 and beyond’ which sets out the strategy for improving health in the Capital.

I have no doubt that tens of thousands of us who were glued to the games will now seek out ways to improve our fitness or maybe take up a new sport. This is fantastic and it will be interesting to see if there is a measurable increase in sports participation in the future. Whether this will actually save the NHS any money remains to be seen. But I believe that there is a more immediate and potentially more beneficial legacy of the home Olympics

The volunteers, or games makers as they were creatively dubbed, were the hit of London 2102. Well informed, charming and helpful – they provided practical and emotional support at every venue. These willing souls embodied the spirit of the Games, and it is the joy, the positive attitude, the generosity, kindness and commitment that needs bottling. Oh if only we could see more of these precious commodities in the public sector. Yes, of course there are many, many committed and wonderful clinicians, managers and support staff in the NHS but most of them would benefit from some extra help.

I have written previously about my reservations concerning voluntary staff within the NHS, however if the principles applied to the Olympic volunteer army were adapted for a support team throughout the public funded health sector – they could provide the positive tipping point so badly needed by our hospitals, health centres and community groups.  I am fully aware that finding people prepared to give up a short period of time for a glamorous global event is very different from asking a more long term (but not full time of course) commitment to a  challenging, potentially distressing but ultimately hugely rewarding cause. An NHS volunteer army – perhaps a bit like the Territorial Army that appears to work so successfully alongside the regular professionals could be mobilised where needed in cases of emergency but also provide regular backup on a day to day basis.

If the government appointed an ‘NHS Volunteer Tsar’ I would suggest that the rules of engagement should be as follows:

National network: Volunteer roles should be clearly identified and recognisable nationally. Defined and routine training programmes should be designed to avoid re-inventing the wheel and ensure consistent quality. Cost of training to be borne from the public purse.
Titles: There should be a recognisable title and role descriptions for these volunteers – in the same way that ‘games maker’ has entered our vocabulary. This title would be a badge, and possibly supported by uniform to be worn with pride.
Extra care layer: A variety of functions and qualifying criteria should be defined. NHS Volunteers should operate in the same way that the games makers do – enhance the ‘customer’ (patient) experience within a defined remit.
These volunteers must NOT replace paid staff. A variety of functions should be the roles should be created as an extra care layer and absolutely must NOT be used as a way to cut costs. Difficult to police, I agree, but the Tsar would have to find a way to monitor this.
NHS establishments should be rewarded for appropriate volunteer practices. Having worked extensively in service improvement projects – I know that the best way to change behaviours within the organisations is to reward good practice. This could be measured in the same way that tariffs are awarded for meeting targets or performance criteria.

Volunteers are like any paid workforce – badly managed they can do more harm than good. But if you can mobilise the extra care layer to support paid staff, provide additional care and practical help for patients, maybe the spirit of the games could live on where it is needed most.

Sunday, 5 August 2012

Are the Olympics good for your health and wellbeing?

Regular readers will have noted that it’s been a while since my blog post. There are two very good reasons for this. Firstly there hasn’t been a healthcare topic that has grabbed me recently and secondly, far more pressing – is the Olympics.

I must confess that I started out as a bit of a doubter – I was thrilled in 2005 when London won the games but as the day dawned, anxiety kicked in. Would the opening ceremony be an embarrassment? Would I be able to get to various business meetings I had arranged in the capital? Would the Nation look foolish if security/transport/catering/anything else went wrong? This got me thinking about the wide spectrum of emotions that London 2012 facing armchair Olympians

Anxiety: Somehow I suddenly felt responsible for everything that goes on in my Capital city. This isn’t a normal state of affairs for me but never has London been under such close scrutiny. Strangely this gave me a couple of sleepless nights. I have also become anxious about getting all my work done when the multiple channels of Olympic coverage are calling me…

Stress/excitement/high blood pressure: The stress is a mixed blessing– the rowing was especially stressful but ultimately hugely rewarding for all Team GB supporters. I have proved myself to be an utter wimp, watching the final stages of each race through my fingers – as if that makes things better. Blood pressure? Those strapping young men in lycra is enough to get any girl’s pulse racing…

Joy: I’m not so partisan that I cannot enjoy success of any Olympian, whichever country they represent. However the tears of joy have flowed with alarmingly regularity every time the National Anthem is played at a medal ceremony. And the roar of the crowds as they support Team GB at every venue is guaranteed to generate goose bumps of delight. Happiness is infectious and supreme achievement is inspirational – the national endorphin levels must be sky high!

Pride: This isn’t just a deadly sin – in the right context, especially pride in others, can be highly beneficial. Pride in our countries – Britain looks stunning. Pride in our Capital City – London is perfect for the greatest show on earth. Pride in our athletes – go Team GB! Pride in the Brits - the event has been organised with impressive precision and more importantly, the British people have provided unprecedented support to their teams and are gracious hosts.

Fitness: mmm – this is a tricky one. I find the athletes incredibly inspiring in terms of their focus, determination and dedication but my friends won’t be surprised to note that I am not inspired to become an extreme sport participant. My twice weekly sessions with my personal trainer and maybe the odd run for a train is the extent of my commitment, Even worse, I hardly move away from the TV when I’m not working as the Olympic schedule is keeping me very busy and not very mobile (apart from jumping up and screaming at the screen for the last few metres of any event).

Sense of belonging: Very important for wellbeing and I hope that this fantastic event will have a huge bonding effect on the Nation. The L word, legacy, is one of the primary reasons for our successful bid and I hope that apart from improved sports facilities and participation, another legacy will be sense of community and celebration of success. The British people are famous for supporting the underdog, but let’s get used to being winners too.

The Olympics and healthcare: So to bring a tenuous link to healthcare, the opening ceremony spent some time focussing on a rather bizarre representation of the NHS (doctors and nurses dancing  around children bouncing on old fashioned hospital beds) as a way to celebrate free healthcare for all, regardless of ability to pay. Next week when the party heads towards Rio (and what a party that will be) – what should be the legacy of London 2012 for the health and wellbeing of the nation?

To celebrate what we do well, appreciate the endeavours of our team mates and peers, and build on our successes so far to create the healthcare system we deserve. No medals on offer, but plenty of goals to aim for.