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.