tag:blogger.com,1999:blog-77460616897468937842024-03-08T15:27:53.531-08:00FinchersFinchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.comBlogger253125tag:blogger.com,1999:blog-7746061689746893784.post-34588543010363899222017-04-22T04:45:00.002-07:002017-04-23T02:16:23.901-07:00What does this snap election mean for health in the UK?<span style="color: #073763;">
</span><br />
<span style="color: #073763;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">Like the majority of the
country, I was gobsmacked by the announcement that an election was to take
place in June. My immediate reaction was to think ‘well this lady is for
turning’ as Theresa May went back on her original statement that an early election
was not planned. First the U turn on National Insurance for the self-employed –
and now this. Comparisons with the ‘non turn-able’ Mrs Thatcher are inevitable
and one can’t help wondering if this could be a trend for the current premiership.</span></span><br />
<span style="color: #073763;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><o:p></o:p></span></span><br />
<span style="color: #073763;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">But Politics aside - my main
concern is what this snap election means for the National Health Service and
healthcare in general. When forming her new cabinet last year, the Prime Minister
indicated that the NHS seems a low priority. She had the ideal opportunity to
remove a bloodied<span style="mso-spacerun: yes;"> </span>but not bowed Jeremy
Hunt from the front line and replace him with a minister with a more conciliatory
approach. Ask any clinician, support worker, or even administrator in the NHS and
they will all tell you that the NHS is already ’24 hours’ for emergency and
critical care but to extend this to non-urgent treatment would be spread
already thin resources to a non-sustainable conclusion. The toxic relationship
between the Secretary of State for Health and the junior doctors has reached a
point where divorce is the best option and a new relationship needs to build.
Ignoring something that is broken means that it will become beyond repair.</span></span><br />
<span style="color: #073763;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><o:p></o:p></span></span><br />
<span style="color: #073763;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">I have some sympathy for
government fiscal policy and agree that a strong economy is vital for a ‘healthy’
NHS but the chronic underfunding of the state provision cannot be ignored.</span></span><br />
<span style="color: #073763; font-family: "verdana"; font-size: x-small;"></span><br />
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: #073763;">I was working on service improvement
projects in the NHS at the time that the 2012 Health and Social Care Act was
being implemented and experienced at first hand the genuine distress caused by
Andrew Lansley’s ill-conceived reforms. At that time it was predicted that General
Practitioners would leave the service in their droves and this is proving to be
the case. Just this week a survey of 15,000 doctors demonstrated that at least
a third of GPs were planning on retiring within the next five years while 19%
of trainee GPs were considering work abroad. This is particularly worrying in
the context of Philip Hammond’s autumn statement – funding more GPs to take the
pressure off Accident and Emergency departments. Where will these GPs come
from? Joined up thinking is required but clearly seems to be absent.</span></span><br />
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: #073763;"><o:p></o:p></span></span><br />
<span style="color: #073763;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">Talking of joined up
thinking – the increase in Insurance Premium Tax (IPT) from 10% to 12% announced
last year and planned for June will have an indirect but potentially devastating
effect on the NHS. We will all have to pay extra for our motor, home and other
essential insurances, and one could argue that the treasury’s finances have to
be boosted from somewhere – but this tax also applies to private medical
insurance. Before people start leaping in with criticism for private healthcare
and ‘why not tax the rich’ – they should be aware of some crucial information (supplied
by Laing & Buisson UK Market report thirteenth edition):</span></span><br />
<span style="color: #073763; font-family: "verdana"; font-size: x-small;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt 18pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18pt;">
<!--[if !supportLists]--><span style="color: #073763;"><span style="font-family: "symbol"; font-size: 10pt; font-weight: normal;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">6.9 million individuals are currently covered by private
medical insurance (PMI) policies </span></span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt 18pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18pt;">
<!--[if !supportLists]--><span style="color: #073763;"><span style="font-family: "symbol"; font-size: 10pt; font-weight: normal;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">10.6% of the population has access to private medical care
through PMI </span></span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt 18pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18pt;">
<!--[if !supportLists]--><span style="color: #073763;"><span style="font-family: "symbol"; font-size: 10pt; font-weight: normal;"><span style="mso-list: Ignore;">· <span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">These policies cost a total of £4.7m in 2015</span></span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt 18pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18pt;">
<!--[if !supportLists]--><span style="color: #073763;"><span style="font-family: "symbol"; font-size: 10pt; font-weight: normal;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">£3.6m claims were paid for private treatment in 2015</span></span><br />
<span style="color: #073763;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><o:p></o:p></span></span> </div>
<span style="color: #073763;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">75% of these people insured
are members of company paid schemes as an employment benefit. These employees
are liable to tax on the benefit so for an average single rate of over £1,000
annually an additional £120 will be added for IPT and the employee pays tax on
£1,120 – the total cost of their cover. </span></span><br />
<span style="color: #073763;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><o:p></o:p></span></span><br />
<span style="color: #073763;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">Thanks to improved survival
rates, improved diagnostic technology and life extending treatments, medical
inflation runs at 10% year on year. This is, of course, the reason that the NHS
needs constant uplift in funding. Add another 2% this year to the cost of
private medical insurance and some subscribers (both company paid and private
clients) will find the costs of private cover unaffordable and may well opt out
of their private schemes.</span></span><br />
<span style="color: #073763;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><o:p></o:p></span></span><br />
<span style="color: #073763;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">So where will these people
seek treatment in the future? The NHS. This is almost a ‘duh’ moment. Come on
Mr Hammond, think about it – how would the NHS cope with a flood of extra
patients who previously accessed private care.<span style="mso-spacerun: yes;">
</span>Could this be a tipping point for the state funded system?<o:p></o:p></span></span><br />
<span style="color: #073763;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"></span></span><br />
<span style="color: #073763;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">Back to the </span></span><span style="color: #073763;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">snap election.
As we all know – during the pre-election build up, the business of government
goes into a state of suspended animation and parliament will be dissolved on 3<sup>rd</sup>
May. This is particularly disappointing for the Association of Medical insurance
Intermediaries (AMII). We had launched a petition to appeal for a change in
government policy regarding IPT for private medical insurance. I strongly believe
that a robust private medical system in the UK can complement and supplement
the NHS rather than compete with it. Increased taxation can only hinder this symbiotic
relationship.</span></span><span style="color: #073763;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">We shall regroup as soon
as parliament sits again and the delay is irritating rather than catastrophic
but we are committed to pursuing our aim of maintaining the affordability of
private medical care. </span></span><br />
<br />
<span style="color: #073763; font-family: "verdana"; font-size: x-small;"><span style="color: #073763; font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: #073763;">Jeremy
Corbyn's plans for the NHS also ignore the value of cooperation between the
public and private sectors with his bold claim of stopping all NHS work in
private facilities. He fails to mention how this will be achieved, ignoring the
shortages of NHS staff, building collateral and need for investment in new
facilities. Chuck in an extra day's bank holiday and his plans become even less
realistic.</span></span><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><o:p></o:p></span><br />
<span style="color: black; font-family: "times new roman"; font-size: small;">
</span></span><span style="color: #073763;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"></span></span><br />
<span style="color: #073763;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">I will refrain from
commenting on the potential outcome of the upcoming election. <span style="mso-spacerun: yes;"> </span>But I hope that whichever party or coalition is
in power after June 8<sup>th</sup>, <span style="mso-spacerun: yes;"> </span>they
will use the opportunity to a) change the Minister of State for Health who will
b) adopt a cooperative rather than confrontational approach to the clinical
staff threatening strike action and c) listen to NHS leaders before acting
further and d) engage with private medical providers to ease the pressure on
the NHS.</span></span><br />
<span style="color: #073763;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><o:p></o:p></span></span><br />
<span style="color: #073763;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">It’s not too much to ask
for – is it?<o:p></o:p></span></span><br />
<span style="color: #073763;">
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</span>Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-55113037352995566632017-01-15T11:27:00.002-08:002017-01-15T11:27:35.226-08:00Dear Mrs May ... We need to talk about the NHS<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><br /></span></b><br />
<div style="margin: 0cm 0cm 0pt 8.5pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></b><span style="font-family: "Verdana",sans-serif; font-size: 9pt;">This letter is sent to
you with good intent, with no political bias. Although I have been a Tory voter
for most of my adult life, when I was working in the NHS during the 2010
election, I felt that a labour victory would have been poor for the economy but
preferable for the NHS. I believe that the two previous Labour Health
Secretaries, Alan Johnson and Andy Burnham understood our state funded health
system while their two Tory successors, Andrew Lansley and Jeremy Hunt, have
done more harm than good.</span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;">I fear that during your short tenure as Prime
Minister so far, you are getting it terribly wrong when it comes to a service genuinely
under severe pressure and I have some very simple advice for you – so please
take note:</span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 9pt;">Avoid mixed messages</span></b><span style="font-family: "Verdana",sans-serif; font-size: 9pt;">: In your first speech outside No.10 just
after accepting the Queen’s direction to form a new government you channelled a
mix of Mother Teresa and the three musketeers with your commitment to make
Britain a ‘<i style="mso-bidi-font-style: normal;">country that works for
everyone…. Do everything we can to help anybody, whatever your background..</i>’
Maybe you were trying to emulate Margaret Thatcher as she quoted St Francis of
Assisi’s prayer when she came to power, but like Maggie, you appear to have
quickly turned from school welfare officer to Headmistress. This is not always
a bad thing – as long as you still have the welfare of our community well in hand
but this doesn’t seem to be the case.</span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 9pt;">There is no quick fix for the NHS:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> But something does
need to be done as a matter of urgency. You need a short, medium and long term
plan. It is vital that primary, secondary, tertiary care and social services
are all linked but we know this is a highly complex process that will take
time. Resources need to be increased at every stage of the patient pathway (including
prevention to stop them becoming a patient in the first place) as each area is
of equal importance. In the short term you must..</span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 9pt;">Admit there is a crisis: </span></b><span style="font-family: "Verdana",sans-serif; font-size: 9pt;">If you don’t believe
doctors, nurses, NHS managers or even patients and their relatives – look at
the statistics. The targets for <span style="mso-spacerun: yes;"> </span>Accident
and Emergency departments and hospital waiting lists are reasonable and achievable
in an appropriately resourced facility<span style="mso-spacerun: yes;">
</span>but if a hospital is short of staff (clinical and administrative), beds,
equipment or places to safely transfer patients within the community, they will
start to miss targets as a matter of routine and this is happening. Now.</span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></div>
<div style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Austerity and a state funded health system don’t
mix:</b> <span style="mso-spacerun: yes;"> </span>Service improvement and efficiency
</span></div>
<div style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>measures
can help but they are not enough. Choose your metaphor – the dead horse has
been <span style="mso-spacerun: yes;"> </span></span></div>
<div style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>flogged, the blood has been squeezed out of the
stone, the NHS has streamlined its services and </span></div>
<div style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>yes there is room for further improvement, but
additional resource (funding) must be made </span></div>
<div style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>available. We are already lagging behind many
of our neighbours on % GDP spent on health and </span></div>
<div style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>last year in his article on health spending
the Kings Fund’s Chief Economist, John Appleby placed </span></div>
<div style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>the UK at 13<sup>th</sup> out of the original
15 EU members. Like it or not – we may have to accept an </span></div>
<div style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>increase in tax to allocate additional resource
where it is vitally needed.</span></div>
<div style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></div>
<div style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Don’t ignore private healthcare</b>: Subcontracting
to local private facilities is already assisting </span></div>
<div style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>some
NHS Trusts with capacity issues and are a realistic option to be considered by
clinical </span></div>
<div style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>commissioning
groups. As I am sure you are aware, for example, hip replacements undertaken in
</span></div>
<div style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>a nearby
private hospital with spare capacity can be a cost effective way of freeing up local
NHS </span></div>
<div style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>beds
<span style="mso-spacerun: yes;"> </span>for trauma cases and ease pressure on
A&E. This is not privatising the NHS and is not a long </span></div>
<div style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>term
fix but it can certainly help in the short term. And how about reducing
insurance premium </span></div>
<div style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>tax
on health insurance subscriptions – do you really want some of the 10.6 million
people with </span></div>
<div style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>private
health insurance to relinquish their cover and put even more pressure on the NHS?
It is </span></div>
<div style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"><span style="mso-spacerun: yes;"> </span>their
right after all.</span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 9pt;">If you don’t trust your Health Secretary, choose a new
one: </span></b><span style="font-family: "Verdana",sans-serif; font-size: 9pt;">It
seemed strange that when forming your cabinet last year you missed an
opportunity to remove an unpopular Health Minister and introduce a new era of
cooperation with a carefully selected individual who could build bridges and work
with key decision makers within the NHS<b style="mso-bidi-font-weight: normal;">.</b>
Instead you seem to have taken on the role of health spokesperson yourself, unhelpfully
berating GPs and making sweeping statements that suggest that you don’t really
understand the key elements of the service. I would assume that you will be
pretty busy with ‘Brexit means Brexit’ and would respectfully suggest that you
either give Jeremy Hunt back his mandate or pick a new Minister. If you are
going to continue to make statements about the NHS then please…</span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 9pt;">Listen: …</span></b><span style="font-family: "Verdana",sans-serif; font-size: 9pt;">To those that are in the know, even if you don’t
like what you hear. Organisations like the independent think tank, Kings Fund, people
like Simon Stevens, Head of NHS England, Clare Gerada, and Helen Stokes
Lampard, former and current chairs of the Royal College of General Practitioners,
Janet Davies, Chief Executive of the Royal College of Nursing. The list is
endless – and these people know what they are talking about. Trust them</span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 9pt;">Watch: </span></b><span style="font-family: "Verdana",sans-serif; font-size: 9pt;">Forget Sherlock or Call the Midwife, if you
only watch one series this year I beseech you to tune in to BBC2’s exceptional documentary,
Hospital. The first programme provided a level, calm but absolutely no-holds-barred
view of what it really is like to work in a major Hospital Trust. After I
watched the programme, I wept tears for not the patients – who without doubt
received excellent care, but for the wonderful clinical staff, managers and
administrators who work under almost unbearable pressure every day. On second
thoughts – maybe you should watch Call the Midwife which shows how health and
social care was before the state system was properly funded..</span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 9pt;">And finally…</span></b></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></div>
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;">Apparently you want
your legacy as PM to be more than overseeing Brexit. Please make sure that your
legacy is not that you were in charge when the NHS finally ceased to be fit for
purpose.</span></div>
<div style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 9pt;"> </span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-32286556184717747002016-11-25T09:26:00.002-08:002016-11-25T09:30:26.384-08:00The prudent should be rewarded, not penalised.<br />
<span style="color: #0b5394; font-family: "verdana";"><span style="color: black; font-family: "times new roman";">
</span><br />
</span><div style="margin: 0cm 0cm 0pt 8.5pt;">
<span style="color: #0b5394; font-family: "verdana";"><span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><span style="color: #0b5394;">I was at The
Association of Medical Insurance Intermediaries (AMII) summit just a stone’s
throw from The Houses of Parliament when the news about the 2% increase in Insurance Premium Tax
(IPT) broke. A financial journalist told me – but I didn’t believe him and
thought this must be a rather poor joke. Three increases on a tax on essential
services in 15 months? Surely not! But yes – Philip Hammond with his Autumn
statement has hoodwinked the public into believing that this increase will have
little personal impact on them. This is without doubt a major stealth tax.</span></span></span></div>
<span style="color: #0b5394; font-family: "verdana";">
<span style="color: #0b5394; font-family: "times new roman";">
</span><br />
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><span style="color: #0b5394;">Even the BBC played
down this tax in their evening news bulletin stating that IPT applied to ‘cars,
homes and some possessions’ A bit more than that I fear.</span></span></div>
<span style="color: #0b5394; font-family: "times new roman";">
</span><br />
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><span style="color: #0b5394;">Let’s start general
insurance. Motor insurance is mandatory so when then increase comes into force
it will have an immediate impact on all drivers and owners of vehicles used for
personal and/or commercial purposes. What isn’t mandatory is the level of cover
required as long as the minimum third party liabilities are insured. Likewise
with home and contents insurance, some mortgage providers insist on buildings
cover but the rest is down to the owner/tenant’s discretion. Theresa May’s
government purports to supports the JAMs (those ‘just about managing’ – an
unfortunate acronym for so many reasons) but these are the very people who
could be hit hardest by increasing insurance costs. Insurance is not a luxury –
it is a necessity and ‘JAMs’ may be tempted to scrap cover or purchase
inadequate levels which could ultimately lead to significant hardship.
Insurance roulette is a game that no-one should have to play.</span></span></div>
<span style="color: #0b5394; font-family: "times new roman";">
</span><br />
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><span style="color: #0b5394;">It would appear that
Mr Hammond is penalising the very behaviours that he wishes us to emulate –
prudence. Instead of being encouraged to forward plan and avoid risk, the
prudent who take appropriate insurance cover will end up with lighter pockets thanks
to this uplift in tax– not good.</span></span></div>
<span style="color: #0b5394; font-family: "times new roman";">
</span><br />
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><span style="color: #0b5394;">But the area that is
being ignored is the impact of increased IPT on private medical insurance
(PMI). <span style="mso-spacerun: yes;"> </span>Yes – it does apply to corporate
and personal PMI premiums and no – the government does not offer any incentive
to those who contribute to the cost of their own health care threefold – once
through taxation to fund the NHS, once through their premiums if self-paid (or
through benefit-in-kind taxation if company funded), and again through IPT. </span></span></div>
<span style="color: #0b5394; font-family: "times new roman";">
</span><br />
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><span style="color: #0b5394;">At the AMII conference
on Wednesday insurers, intermediaries and the well-informed were all reeling at
the shock announcement. Ironically just a couple of hours previously we had
been discussing the role of private healthcare in the UK and the value it can
deliver in supporting the NHS. The levy on PMI premiums had been described by
one speaker as an ill-conceived taxation.</span></span></div>
<span style="color: #0b5394; font-family: "times new roman";">
</span><br />
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><span style="color: #0b5394;">Currently 10.6% of the
population in the UK are covered by some form of private medical insurance. Yes
– 10.6%. The independent healthcare sector is worth in excess of £40bn annually
– not to be overlooked. Putting political shenanigans aside such as comments on
‘the privatisation of the NHS’, detractors of the private healthcare industry
should consider the support that the sector can and does provide to the NHS.
While the vast majority of us want to see additional investment for the state
funded system, in the meantime capacity issues and waiting times within the NHS
are now increasingly alleviated by subcontracting into the private sector. The
reduction of waiting time for ‘cold’ but nonetheless essential surgery such as
hip replacements can make a huge difference to NHS patients. </span></span></div>
<span style="color: #0b5394; font-family: "times new roman";">
</span><br />
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><span style="color: #0b5394;">Any increased taxation
on the insurance that funds the majority of private patients can only have a
negative effect on this industry sector as a whole. But there could be a more
immediate and potentially catastrophic impact of this increased taxation. While
I have faith that the PMI industry is sufficiently robust to cope with this
latest setback, there can be no doubt that a 2% uplift in tax applicable to
premiums will send some individuals and corporate customers to decide that
their PMI is no longer affordable. Indeed one insurer I spoke to said this
could be their ‘tipping point’ for individual PMI. </span></span></div>
<span style="color: #0b5394; font-family: "times new roman";">
</span><br />
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><span style="color: #0b5394;">And who will be the
individuals who opt out of private cover due to rising costs? They will be the
over 50’s – those who are starting down the slippery slope to increased
healthcare needs. These healthcare needs will have to be met by the already
creaking NHS which could potentially face a flood of patients who previously
would have been treated in the private sector. Add to this the number of
corporate PMI schemes that may shrink – possibly only covering management or
senior staff, and Philip Hammond may be creating a perfect storm to further
compromise an already bloodied and bowed public offering.</span></span></div>
<span style="color: #0b5394; font-family: "times new roman";">
</span><br />
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><span style="color: #0b5394;">Sadly, after many discussions
with Members of Parliament and political commentators over the past few years, I
must accept that there would have to be a huge shift in public opinion before
any government would risk supporting investment by individuals and companies in
private medical insurance. In these troubling times of ‘pitchfork politics’ unfortunately
no political party has the courage to adopt this wise and pragmatic approach.
Instead, by missing the bigger picture, the Chancellor has inadvertently dealt
a potentially highly damaging blow to the much loved NHS. </span></span></div>
<span style="color: #0b5394; font-family: "times new roman";">
</span><br />
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><span style="color: #0b5394;">A sustainable solution
for healthcare in the UK must include an understanding of the fine balance to
be achieved between the public and private sector, along with an appreciation
of the insurances required to facilitate access to paid care.</span></span></div>
<span style="color: #0b5394; font-family: "times new roman";">
</span><br />
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><span style="color: #0b5394;"> </span></span></div>
<span style="color: #0b5394; font-family: "times new roman";">
</span><br />
<div style="margin: 0cm 0cm 0pt 8.5pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><span style="color: #0b5394;"> </span></span></div>
<span style="color: black; font-family: "times new roman";">
</span></span><br />Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com2tag:blogger.com,1999:blog-7746061689746893784.post-79483980138701649132016-10-09T05:51:00.001-07:002016-10-09T05:51:59.160-07:00Frailty thy name is woman?<br />
<div style="background: white; margin: 0cm 0cm 0pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 11pt;"><span style="color: #0b5394;"><br /></span></span></div>
<span style="color: #0b5394;">
</span><span style="font-family: "Verdana",sans-serif; font-size: 11pt;"><span style="color: #0b5394;">There were two
significant stories about attitudes towards women in the news yesterday. The
first most newsworthy reportage was regarding the ever charming (not) Neanderthal
US presidential candidate Donald Trump’s tactics for hitting on attractive
women.<span style="mso-spacerun: yes;"> </span>(*shudder*) The other, less
sensational report hidden in the middle pages of yesterday’s Daily Telegraph
was the comments by Lady Barbara Judge, who stated that long maternity breaks
are bad for women as they may lose their jobs.</span></span><span style="color: #0b5394;">
</span><div style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 11pt;"><span style="color: #0b5394;">Although the thought
of Trump as president chills my blood, it was actually Lady Barbara’s comments
that caused me far more offence. Lady Barbara is the current Chairman of the
Institute of Directors (IoD). The IoD website proudly states that their new
chairman was <em>‘<span style="background: white;">once described as the best-connected woman in Britain, …… has had a long
and very distinguished career in law and banking before becoming the IoD's
first female chair</span>’ </em>Oh dear - it does bother me when any report uses the phrase 'first female' - when will the powers-that-be rate an individual on who they are and not the number of X or Y chromosomes they sport?</span></span></div>
<div style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="color: #0b5394;"><br /></span></div>
<div style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 11pt;"><span style="color: #0b5394;">I am a member of the
IoD and am also proud to be in their Policy Voice group which is canvassed
regularly for views on current legislation, business issues and working practice.
These views are shared with the relevant government ministries and I gain great
satisfaction from knowing that my opinions are noted in the corridors of power.
Never does the questionnaire ask me my gender – as quite rightly this simply is
not significant.</span></span></div>
<span style="color: #0b5394;">
</span><div style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 11pt;"><span style="color: #0b5394;"> </span></span></div>
<span style="color: #0b5394;">
</span><div style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="color: #0b5394;"><span style="font-family: "Verdana",sans-serif; font-size: 11pt;">The article in the
Daily Telegraph was reporting on Lady Barbara’s keynote speech at The </span><span style="background: white; font-family: "Verdana",sans-serif; font-size: 11pt; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold;">Wealth Management Association’s
Women in Wealth Forum</span> when she <span style="font-family: "Verdana",sans-serif; font-size: 11pt;">claimed that she took just 12 days maternity
leave when her son was born. She should be neither proud nor ashamed of this
fact but grateful that she had choice. And this is the key point – despite Lady
Barbara’s view that maternity policies in the UK mean that women may ‘come off
the tracks’ – paid maternity leave gives mothers choice. They can choose to
take the paid benefit, they can choose to extend the period of leave further
and they can then choose to return to work. This choice is not always driven by
financial need but also an emotional and personal decision. Yes of course any
absence from a job for any reason has its risks –the highest being that the
absentee may not have the appetite to return to their respective coal face.
However in my experience, although re-integration can be challenging and the
pull of a small person at home heart-rending, many women return from maternity
leave with a renewed vigour for their role and a pragmatic approach to business
that can have the net effect of improving performance. </span></span></div>
<span style="color: #0b5394;">
</span><div style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 11pt;"><span style="color: #0b5394;">The article goes on
to report that Lady Barbara believes that American law where companies with
more than 50 employees are only obliged to pay 12 weeks of unpaid leave is
better than the British system. Lady Barbara may believe that current
employment law allowing up to a year off, with 39 weeks paid absence is
over-generous to women but is she really advocating that we go back to those
dark days when a woman had to choose between being a mother or having a career?
As she is the ‘front man’ for the IoD, I truly hope this is not the case.</span></span></div>
<span style="color: #0b5394;">
</span><div style="background: white; margin: 0cm 0cm 0pt;">
<span style="font-family: "Verdana",sans-serif; font-size: 11pt; mso-bidi-font-family: Arial;"><span style="color: #0b5394;"> </span></span></div>
<span style="color: #0b5394;">
</span><div style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="color: #0b5394;"><span style="font-family: "Verdana",sans-serif; font-size: 11pt;">It is interesting to
note that the Women in Wealth Forum, where this controversial view was aired,
make no mention of these comments in their press release outlining Friday’s
event. Instead and perhaps even more surprisingly, they focus on Lady Barbara’s
comments regarding appearance: </span><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 11pt; mso-bidi-font-family: Arial;">“70 per cent of</span></i><span style="font-family: "Verdana",sans-serif; font-size: 11pt; mso-bidi-font-family: Arial;"> <i style="mso-bidi-font-style: normal;">first perceptions is based on how you look, 20 per cent is how you sound
and only 10 per cent is based on what you say. When you walk into a room, you
can't make a second first impression and so you want to take charge of other
people's impressions’. </i></span><span style="font-family: "Verdana",sans-serif; font-size: 11pt;">I have seen and heard this charismatic, intelligent woman
speak and she gives off an air of wealth and privilege, which in itself is not
necessarily a negative thing, but she also possesses the sheen of a bygone era
and sadly it would appear that her views echo this impression.</span></span></div>
<span style="color: #0b5394;">
</span><div style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 11pt;"><span style="color: #0b5394;"> </span></span></div>
<span style="color: #0b5394;">
</span><div style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 11pt;"><span style="color: #0b5394;">I admire Lady Barbara’s
courage in voicing a potentially unpopular view but feel that this does not
help the case for family friendly workplace policies. The biggest challenge
facing most businesses is finding and retaining the best skill mix to keep the
business moving forward. Appropriate employee benefits and fair workplace
practices are absolutely crucial in maintain this skills base with their
associated intellectual property.</span></span></div>
<span style="color: #0b5394;">
</span><div style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 11pt;"><span style="color: #0b5394;"> </span></span></div>
<span style="color: #0b5394;">
</span><div style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="color: #0b5394;"><span style="font-family: "Verdana",sans-serif; font-size: 11pt;">Interestingly again –
the Wealth Forum’s purpose is stated as ‘</span><em><span style="background: white; border-image: none; border: 1pt windowtext; font-family: "Verdana",sans-serif; font-size: 11pt; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold; mso-border-alt: none windowtext 0cm; padding: 0cm;">Perception, tackling unconscious bias and creating a flexible culture
discussed as key issues for Women in Wealth Management</span></em><em><span style="background: white; border-image: none; border: 1pt windowtext; font-family: "Verdana",sans-serif; font-size: 11pt; mso-bidi-font-weight: bold; mso-border-alt: none windowtext 0cm; padding: 0cm;">’. ‘</span></em><em><span style="background: white; border-image: none; border: 1pt windowtext; font-family: "Verdana",sans-serif; font-size: 11pt; font-style: normal; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-border-alt: none windowtext 0cm; padding: 0cm;">Flexible culture’ resonates….</span></em></span></div>
<span style="color: #0b5394;">
</span><div style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<em><span style="background: white; border-image: none; border: 1pt windowtext; font-family: "Verdana",sans-serif; font-size: 11pt; mso-bidi-font-weight: bold; mso-border-alt: none windowtext 0cm; padding: 0cm;"><span style="color: #0b5394;"> </span></span></em></div>
<span style="color: #0b5394;">
</span><div style="background: white; margin: 0cm 0cm 13.5pt; text-align: justify;">
<span style="color: #0b5394;"><span style="font-family: "Verdana",sans-serif; font-size: 11pt;">Apparently Lady Barbara quoted her mother
who, (in the 1950’s I suspect) said </span><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 11pt; mso-bidi-font-family: Arial;">‘When a baby is born it needs to be fed, bathed and diapered. An
18-year-old girl can do that. Your job is to get the money to pay the
18-year-old girl. When you have to be there is when the child gets smarter than
the nanny’. </span></i><span style="font-family: "Verdana",sans-serif; font-size: 11pt; mso-bidi-font-family: Arial;"><span style="mso-spacerun: yes;"> </span>Ouch</span></span></div>
<span style="color: #0b5394;">
</span><div style="background: white; margin: 0cm 0cm 13.5pt; text-align: justify;">
<span style="color: #0b5394;"><span style="font-family: "Verdana",sans-serif; font-size: 11pt;">I believe that the most important message for
any woman (or man for that matter) in business</span><span style="font-family: "Verdana",sans-serif; font-size: 11pt; mso-bidi-font-family: Arial;"> is to aim
high, do your best and believe that you can achieve anything you put your mind
to. This is irrespective of whether you take a career break for whatever
reason. This was the message that my mother gave me and the one I have passed
in to my daughter. </span></span></div>
<div style="background: white; margin: 0cm 0cm 13.5pt; text-align: justify;">
<span style="color: #0b5394;"><span style="font-family: "Verdana",sans-serif; font-size: 11pt; mso-bidi-font-family: Arial;"></span></span><span style="font-family: "Verdana",sans-serif; font-size: 11pt;"><span style="color: #0b5394;">I very much hope that the progress that women
have made over the last few decades in achieving work life balance, raising
families and pushing through the glass ceiling (yes – I admit it still exists)
will not be hindered by the archaic views of a minority. </span></span><span style="color: #0b5394;">
</span></div>
<div style="background: white; margin: 0cm 0cm 13.5pt; text-align: justify;">
<span style="font-family: "Verdana",sans-serif; font-size: 11pt; mso-bidi-font-family: Arial;"><span style="color: #0b5394;"> </span></span></div>
<span style="color: #0b5394;">
</span><div style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Verdana",sans-serif; font-weight: normal; mso-bidi-font-size: 11.0pt;"><span style="color: #0b5394;"> </span></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-44914051345141773052016-07-09T09:53:00.002-07:002016-07-09T09:55:54.084-07:00Motherhood,business and politics<div align="left">
<br /></div>
<div align="left">
<span style="color: #0b5394;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt;"><strong>Motherhood,
business, politics.</strong></span></span></div>
<div align="left">
<span style="color: #0b5394;">
</span></div>
<div style="margin: 0cm 0cm 0pt;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt; font-weight: normal;"><span style="color: #0b5394;">I can identify closely with each of the above, yes, I’m a
mother, a businesswoman and I am fascinated by politics. But there are other,
possibly equally important aspects of my being –sports fan, widow, comic (I
think I’m very funny sometimes), writer, friend…. </span></span><br />
<span style="color: #0b5394; font-family: Verdana;"></span><br /></div>
<div align="left">
<span style="color: #0b5394;">
</span></div>
<div style="margin: 0cm 0cm 0pt;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt; font-weight: normal;"><span style="color: #0b5394;">Tory leadership candidate Andrea Leadsom’s faux pas in
trying to attack her opponent Theresa May on her childless status in her recent
Times newspaper interview is at best tactless and insensitive and at worst
(hopefully) political suicide.</span></span><br />
<span style="color: #0b5394; font-family: Verdana;"></span><br /></div>
<div align="left">
<span style="color: #0b5394;">
</span></div>
<div style="margin: 0cm 0cm 0pt;">
<span style="font-family: "verdana" , sans-serif; font-size: 9pt; font-weight: normal;"><span style="color: #0b5394;">Or will it be political suicide? How many ‘yummy mummies’
will see this as a good enough reason to favour an apparently inexperienced
chancer with a flexible attitude to truth over a heavyweight cabinet minister
with nearly two decades in top tier politics.</span></span><br />
<span style="color: #0b5394; font-family: Verdana;"></span><br /></div>
<div align="left">
<span style="color: #0b5394;">
</span></div>
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<span style="font-family: "verdana" , sans-serif; font-size: 9pt; font-weight: normal;"><span style="color: #0b5394;">I have had the privilege during my career to have met and
worked with some phenomenal women, and their motherhood status has never been a
consideration. Please judge us by what we do, how we behave and not our fertility
or desire to reproduce. </span></span><br />
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<span style="font-family: "verdana" , sans-serif; font-size: 9pt; font-weight: normal;"><span style="color: #0b5394;">I am becoming increasingly weary with the martyr approach
to motherhood. Firstly being a mother is a gift – a precious gift – but not a
badge of honour. There are hordes of women who ache to be mothers but for a
variety of reasons this has just not happened. Most of these women live
fruitful, fulfilling and happy lives. There are equally as many women who have
chosen not have children yet find themselves unreasonably having to explain
their decision – often to strangers who have no right to ask the question in
the first place. </span></span><br />
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<span style="font-family: "verdana" , sans-serif; font-size: 9pt; font-weight: normal;"><span style="color: #0b5394;">Leadsom’s premise that having children makes her care more
than her opponent about the future of the country is, in my opinion, offensive
and erroneous.</span></span></div>
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<span style="font-family: "verdana" , sans-serif; font-size: 9pt; font-weight: normal;"><span style="color: #0b5394;">The motherhood mafia is epitomised by the website Mumsnet.
While I concede that this site offers support and help for many mothers, the
core of this concept is that motherhood is especially challenging. Yes, it can
be tough, but no tougher than climbing the greasy pole in the workplace,
managing a difficult relationship with your partner, caring for an elderly
relative, coping with a needy friend, juggling finances and every other rose
petal or thorn in the pot pouri that is life.</span></span><br />
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<span style="font-family: "verdana" , sans-serif; font-size: 9pt; font-weight: normal;"><span style="color: #0b5394;">A quick glance at Mumsnet today offers the following
headline, <span style="mso-spacerun: yes;"> </span>‘Does anyone else not enjoy
the newborn stage?’ Duh? Does anyone enjoy interrupted nights, your precious
little bundle regurgitating his or her food over your shoulder just as you’ve
changed into your best top, stinking nappies etc etc? But does anyone enjoy
that first smile, gurgle, giggle, look of wonder at the world around them? Of
course you do – it all goes with the territory – it is nature and it’s nothing
new. So please get over it. </span></span></div>
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<span style="font-family: "verdana" , sans-serif; font-size: 9pt; font-weight: normal;"><span style="color: #0b5394;">Another section of this site for mothers advises the
readers how to ‘survive’ a car journey with toddlers. Survive? Are we being
just a touch dramatic ladies?</span></span></div>
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<span style="background: white; font-family: "verdana" , sans-serif; font-size: 9pt; font-weight: normal;"><span style="color: #0b5394;">Possibly the most annoying section of the
motherhood community is those mums in cafés and restaurants who feel that it is
necessary for some reason to speak to their little darlings just a few decibels
higher than is really necessary, while parking their designer buggies right in
front of the exit or route to the loos. Loosely translated their high pitched meanderings
come across as ‘look at me – I’ve pro-created’ </span></span></div>
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<span style="color: #0b5394;"><span style="background: white; font-family: "verdana" , sans-serif; font-size: 9pt; font-weight: normal;">I don’t care if the next prime minister is
male or female, married or single, gay or straight. What I do care is that they
are the best person for the job, that they will have integrity and demonstrate
the ability to negotiate and lead. Most of all, the successful candidate should
not try to take personal credit for some good</span><span style="background: white; font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">
fortune that nature has bestowed upon them.</span></span><br />
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<span style="background: white; font-family: "verdana" , sans-serif; font-size: 9pt; font-weight: normal;"><span style="color: #0b5394;">And a final word for Ms Leadsom – if you
are successful in leading the Tory party – you’ll need to build a good
relationship with one of the most powerful and respected women of this millennium
so far – Angela Merkel, Chancellor of Germany. Oh – and you might want to take
note – Ms Merkel has no children.</span></span></div>
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Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-10300879909585515432016-04-10T04:45:00.001-07:002016-04-10T04:45:36.328-07:00Employee engagement is all about Love.<br />
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">‘Employee engagement’ has
graduated well past jargon to an acceptable and valuable measure linked to productivity
in the workplace. But what does ‘engagement’ mean – and how can it be
quantified? <o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">If you are seeking awards
or hope to tick the engagement box then there is a plethora of questionnaires
and benchmarks to use. But employers should really go deeper to assess not only
engagement but the emotional intelligence and culture of the company. In short –
employee engagement should not be measured in isolation and employers should be
clear not only what they are measuring but how they intend to use the
information gathered to achieve ideal relationships.<o:p></o:p></span></div>
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><o:p></o:p></span><br />
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">The CIPD (Chartered
Institute of Personnel Development) has produced a variety of papers on the
subject and quote a definition from Utrecht University stating that work
engagement has three elements:<o:p></o:p></span><br />
<ul>
<li><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">vigour</span><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"> (energy, resilience and effort)</span></li>
<li><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"></span><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">dedication</span><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"> (for example, enthusiasm, inspiration and pride)</span></li>
<li><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"></span><span style="font-family: "symbol"; font-size: 10pt; font-weight: normal;"><span style="mso-list: Ignore;"><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">absorption</span><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"> (concentration and being engrossed in one’s work)</span></li>
</ul>
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"></span><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">mmm – not sure how helpful
that is..<o:p></o:p></span><br />
<br />
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">The
CIPD also states that ‘positive relationships are evidenced with profit,
revenue growth, customer satisfaction, productivity, innovation, staff
retention, efficiency and health and safety performance’. Perhaps this is a little
more helpful definition– but it doesn’t really reach the heart of the matter. </span><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">A
company can measure highly on all of the above but may not necessarily have a
team of ‘engaged employees’. You can have accompany car park full of high
performance cars owned by a successful sales team – but could they be even more
successful or maybe the performance is unsustainable? How much do they actually
care about their customers and colleagues?<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">At
the risk of sounding fluffy – I believe that true employee engagement is about
love. Passion for your job, care for your colleagues, love for the company and
an emotional investment in your customers. And this is where the measure of
engagement should start – with your customers – do they feel the love?<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">Kevin
Kruse, a contributor to Forbes magazine refers to employee engagement as ‘a
feeling’ and he compares corporate relationships with ‘the quantity of love you
may have for your spouse’ He goes on to say that although you cannot truly
quantify love, maybe you could use the five point Likert scale (1- strongly
disagree to 5- strongly agree) to rate the key relationships. For example: </span><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">A
person deeply in love is …<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt 18pt; mso-list: l1 level1 lfo2; text-align: justify; text-indent: -18pt;">
<!--[if !supportLists]--><span style="font-family: "wingdings"; font-size: 10pt; font-weight: normal;"><span style="mso-list: Ignore;">Ø<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">More
likely to brag about their partner (employer) than someone who isn’t in love<o:p></o:p></span></div>
<span style="font-family: "wingdings"; font-size: 10pt; font-weight: normal;"><span style="mso-list: Ignore;">Ø<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">More
likely to tell their friends (colleagues and customers) how good their relationship
is<o:p></o:p></span><br />
<span style="font-family: "wingdings"; font-size: 10pt; font-weight: normal;"><span style="mso-list: Ignore;">Ø<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">Less
likely to fantasise about ‘hooking up intimately’ with another person or think
about divorce (talking to a head hunter or seeking employment with a
competitor)<o:p></o:p></span><br />
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">I
would add another measure to this list – they are more likely to act in ‘loving
ways’ (helpful, positive) with their customers and colleagues.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">I have
been reminded of the damaging the lack, or loss, of love can have on relationships
with customers twice over the past couple of days. A friend of mine was
referred to the Accident and Emergency department of an NHS hospital the other
day. Heavily pregnant, she was in a potentiallybut not imminently urgent situation
and accepted that a certain amount of delay and hanging around would be
involved. But what she wasn’t prepared for was the ill humour of the doctors. She
was seen by several of them during her 7 hour stay during which time they were professional
and undertook the medical investigations required but, in the words of my
friend, ‘all had faces liked slapped a*ses’. Yes – they are royally p*ssed off
with the current contract debacle and the lack of love they are feeling from
their employer is translating directly into the emotional intelligence of the
group and therefore the customer (patient) experience. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">How
sad that so much goodwill has been lost and I wonder how long it will take for
that group of employees to become re-engaged. In the meantime, patients may not
suffer clinically but they certainly won’t have such a good customer experience
because of this lost love.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">A
more trivial example of poor employee engagement was clear at the restaurant I
visited with my family for a birthday celebration on Friday night. One of the
top veggie restaurants in London and only Michelin-listed one around, we were
expecting exemplary service and great food. Alas we had neither. Luckily we were
in good enough spirits (both metaphorically and literally) not to let the
unhelpful and grumpy waiting staff spoil our evening. But on refection the lack
of warmth we encountered was shocking. One of our group does not like dairy but
every one of the main courses involved whey, curd, yoghurt or even ‘sheep’s
milk’. When we asked if she could perhaps order two starters, and maybe have a
larger portion of one as a main course she was told ‘No’. And no alternative
was offered. There were plenty of staff around so we can assume that this
waitress was not over-worked but she just didn’t care enough about her job, her
employer and certainly not about the customer, to make any effort to enhance
our experience. Maybe the employer doesn’t even care enough about the customer either
to ensure that the staff offer good service. So there was very little love
around (apart from our table of course).<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">I
was sufficiently disappointed to be galvanised into placing a negative review
on trip adviser in an effort to avoid other customers being disappointed. A
clear example of how lack of caring for the business or the customer could have
a detrimental effect on the bottom line.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">An employee’s relationship
with their employer is one of the most important relationships they ever encounter
and companies should make every effort to ensure that this is healthy and
positive and two-way.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">The best way to ensure
great customer satisfaction and employee engagement is to make sure that in the
words of the song, each team member should… ‘Love the one you’re with’.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><o:p> </o:p></span></div>
<br />
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<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><o:p> </o:p></span></div>
<br />
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<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><o:p> </o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-14441054668967362352016-04-02T05:38:00.000-07:002016-04-02T08:04:00.082-07:00The living wage – it's not just about salary.<span style="background-color: white; color: #073763; font-family: "verdana" , sans-serif; font-size: x-small;"><strong></strong></span><br />
<span style="color: #073763;"><span style="background-color: white;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt;"><o:p><strong></strong></o:p></span></span></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="color: #073763;"><span style="background-color: white;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;">Increasing the minimum wage payable in the UK for those of 25 years and above must be a good thing. I’m not convinced by the age criteria though – how can it be
right for a 20 year old and a 26 year old to be doing the same job but not
earning the same income? I do wonder if age discrimination could apply here – a
test case just waiting to happen methinks.<o:p></o:p></span></span></span></div>
<span style="background-color: white; color: #073763;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: #073763;"><span style="background-color: white;">But minutiae aside – how is
the legislation making a 'living wage' mandatory going to affect the employment landscape in the UK? Employee
benefits consultants and healthcare advisers will have some larger clients operating in a
variety of sectors, some of whom may feel a significant financial impact of this
uplift in their wage bill. Who will ultimately pay for this?<o:p></o:p></span></span></span></div>
<span style="background-color: white; color: #073763;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: #073763;"><span style="background-color: white;">This new legislation
reminds me of the introduction of the Patient Protection and Affordable Care
Act (PPACA or ‘Obamacare’) in the US in 2010. I attended several conferences across
the pond where employers and benefits providers discussed this in great detail.
The difference between PPACA in the US and ‘Living wage’ in the UK are that the
first introduced a mandatory level of health care benefit to be funded by
employers and the second is a mandatory level of pay. Both initiatives have the
effect of compromising funds available to be spent on a section of the
workforce.<o:p></o:p></span></span></span></div>
<span style="background-color: white; color: #073763;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: #073763;"><span style="background-color: white;">As ‘Obamacare’ was
introduced there was much bluster for the food and beverage industry – with one
spokesman stating ‘This could bankrupt America’ – of course it hasn’t.<o:p></o:p></span></span></span></div>
<span style="background-color: white; color: #073763;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: #073763;"><span style="background-color: white;">In the US, employers found
ways of getting round this increased benefits bill which was estimated at being
between a 6% and 10% uplift in costs. After Supreme Court challenges against
the Bill failed, industry bosses changed employment practices – swapping full time
employees for more part time staff (to avoid the minimum number of full timers
required for the Act to apply). Salaries were subjected to downward pressure to
offset the healthcare benefit costs. One study undertaken 6 months after the
introduction of the PPACA showed that rather than charge the cost of the uplifted benefits bill on
to customers, 46% employees found a way to pass the increased expense to the
employees and only 9% companies absorbed the costs via their profit margin.<o:p></o:p></span></span></span></div>
<span style="background-color: white; color: #073763;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: #073763;"><span style="background-color: white;">Interestingly, in another
survey, a large number (44%) of enlightened employers actually planned to
increase their health management and wellbeing programme spend in an effort to
reduce the claims on the mandatory health insurance, and therefore reduce premium
cost.<o:p></o:p></span></span></span></div>
<span style="background-color: white; color: #073763;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: #073763;"><span style="background-color: white;">This brings me back to the
UK and my main area of concern regarding the living wage which is the impact on
employee benefits. While of course supporting a living wage for all, I fear
that something else will be sacrificed to balance employment costs. <o:p></o:p></span></span></span></div>
<span style="background-color: white; color: #073763;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: #073763;"><span style="background-color: white;">Corporate healthcare benefits
such as cash plans (offering reimbursement of a range of health related services)
has enjoyed a period of dramatic growth over the past decade – 12% in 2014 - as
companies provide this low cost, but much appreciated benefit to entire
workforces including ‘lower paid’ staff. It is estimated that there are
currently well over three quarters of a million employer paid plans currently
in place. Company paid private medical insurance schemes account for over 75%
of the UK PMI market and corporate dental plans continue to be highly popular. Those
covered by a company paid life insurance, critical illness and income
protection schemes has also grown by 1.25 million over the past five years.<o:p></o:p></span></span></span></div>
<span style="background-color: white; color: #073763;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: #073763;"><span style="background-color: white;">Put simply – good health
is good business. A well-designed healthcare benefits plan protects the health,
wellbeing, and engagement of employees –and therefore productivity of the workforce.
<o:p></o:p></span></span></span></div>
<span style="background-color: white; color: #073763;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: #073763;"><span style="background-color: white;">So employers please take
note. Cutting employee benefits to offset the increased wage bill due to the
living wage could be false economy. Investment in health is money well spent.<o:p></o:p></span></span></span></div>
<span style="background-color: white; color: #073763;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="background-color: white; color: #073763; font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><o:p> </o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-5415181984387590422016-03-28T12:11:00.002-07:002016-03-28T12:17:29.806-07:00Jeremy Hunt may win the battle but he will lose the war with the Junior Doctors<div style="text-align: justify;">
<span style="color: #073763;"></span><br /></div>
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<span style="font-family: "verdana" , sans-serif; font-size: 10pt;"><strong><span style="color: #073763;"> <span style="color: black;"><span style="color: #073763;">Come on Jeremy – take a leaf out of George’s
book.<o:p></o:p></span></span></span></strong></span></div>
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<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: black;"><span style="color: #073763;">One good thing has come
out of the recent welfare budget debacle. George Osborne demonstrated how a government
minister can quickly change their mind in the face of irrefutable arguments
against a bad decision.<o:p></o:p></span></span></span></div>
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<span style="color: #073763;"> </span></div>
<div style="mso-line-height-alt: 7.5pt; text-align: justify; vertical-align: baseline;">
<span style="color: black;"><span style="color: #073763;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt;">Oh if only Jeremy
Hunt would do the same thing. The junior doctor’s opposition to the Health
Secretary’s new contract has now reached a previously unthinkable stage as they
plan </span><span style="font-family: "verdana" , sans-serif; font-size: 10pt;">a ‘full withdrawal of labour’ between
8am and 5pm on April 26 and then 8am to 5pm on April 27. This conflict must
stop – and it is down to Hunt to make the pain go away.<o:p></o:p></span></span></span></div>
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<div style="mso-line-height-alt: 7.5pt; text-align: justify; vertical-align: baseline;">
<span style="font-family: "verdana" , sans-serif; font-size: 10pt;"><span style="color: black;"><span style="color: #073763;">I use the word conflict advisedly – this is much more than a
dispute<span style="mso-spacerun: yes;"> </span>now – it is more akin to a bloody
civil war – where the blameless victims are anyone who may need the state
health service now or on the future. And maybe the doctors are victims too.
When the arguments started in earnest around this new contract in 2014 I felt
sure that clinicians wouldn’t jeopardise the wellbeing of their patients, and
as a healthcare professional myself, felt that I could never condone strike
action. But two years on – no-one can doubt the strength of feeling among these
doctors and their desperation that has lead us to this sorry state.<o:p></o:p></span></span></span></div>
<div style="text-align: justify;">
<span style="font-stretch: inherit; word-spacing: 0px;"></span><span style="color: #073763;"> </span></div>
<div style="text-align: justify;">
<span style="-webkit-text-stroke-width: 0px; font-stretch: inherit; widows: 1; word-spacing: 0px;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: black;"><span style="color: #073763;">Hunt insists that the
doctors ‘don’t understand’ the contract. Come on Jeremy – it may have escaped
you, but you actually have to be pretty intelligent to become a doctor. The
British Medical Association doesn’t just employ doctors, they will have had
lawyers look at the contract too – and I am confident that they do understand
it. And they don’t like it. Never will. <o:p></o:p></span></span></span></span></div>
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<span style="-webkit-text-stroke-width: 0px; font-stretch: inherit; widows: 1; word-spacing: 0px;"><span style="color: #073763;">
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</span></span></span><br />
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<span style="-webkit-text-stroke-width: 0px; font-stretch: inherit; widows: 1; word-spacing: 0px;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: black;"><span style="color: #073763;">I have been privileged to
have worked alongside many junior doctors and have been treated as a patient by
several too and I have never come across a lazy doctor. They work their butts
off. They care about their job, they care about their patients and they always
do more than their contracted hours. Yes, there may be some need for cost
cutting and reshaping in the NHS but if you are going to bash anyone- do not
bash the doctors. <o:p></o:p></span></span></span></span></div>
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</span></span></span><br />
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<span style="-webkit-text-stroke-width: 0px; font-stretch: inherit; widows: 1; word-spacing: 0px;"> </span></div>
<div style="text-align: justify;">
<span style="-webkit-text-stroke-width: 0px; font-stretch: inherit; widows: 1; word-spacing: 0px;"></span> </div>
<div style="text-align: justify;">
<span style="-webkit-text-stroke-width: 0px; font-stretch: inherit; widows: 1; word-spacing: 0px;"><span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: black;"><span style="color: #073763;">Savings must be found elsewhere
and the planned changes to the NHS working week must be reformulated. If the
doctors do finally give in - which is clearly what Jeremy Hunt believes they
will do – he won’t have won. The battle will be momentarily over but the war
will still wage. In a great little memoir on power – Robert Greene states <i style="mso-bidi-font-style: normal;">‘Any <span style="mso-spacerun: yes;"> </span>triumph you think you have gained through
argument is really a Pyrrhic victory: the resentment and ill will you stir up
are stronger and last longer than any momentary change of opinion. It is much
more powerful to get others to agree with you through your actions, without
saying a word. Demonstrate, do not explicate’</i><o:p></o:p></span></span></span></span></div>
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<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><span style="color: black;"><span style="color: #073763;">So Mr Hunt, take heed.
Please do not beat these hard working, dedicated decent human beings into a
grudging submission. Less of the explanations, more of the demonstration.
Withdraw the contract – redraft another one in close association with the BMA –
and then everyone can get on with what they do best – looking after patients.<o:p></o:p></span></span></span></div>
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<span style="font-family: "verdana" , sans-serif; font-size: 10pt; font-weight: normal;"><o:p><span style="color: #073763; font-family: "times new roman"; font-size: small;"> </span></o:p></span></div>
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Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-36268520034877891102013-07-30T06:13:00.001-07:002013-07-30T06:13:19.458-07:00The NHS Direct/111 confusion epitomises the problems with government health policy.<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">If
ever a snapshot was needed to illustrate that a plan isn’t working, the recent
news that NHS Direct are withdrawing from 111 contracts provides just such an
unwelcome image. Originally running around a third of 46 regional contracts to
run the 111 telephone helpline service, NHS Direct has now pulled out of the ‘financially
unsustainable’ arrangements. That leaves eleven regions with no provider to run
this fledgling service. The reasons that NHS Direct (itself an NHS Trust) cited
for the withdrawal was that projections<span style="color: #333333;"> </span>reported
earlier this month showed they had lost £2.8m since April and were "<i style="mso-bidi-font-style: normal;">heading for a deficit of £26m if we continue
to run the same volume of 111 services until the end of this financial
year".<o:p></o:p></i></span><br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">This
is a new embarrassment for the embattled coalition health team as another plan
fails to quite come together as predicted.<span style="mso-spacerun: yes;">
</span>Interestingly, but not surprisingly when this story broke – news items included
Andy Burnham, shadow Health Secretary as he said it was a <i style="mso-bidi-font-style: normal;">"mess of the government's making" </i>which had led to nurses
being replaced by computers<i style="mso-bidi-font-style: normal;"><o:p></o:p></i></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">During
a debate in the House of Lords<span style="color: #333333;">,<a href="http://www.blogger.com/null" name="1307293000055"></a> the Lib Dem peer, </span></span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN; mso-bidi-font-weight: bold;">Lord Willis of Knaresborough<b> </b>gamely tried
to<b> </b>defend the service<b>:</b></span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN;"> <i style="mso-bidi-font-style: normal;">‘My Lords, may I try to redress the balance? There is a real sense that
very significant numbers of people calling the 111 service get a good service.
On 9 June, I had reason to call 111 because I was having a heart attack. The
response from 111 was excellent, in York. At the same time not only did the
service call the paramedics but it had me in hospital within 25 minutes to an
absolutely superb accident and emergency service. If York can do that in such
an efficient and superb way, why cannot we guarantee that service throughout
the country?</i></span><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p></o:p></span></i></div>
<br />
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<span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN;">With a spectacular own goal the venerable Lord
demonstrated that 111 is a confusing and potentially dangerous option facing the
man in the street with a health issue. No Lord Willis – you should not have
called 111 – you should have dialed 999! 111 is billed as the service t</span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">o call<i style="mso-bidi-font-style: normal;"> ‘when it’s less urgent
than 999’ </i>and NHS Choices website advises the public to call<i style="mso-bidi-font-style: normal;"> </i>111 <i style="mso-bidi-font-style: normal;">‘if</i></span><i style="mso-bidi-font-style: normal;"><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN;"> you urgently need
medical help or advice but it's not a life-threatening situation’. </span></i><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN; mso-bidi-font-size: 12.0pt;">What was, in theory, a good idea has now sadly deteriorated
to farce as a money saving, efficiency enhancing idea is spoiled though poor
procurement, poor communications and poor implementation.<o:p></o:p></span></div>
<br />
<div style="margin-bottom: 0pt;">
<span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN; mso-bidi-font-size: 12.0pt;">Which brings me to my checklist for Jeremy Hunt to use
when trying to move the NHS forward.</span><span lang="EN" style="mso-ansi-language: EN;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">When
you have an idea for an NHS service redesign or enhancement:<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Think
about the logistics. How will it work? Where are the pitfalls, or weak link in
the chain? What will a successful outcome look like? Does the expertise and
resource exist and if not – how is this generated?</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Assess
the benefits. Will a successful outcome mean either a better or more efficient service,
better clinical outcomes and/or more cost effective care? Basically – undertake
an independent and transparent cost benefit analysis. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Create
a robust procurement process. ‘Screwing’ a provider down to an unacceptably cheap
price means that you either have an unsustainable model or you will receive
substandard delivery. Either can ultimately lead to disaster and expensive
damage limitation further down the line. Use the considerable procurement
expertise available within the NHS. Good, sustainable contracts are born out of
the premise that every party is satisfied with the deal.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">4.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Ensure
that robust monitoring is in place. Just because something starts well, you can’t
guarantee it will continue that way.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">5.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Create
and implement an effective communications strategy. I have no doubt that one of
the biggest failings in the 111 service is lack of clarity for the public.</span></div>
<div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">6.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Keep
politics out of it. I know this is a fantasy rather than a realistic possibility,
but our politicians and key NHS leaders should focus on the job in hand, not
play a politically expedient game. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">This
really is very basic stuff, but I suspect that if these simple rules had been
applied, we would not be facing the confusing and worrying situation regarding
our emergency and non-emergency NHS services right now.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Ah
well – a girl can dream…<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p><span style="font-family: Times New Roman; font-size: small;"></span></o:p></span><br /></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-84976489843615588952013-07-20T04:06:00.000-07:002013-07-20T04:06:02.464-07:00Good public health policy takes courage
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
was sitting in the Friday afternoon rush hour traffic yesterday and glanced to
my right to see the epitome of a public health nightmare sitting in the car
next to mine.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">A
hugely overweight man was driving his executive car with the cabriolet roof
down. He looked hot and sweaty and his balding head was bare to the 33 degree
heat. He was (I kid you not) smoking a cigarette, occasionally drinking from
the large MacDonald’s branded container. The hand that was on the steering
wheel was tapping furiously as he was clearly stressed at the crawling traffic.
The one safe thing he was doing was wearing a seat belt.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">This
poor man is a real life caricature of the ‘ticking healthcare time bomb’ so
often referred to by healthcare leaders and politicians. I suspect that when my
hapless subject got home he poured himself a large gin and tonic or similar to
ease the hassle of is day. Diabetes, respiratory problems and heart disease,
let alone joint and musculoskeletal issues are knocking firmly at his door as
the grim reaper will held at bay by medical professionals who will try to fix
him as the inevitable happens.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Is
this man a lost cause? Possibly. Does he know that his habits are life
limiting? Probably. Will he do anything about it? Who knows.<span style="mso-spacerun: yes;"> </span>I am in no position to judge as I am far from
saintly when it comes to healthy eating and drinking habits so I do have great sympathy
for Mr Cabriolet Man. But how interesting that he has at least vastly increased
his chances of surviving a road traffic accident by wearing his seat belt. And
why does he wear a seat belt? Because it’s the law.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Of
course we can’t make unprotected sunbathing, alcohol, or even getting stressed
against the law. But surely those charged with protecting the health of the
public should take every reasonable action they can to not only educate us, but
strongly guide us towards healthy behaviour. Especially the impressionable young.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">We
know that educational programmes help enormously as at least the general public
now know that smoking kills, excess alcohol ruins lives and healthy eating and exercise
are the route to longevity. We also know that despite these programmes, there
are generations in the UK making very unhealthy choices.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">A
study reported yesterday regarding early death rates due to liver disease in
young women is truly shocking. For women born in the 50s , the death rate due
to alcohol related disease is 8 per 100,000, for those born a decade later the
rate rises to 14 per 100,000 and those born in the 70s, women only in their 30s
right now, are dying at a rate of 20 per 100,000. Various causes have been
cited, but cheap booze must play a part in this yet the government shies away
from minimum pricing for alcohol.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Smoking
is an equally depressing story as although statistics show that smoking rates
are decreasing, we still see young children and teenagers smoking even though
they know it’s bad for them. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Controlling the smoking habits of a
population is potentially one of the biggest public healthcare challenges a
nation can face. We know that, apart from the human loss and suffering, smoking
costs the NHS and estimated £2bn a year.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">How
disappointing, then that the government have decided to postpone a decision
regarding plain packaging for cigarettes – a move that had been expected to
reduce young smokers. In a strongly worded letter to the Guardian Newspaper, a
group of chest physicians, paediatricians and public health specialists make a
powerful case for plain packs saying.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<i><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">The
tobacco industry targets young people because it needs to replace the 100,000
people in this country who are killed each year by smoking related diseases.
Every day roughly 570 children aged 11-15, nearly 30 classrooms full, start
smoking. Tobacco packaging is designed to manipulate perception of risk. For
example, even though terms that dishonestly imply relative safety in cigarettes
like "light" and "mild" have been banned, research shows
that smokers continue to believe that cigarettes in lighter colour packs are
less hazardous.The government must now either bring forward legislation or
allow parliament a free vote on what is an urgent child protection issue.’ </span></i><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p></o:p></span></div>
<u1:p></u1:p>
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<div style="margin-bottom: 0pt;">
<span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN;">It is equally disappointing that the coalition will also delay a move to
introduce a minimum unit price for alcohol.<u1:p></u1:p>Protecting the health
of the public while maintaining their right to personal choice is a tough job.
Introducing unpopular measures can a poison chalice for health ministers and
legislators. Like the brave move to make the wearing of seat belts in cars
compulsory for drivers in 1983. This was a contentious issue for several
decades before it finally became law and has saved thousands of lives, while
creating a behaviour that is now automatic and part of everyday life.<u1:p></u1:p>Good
public health strategy needs to be backed up by legislation where possible.
Legislation that is designed to limit choice and change behaviour takes courage.</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p></o:p></span></div>
<u1:p></u1:p>
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<div style="margin-bottom: 0pt;">
<span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN;">We need to see that courage from the government now.</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p></o:p></span></div>
<u1:p></u1:p>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p><span style="font-family: Times New Roman; font-size: small;"> </span></o:p></span></div>
<br />
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<span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN;"><o:p><span style="font-family: Times New Roman; font-size: small;"> </span></o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-12069580916562848512013-07-16T14:07:00.002-07:002013-07-16T14:21:36.239-07:00How do we stop the bad news coming from the NHS?<br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Regular
followers of this blog may have noticed that it has been a few weeks since I
last posted any commentary. I could use the excuse that a heavenly week in
Devon and Cornwall, followed by some speaking engagements intervened, but the
truth is that I have been at a loss for words. <o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Bad
news and the NHS are now synonymous. Horrific stories of poor care, failing hospitals,
commissioning teams in panic mode, financial meltdown of Trusts and most
frightening of all, unexplained high death rates make for very upsetting
reading. I don’t want to be another purveyor of doom adding to the cacophony of
despair but it is hard to find some positive insight into the disarray of our
state funded healthcare system.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Most
distasteful of all is the political interference, name-calling and finger
pointing, not forgetting a hefty dose of arse-covering into the bargain.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">In
my opinion, the recent review of the Liverpool Care Pathway epitomises the current
crisis. Medicine, and many related functions, is an inexact science. Clinical
decisions have to be made on the best advice available at the time, backed up
by robust evidence and those decisions monitored through clinical governance which
is best delivered by clinical peers. Sadly the human element can override good
science and even worse, a culture of poor care totally undermines good
medicine.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">It
is absolutely right that a review was instigated into the use of the pathway,
originally created to ease suffering of those near death, but absolutely wrong
that this review was needed in the first place. How dreadful to learn that this
carefully designed set of guidelines was in many cases distorted and recreated
by badly trained or badly managed staff with little or no consideration for patients
or their loved ones. Yet again, we have been shocked to hear of staff
displaying ignorance, callousness and in some cases, downright cruelty all in
the name of ‘care’.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">The
review, led by Rabbi Baroness Neuberger, was originally set up to research the
use of this pathway but en route uncovered significant shortcomings in the
treatment of the dying, notably at weekends when senior clinicians were absent.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">How
on earth did we get to a state where a nurse felt it was acceptable to shout at
a relative for trying to give a patient a drink? Is the stress of the job
turning good people bad or are they just the wrong people for the job in the
first place? And how do good managers, senior clinicians and medical leaders turn
this mess around?<o:p></o:p></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
have just been watching some news footage from the House of Commons with the current
Secretary of State for Health Jeremy Hunt lobbing salvos a cross the House
aimed at the previous Labour Health Minister, Andy Burnham who with equal
vigour retaliated. The headline for an article by Sean Worth in the Telegraph
today shouts ‘Labour must bear the blame for the shameful decline of the NHS’
and the BBC has reported that Professor Sir Brian Jarman, <span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">‘an independent
expert on mortality rates has suggested that ministers have suppressed details
of NHS failings to avoid losing votes’.<o:p></o:p></i></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Maybe
Professor Jarman has the key and maybe he’s right when he advises us that we
should take heart that following Sir Bruce Keogh's report, 14 Hospital Trusts have been identified as failing and
11 will now be subject to closer scrutiny and urgent service improvement activity.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
also agree with his premise that ‘<i style="mso-bidi-font-style: normal;">a
"basic problem" with the NHS was that the government both provided
health services and monitored them’<o:p></o:p></i></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Maybe
that’s the answer. Let independent and wise individuals such as Baroness Neuberger
review specific areas of concern and let us find an independent, non-political
means of monitoring quality of care. Let there be zero tolerance for cruelty or
poor clinical practice. A cruel or incompetent nurse, doctor (and that should
include GPs) or healthcare assistant should be suspended pending investigation
and poor clinical practice should be offensive not just to patients but to
staff with no exception. Let clinicians have the final say on clinical issues
and most important of all, keep politics out of it. <o:p></o:p></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Improve
from within and then maybe the bad news will stop.</span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN;"><o:p></o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-26802113880664924642013-06-22T06:55:00.001-07:002013-06-22T06:55:08.441-07:00Who should watch the watchers?<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Like
many others, I believe in the ultimate goodness of the majority of people,
especially those involved with the care and protection of others. So of course
I, like many others, hoped that the tranche of scandals emerging from a closer
scrutiny of the NHS would now be over. <span style="mso-spacerun: yes;"> </span>But we were wrong. This most recent disclosure
of the failings of the Care Quality Commission (CQC) is perhaps the most
shocking lapse of morality of all.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Although
full details and allocation of blame are yet to emerge, it would appear that
the regulatory body designed to protect the wellbeing of patients and maintain
standards in UK care facilities have failed spectacularly in their duty. Not
only have they failed to monitor standards in an efficient and robust manner,
the former Chief Executive, Cynthia Bower, plus her deputy Jull Finney and the
media manager Anna Jefferson stand accused of actively covering up damning
information regarding their investigation of the high death rate of babies at the
University Hospitals of Morecambe Bay NHS Trust. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">There
have been concerns over the CQC for some time and there is no suggestion that
the new Chief executive was in any way involved but this latest scandal puts
several major issues (again) under the spot light.<o:p></o:p></span></div>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span></b><br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Firstly –</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"> just what has happened
to the moral compass within pockets of our state funded health system? The Francis
report, investigating the Mid Staffs scandal where up to 1000 patients may have
died as a direct result of poor care was supposed to be the beginning of the
end of these tragic stories. This latest shocker regards the maternity unit at the
Morecombe Hospital Trust where a high baby death rate prompted investigation. Babies
were possibly dying as a direct result of poor practice. It is now suggested
that senior CQC officials covered up information which could have saved other
tiny babies. And yet, it would appear, these people put their own jobs and
personal interest above the care of the very people they were supposed to
protect. At the risk of being over-dramatic, if they were guilty – how do they
sleep at night? Is this because they were working in a poisoned environment, immersed
a blame culture, with perverse team ethics or no collective emotional responsibility?
This is heavy stuff.<o:p></o:p></span><br />
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Secondly </span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">– this demonstrates
in blazing clarity the enormous task that faces the CQC. An impossible task in
fact. How can a team of experts (I use the term loosely) monitor and
investigate over 40,000 health and care facilities throughout the UK? Professor
Julian Le Grand, from the London School of Economics stated today that the way
the organisation was set up it was ‘daft’ by creating a generalist organisation
and merging health and social care for this monumental remit. <o:p></o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Thirdly</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"> – the regulatory and
monitoring landscape following last year’s health and social care act is very
confusing. In a poster created by NHS Employers the section entitled ‘Monitoring
the NHS’ describes the 3 key areas as follows:</span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Care
Quality Commission</span></i></b><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">: ‘..is the
independent regulator of all health and social care services in England. Its
job is to make sure that the care provided meets national standards of quality
and safety’<o:p></o:p></span></i></div>
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Monitor:
</span></i></b><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><span style="mso-spacerun: yes;"> </span>‘..promotes the provision of healthcare services
which are effective, efficient and economic and maintains or improves the
quality of services’<o:p></o:p></span></i><br />
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Healthwatch
England</span></i></b><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">: <span style="mso-spacerun: yes;"> </span>‘..is the independent consumer champion for
health and social care in England. Working with a network of 152 local Healthwatches,
it ensures that the voices of patients and those who use services reach the
ears of decision makers’<o:p></o:p></span></i><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">This
poster also describes NICE, Health Education England, Department of Health,
NHS England, Clinical Commissioning Groups, NHS Trust Development Authority,
and Health and Wellbeing Boards. All with some level of responsibility
for standards. Confused? Who wouldn’t be?<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">How
should we be monitoring our health and social care services? And who should
watch these watchers? What needs to be done?<o:p></o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Clarify where the
buck starts and stops:</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"> Well defined areas of organisational and personal responsibility,
measurable standards and a simplified regulatory framework are needed<o:p></o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Give relevant experts
the appropriate powers</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">. In my opinion, one of the reasons that the cardiac and
stroke networks were so successful in improving standards was that specialist
units were awarded accreditation by appropriately qualified clinical
specialists. It has emerged that lay people, fireman and other generalists
within the CQC were tasked with inspecting hospitals – no wonder significant
flaws were missed.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Neutralise conflicts
of interest. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">It
has been suggested that the newly formed Clinical Commissioning Groups should
bear the burden of regulatory monitoring responsibility. No they shouldn’t –
they have enough to do and there is already a risk of blurred lines between
poacher and gamekeeper.<o:p></o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Separate health monitoring
from social care monitoring.</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"> We don’t have joined up care yet so it doesn’t
make sense to have joined up monitoring. If the CQC remains, specialist teams
must be created.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">And,
most important of all….<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Recognise that
monitoring alone isn’t enough to create high quality care.</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"> Measuring only does
that – it measures. Investment of time, energy and money are still required to
build strong leadership within the NHS and support a culture of honesty,
transparency, decency and clinical excellence.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
believe (and hope) that there is sufficient intellect, expertise, commitment
and skills already within the NHS to make this happen. They just need gathering
up and pointing in the same direction.<o:p></o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-79503566296992319832013-06-02T04:49:00.004-07:002013-06-02T04:49:46.945-07:00How can you measure care?
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">It
has just been revealed by the Health Services Journal that Sir Mike Richards
has been appointed as the new Chief Inspector of Hospitals. The purpose of this
unenviable role has been described by David Cameron to ensure that </span><i style="mso-bidi-font-style: normal;"><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN;">“a hospital is clean,
safe and caring, rather than just an exercise in bureaucratic box-ticking”.</span></i><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p></o:p></span></i><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">The
‘clean and safe’ bit is relatively simple to monitor. There are a multitude of
matrices available to set and measure performance standards, clinical outcomes
and achievement of targets. But it is the care bit that’s tricky.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">The
new Chief Inspector, whose team will become part of the Care Quality Commission
(CQC) has said that he ‘<i style="mso-bidi-font-style: normal;">will champion the
interests of patients’</i>. This laudable aim fails to provide a definition of
how to measure those interests so I looked to the CQC for clarification. Their
website states their aims related to hospitals and GPs as:<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<i style="mso-bidi-font-style: normal;"><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN;">‘We check all hospitals in England to ensure they are meeting national
standards, and we share our findings with the public…..We inspect GP practices
and other primary medical services in England to check that they are meeting
the national standards of quality and safety’<o:p></o:p></span></i></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">It
is absolutely right that national standards of quality and safety are met and
monitored on a regular basis. But we still don’t have a benchmark for care.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Emotional
intelligence is becoming an accepted principle for describing individuals,
departments and organisations. One model to assess emotional intelligence is
based on the three I’s – Intention, Interpretation and Impact. If you imagine a
ward or GP surgery environment it is logical to project the three I’s to
measure care and I would like to see this explored on a more formal basis for
the NHS.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">In
the meantime, of course patient feedback and the ‘friends and family’ test are
a valuable tool, albeit a subjective one. But then – care is subjective isn’t
it?<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Always
happy to hear good news healthcare stories I am pleased to have two to report this
week. One of my daughter’s colleagues is facing the agony of a very premature
baby, born at 26 weeks, fighting for survival in a hospital in Portsmouth. The
baby’s father has said that the one thing he doesn’t have to worry about is the
care. A nurse is by the baby’s incubator at all times and the precision and intensity
of each procedure (such as taking blood samples form underdeveloped veins) is enhanced
by the palpable desire of each doctor, nurse and therapist for the baby to
survive and thrive. The baby’s parents are in no doubt of the genuine commitment
and care of the team who hold this precious life in their hands as medicine and
care are combining to give this little mite the best possible chance.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Another
example of care is much more low-key. Regular readers of this blog may recall
my account of a gentleman (Tom) who was receiving poor care in a ward after breaking
his hip. (‘<i style="mso-bidi-font-style: normal;">Good care is about personal
responsibility’ </i>21 April). Suffering bed sores, missing meals because he
couldn’t reach his food, and becoming more frail by the day, the poor care
received was having a direct impact on his will to live. I am pleased to report
that Tom’s wife arranged for him to be moved to another hospital where the ward
delivered the sort of care every patient should suspect. The medical treatment
was the same, but the emotional and physical care was clearly far superior in
this second hospital. Little things like making sure his cup of tea was just how
he liked it, alongside scrupulous cleanliness and appropriate treatment for his
bed sores. Tom is now home – working hard on his exercises and looking forward
to walking his beloved dogs again before too long. What a difference moving
from an environment with a poor emotional intelligence to one which embodied
positive physical and emotional support.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
shall leave the last word to Tom’s wife – who used her own personal benchmarking
system:</span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><i style="mso-bidi-font-style: normal;">‘You could feel the care the
minute we walked in the door’<o:p></o:p></i></span></div>
<br />
<br />
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Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-823915162772178752013-05-18T08:01:00.002-07:002013-05-20T01:43:16.777-07:00Public and private can make excellent bedfellows, especially in treating cancer<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
was recently asked to write about the future for my latest blog in Health
Insurance Magazine and I included a plea for increased cooperation between the
public and private sectors. As I wrote <i style="mso-bidi-font-style: normal;">‘There
are still some Neanderthals out there who subscribe to the public good, private
bad mantra’<o:p></o:p></i></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
experienced a fantastic example of private and public partnership a few weeks
ago when I attended the launch of a molecular screening laboratory in London’s
University College (UCL) Cancer Institute. The technical detail of this collaboration
between Sarah Cannon, the cancer arm of Hospital Corporation of America (HCA) International
and UCL Advanced Diagnostic, part of the UCL Cancer Institute is described in more
detail in their press release:<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><a href="http://sarahcannonresearch.com/about/newsroom/new-genetic-sequencing-lab-creates-tipping-point-for"><span style="color: blue;">http://sarahcannonresearch.com/about/newsroom/new-genetic-sequencing-lab-creates-tipping-point-for</span></a><o:p></o:p></span></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">This is the coming together of an NHS Hospital (UCL) and an American Healthcare
company (HCA) to research and treat a range of cancers. The mission of this
venture is to enable patients to ‘live with cancer’ through a patient centred
approach. No this isn’t the ‘patient centred’ sound bite often quoted by politicians
and health officials – this is personalised medicine - the patient focussed analysis
which identifies the genetic drivers for specific cancers. In a nutshell, the
genetic abnormality which triggers the cancer is identified through molecular
profiling undertaken in this joint venture laboratory. The techniques used can
now sequence multiple genes in the fraction of the time previously required. Traditional
biopsy assessment can be supported with genetic pathway analysis leading to
individual treatment regimes saving time, money and lives. <o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Multiple
clinical trials will establish the appropriate treatment pathways and this
cancer screening unit gains its income from a variety of sources including charities,
research organisations, government funding and drug company sponsorship.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Patients,
often with little hope of cure or even a short term future, will be given the lifeline
of this molecular screening to find the best possible chance of addressing
their genetic abnormality to offer an improvement in longevity and quality of
life.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">This
laboratory is targeting 11 (rising to 35 by July) genetic abnormalities using samples
collected from a traditional biopsy. Patients will be admitted to clinical
trials from a variety of sources (NHS, research establishments and the private
sector) and the initiative is, in my opinion, a significant good news story.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Several
major points struck me as I attended this press launch. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Firstly,
the genuine passion and commitment of the key clinicians and executives. If you
have to face cancer, I can think of no better individuals to join your armoury
for your personal battle. Backing professional conviction with hard facts and a
heavy dose of realism, the clinical team from UCL and HCA and senior executives
from Sarah Cannon seemed to find the right words to inspire and convince. Professor
Chris Boshoff saying ‘<i style="mso-bidi-font-style: normal;">the future is now</i>
<i style="mso-bidi-font-style: normal;">available in this laboratory’</i> managed
to avoid sensationalism in his tone and Dr Howard Burris, president of clinical
operations at Sarah Cannon referred to this speeding up of tailored diagnosis
as a ‘<i style="mso-bidi-font-style: normal;">game changer as we speed up the
development of novel therapies’.</i> Exciting stuff.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">The
second key point was the space, manpower and technology available in the pristine
laboratory premises. These impressive facilities simply could not have been
provided by the public sector alone.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Thirdly,
with disappointment I noted that one journalist (but only one I’m pleased to
report) was intent on finding the downside of this development. She started her
questioning with the comment ‘<i style="mso-bidi-font-style: normal;">I’m sorry
to be cynical but…’ </i><span style="mso-spacerun: yes;"> </span>Of course she
wasn’t sorry at all as she harped on about the NHS not being able to fund this initiative
and suggested that NHS patients would not be referred to the facility. Regular
followers of healthcare news will know the high-circulation tabloid well – it constantly
sensationalises health reports and often focusses on the bad, rather than good
news stories. The speakers responded to her with courtesy and patience. The point
which she chose to miss was that eligible NHS patients presenting with one of the
cancers under investigation at the unit will be enlisted in clinical trials as appropriate.
Their cancer tissue, collected from traditional sampling techniques can be sent
to this laboratory for testing and their tumour signature identified within 7
days. The cost of this is marginal compared to the amount of money saved though
inappropriate treatment and the human cost of repeat biopsies and wrong
pathways. Add to this the income generated from funded research and additional sponsorship
and this is a laudable public private venture.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Dr
Burris struck a chord with me when he said that the biggest cost in drug
development is time. This is also the most precious currency of any cancer
patient. The ground-breaking molecular screening speeds up the voyage of
discovery for cancer diagnosis and tailored therapy and can buy precious days,
weeks and years for cancer sufferers. </span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">As one patient who, after ten years of
toxic therapies, has benefitted from newly targeted drug treatment for his rare
cancer said ‘I feel like a normal human again’. However mealy mouthed or cynical
you may be about public private partnerships in health – this is a powerful testimony in favour.</span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
</div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p> </o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-23774192346731726902013-05-11T03:47:00.000-07:002013-05-11T03:47:16.051-07:00NHS managers could learn a thing or two from Sir Alex Ferguson
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">As
Manchester United fans across the globe prepare themselves for the ‘end of an
era’ and mourn the retirement of Sir Alex Ferguson, it is worth reflecting on
why he has been one of the greatest football managers of all time.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Regular
followers of this blog will be familiar with my penchant for combining two of
my great passions – football and health - so of course this landmark is just
too significant to go without comment.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Non-believers
may wonder why a football related subject should dominate headlines worldwide
but Ferguson has his hands on the rudder of a 1 to 2 billion dollar enterprise,
equally beloved by the stock market and football fans alike. Why has he been so
influential and why have so many column inches been dedicated to this recent
news? Because Ferguson is not only a great manager, he’s also a great leader and
it’s quite rare to have both in one package.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Much
has been reported about the lack of leadership and management in the NHS, both
from a macro and micro perspective. Progress, service improvement and high
quality care CAN be achieved in our hospitals and primary care facilities, if
the teams have some decent leadership. And I’m not just talking about the
boardroom, I’m talking about the doctor’s surgery, the bedside, and even the operating
theatre – each department needs strong management. So NHS managers and leaders,
please read the list below and take note.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Why
was Sir Alex Ferguson so successful in managing a diverse group of individuals,
each with their own agenda, but with, in theory, a common goal?<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Discipline</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">: I’m not suggesting that
the hairdryer technique (where Ferguson blasts anyone who displeases him with a
nose to nose tirade) but teams do need to play by the rules. Boundaries should
be clear, rules well defined and bad behaviour should be noted and censured.<o:p></o:p></span></div>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span></b><br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Reward good performance,
address bad performance. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">The two golden words that could go a long way to fixing
the NHS – performance management. Many have seen examples of incredible
commitment and dedicated care alongside laziness, complacency and cruelty. For
every individual failure there was a manager who either missed or ignored bad behaviour
and practice. Performance management requires integrity and courage.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Instil pride in the
brand and the team. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Ferguson
made it clear that when a player behaved badly on or off the pitch, he was
damaging the Manchester United brand. The NHS has a fantastic brand and yet so
many managers ignore this fact. I have seen brand loyalty (to almost a pathetic
degree) in workers within the private sector which benefits customers, staff
and the organisation in equal measure. Staff should wear their uniform with
pride and be encouraged to honour their own teams.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Manage egos and
personalities bigger than the brand. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Cantona, Keane, Ronaldo – Ferguson had a
knack for channelling genius and is probably responsible for saving the career
of many an upstart<b style="mso-bidi-font-weight: normal;">. </b>His
controversial sale of David Beckham still smarts, but maybe he was probably right
in recognising that the Beckham circus could have unbalanced the team dynamics.
One of the biggest challenges facing NHS leaders is how to manage clinical
teams. The clinical card is often produced to win a work stream argument. These
days, I have found that the big egos aren’t just the consultants (historically
the most difficult to manage, especially orthopods and heart surgeons) but
therapists, GPs and nurses sometimes inappropriately use their clinical
qualifications as a type of diplomatic immunity. Their clinical concerns must
be heard and carefully balanced with the harsh reality of health economics.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Earn your stripes</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">. Ferguson worked his
way up and was a player himself. The best NHS managers either have a clinical
qualification or at least worked within a clinical environment. Jeremy Hunt, the
Health secretary, is suggesting that prospective nurses spend more time on the
ward before embarking on their training but I think it would be more effective
to insist that every manager spends some time either observing or assisting patient
care so they really understand the stress and pressure that clinical teams
face.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Lead by example and
encourage a healthy work ethic. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Even at the age of 71, Ferguson is first at
the training ground for early morning sessions. Too many NHS managers stay in
their ivory towers and should spend more time in committee than at the
coalface.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Celebrate success! </span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Ferguson’s ‘dad dance’
at every goal leaves something to be desired, but no-one could doubt his
pleasure. There is so much good in the NHS and it should be celebrated. <b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">For senior leaders
only – manage the press. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Ferguson was criticised for blacklisting several organisations
and reporters during his career. But he is a canny Scot and he knew that he
needed to control the message. I was at a launch of a new joint NHS/private
venture on cancer research the other day. It is potentially a fabulous
collaboration, and I shall be writing about it soon. But there was one reporter
there, from a newspaper that famously overdramatises health stories and so often
gets the facts wrong. She kept chipping away at the potential negative elements
of the venture, and even her questions demonstrated that she didn’t quite get
it – but these bad news stories dominate the UK press and undermine improvement
efforts. Yes, it’s important that the public know about catastrophic events
such as the unnecessary deaths at Mid Staffs and flaws in government reforms but
the NHS PR machine needs to work harder in sharing the good news too.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
wish you every happiness and good health in your retirement and many many
thanks for the hours of pleasure you have given millions Manchester United fans
for over a quarter of a century.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Just
one thing – could you consider postponing your retirement and replacing Sir
David Nicholson as Chief Executive of NHS England? It’s about time the NHS had
a premier league manager.<o:p></o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-51280413264654562122013-04-28T04:35:00.001-07:002013-04-28T04:35:51.579-07:00The ‘bed blockers’ who can make or break the NHS - practical pathway mapping urgently needed.<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Andy
Burnham, Shadow Secretary for Health has now outlined his ‘ideas’ for
additional healthcare reform if Labour should win power at the next election. He
was quick to state that these are just ideas at this stage but confirmed that he
is identifying a ‘clear direction of travel’ for his policies.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">The
main thrust of his ‘direction of travel’ was to merge social care with the NHS.
It would be hard to disagree with Burnham’s assessment that ‘Councils and the
NHS don’t work well together’ and most involved with care would endorse a ‘fully
integrated system’. His concept of one owner for the responsibility physical,
mental and social wellbeing is worthy. But is it workable? What does fully
integrated care mean? And how can we make this a reality?<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Burnham
is absolutely right that a major challenge facing NHS hospitals are the elderly
patients who need ongoing care but have no current need for the acute care for
which most hospitals are designed. This vulnerable section of the community make
up between a quarter to a third of hospital occupancy at any one time which
explains why they are sometimes referred to as ‘bed blockers’.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">In
the same way that that increasing the number of lanes in a motorway can only
ease traffic congestion if the slip roads lead somewhere, so NHS improvements
can only work if there is a suitable onward referral route for patients ready
for discharge. Many patients stuck in acute hospital wards no longer need
hospital care but need to continue their convalescence with ongoing care in the
community. This care can take place either in their own homes with additional
support or in a community care facility. </span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span> </div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">When I was working on stroke
improvement initiatives in North West London, we made fantastic progress on
providing specialist targeted care for stroke patients. The London Stroke Model
defined that stroke patients should be admitted to hyper-acute stroke units within
stringent time limits from the initial call for an ambulance. After up to three
days of intensive treatment and therapy these patients would be transferred to
stroke unit where the specialised care would continue. This system works extremely
well, with every stroke unit in North West London reaching the required
standards for accreditation and additional funding within a few months. Stroke patients
received world class diagnosis, assessment and urgent treatment, vastly
improving their chances of not only survival, but retention of a good quality
of life. </span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span> </div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">An additional bonus was that each hospital that reached and maintained
the required admission times would earn significant uplift in their tariff. Every
stroke patient not admitted directly to the specialist unit would count against
the hospital. As part of the accreditation process, I joined inspection teams
in hospitals to ensure that these stroke units met their targets for accepting
stroke patients. The most challenging aspect of applying this stroke model was freeing
up beds in these units to enable new patients for admission. Time and again, a
patient who no longer required specialist care but needed community support
would languish in their hospital bed because there simply was nowhere else to go.
In one stroke unit, we had a patient, a homeless man, who was well rehabilitated
and no longer needed intensive therapy, but had been in the unit for 66 days (the
average length of stay in a stroke unit is around 20 days) because he simply
had no home to go to. (We actually threw a leaving party for him when he
finally had somewhere to stay). This bed blocking creates a damming effect (and
damning for that matter) on the entire system, back to the moment when an
unfortunate patient first has a stroke.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Burnham’s
ideas of an integrated system are coming from a good place but his direction of
travel is fundamentally flawed. </span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Burnham’s
ideas are:</span></div>
<div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 11pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">NHS
leads on the physical, mental, and social wellbeing of patients</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 11pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Councils
should hold the budget and define the health and wellbeing strategy to make a
better link between health and social care</span></div>
<div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 11pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">NHS
should lead on provision, council lead on strategy and commissioning<o:p></o:p></span></div>
<br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Opposition
is a luxury in politics. You can make bold statements without actually providing
an explanation of how highfalutin’ claims can be made real. Burnham’s plans
sound like a rehashed, but even less workable solution than the current Health
and Social Care Bill, currently being led by The Health Secretary, Jeremy Hunt.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Yes
we need more integration between health and social care.<span style="mso-spacerun: yes;"> </span>But let’s not make life even more complicated
than it is already. Councils are NOT the right bodies to set strategy for
healthcare but they should lead social care, and maybe public health.
Integration is needed at the interface between the two. To try to reform all at
once is terrifying and unworkable. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">What
we need is multidisciplinary pathway mapping – from cradle to grave, from
diagnosis to cure, from acute to chronic care. Individual responsibilities to
be defined for each area of care and ownership identified for coordination and cooperation.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Mr
Hunt and Mr Burnham – if you would like a lesson in clinical and social pathway
mapping, I would be more than happy to oblige.<o:p></o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com1tag:blogger.com,1999:blog-7746061689746893784.post-39514077075715987572013-04-21T04:43:00.001-07:002013-04-21T04:48:03.145-07:00Good care is about personal responsibility<br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">What
is the best way to take the temperature of the NHS? Ask the patient’s
relatives. This is why the Cure the NHS organisation has such a powerful voice –
or at least it should have,<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
try to avoid hysteria and over reporting of bad news stories about the NHS in
this blog but every so often I have to share a ‘tale from the front line’<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">A
friend’s husband, a fit and active 70 year old (I’ll call him Tom), recently
fell and broke his hip while walking his dog. Two weeks later, he is a frail,
broken elderly in-patient with bed sores and a post-operative infection. The
care he has received in the hospital in Hampshire has been poor – very poor.
Tom’s wife, we’ll call her Liz, is a retired nurse, so she knows something
about care and standards. Liz was horrified to note that Tom had bed sores, nasty
places on his back and ankle, and challenged one of the nurses about how this
could happen. Surely he was being turned regularly – the essential protocol to
avoid the breaking down of thin skin due to pressure, lack of movement and poor
circulation. ‘Ah’ said the nurse </span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">in
charge, ‘that would be the agency nurses’. A cheap shot and a poor example of ownership,
leadership and responsibility. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Liz
also noticed that untouched food was left out of reach from Tom and now makes
sure she is there at meal times so she can make sure he eats.</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">To
add insult to injury, Liz noticed that the floor beneath Tom’s bed was filthy, with
unidentified stains and dust. It was clear that this was of no concern to the
nurses when Liz pointed out that this dirt could be an infection risk, so she
asked if she could borrow a mop and bucket and clean the floor herself. She was
advised that there were no cleaning materials kept on the ward (apart from
antiseptic solutions and wipes), as the contract cleaners were in charge of
that. Liz enquired whether the contract cleaners could be called to undertake
this task and was advised that they only appeared on the ward on pre-arranged
times.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Have
we learnt nothing from the Mid Staffs scandal? How come if you drop a bottle of
tomato ketchup in a supermarket a cleaner appears within minutes? How often
have we all heard ‘could a cleaner please go to platform 1’ at our stations but
not so in a hospital?<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">A
visit to the NHS choices website gives this particular hospital some reasonable
ratings. 8.9/10 for cleanliness, 7.74/10 for overall care and 4.5/5 for patient
feedback. Perhaps Tom has been unlucky – maybe an unfortunate set of
circumstances has led to this isolated, but nonetheless, unacceptable lapse in
service? But this is a very personal crisis and Liz fears that Tom, a normally
robust and positive personaility, has given up and may not survive this
episode.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Professor
Don Berwick, the man tasked in improving patient safety in the NHS, says that
redesign of service delivery is needed to make ‘zero harm a reality’. He lists
seven imminently sensible criteria to be assessed and improved: </span></div>
<ul>
<li>
<span style="font-family: Symbol; font-size: 11pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Identifying aims for improvement in quality<o:p></o:p></span></li>
<li><span style="font-family: Symbol; font-size: 11pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Building capacity through training and education<o:p></o:p></span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Oversight, accountability and influence<o:p></o:p></span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Patient and public involvement<o:p></o:p></span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Measurement, tracking, transparency and learning</span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Impact for legal penalties and criminal liability on patient safety</span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="font-family: Symbol; font-size: 11pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Leadership</span></li>
</ul>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
absolutely agree with all of the above and will be fascinated to see the
outcomes of this initiative.<span style="mso-spacerun: yes;"> </span>But in the
meantime, let’s try to keep this real. Behind the jargon and theory, there are
two key players – the care givers and the care receivers. If you ask any
patient or their relatives what they want out of the care givers I would guess
that their number one request would be simple. Ownership and responsibility. Don't
blame agency nurse, contract cleaners, the doctors, targets, budget cuts,
reform, phase of the moon or anything else. Ultimately – whoever you are, if
you are caring for a patient, it is your responsibility to be the best and do
the best you possibly can.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Or
am I being naïve?<o:p></o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-10346955896084292262013-04-06T03:47:00.003-07:002013-04-06T03:47:53.695-07:00Damned if you do and damned if you don’t.
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
have a great deal of sympathy for Sir Bruce Keogh, Medical Director of the NHS
and anyone else tasked with the challenge of interpreting patient safety
figures. Like it or not, (and most of us don’t) – medicine is not an exact
science. The nearest we can get to certainty is clinical governance - assessing
outcomes and constantly monitoring effectiveness of treatments, surgical
interventions, procedures and the departments providing these services. Clinical
governance relies on statistics and as with any such analysis, validity and
relevance needs to be verified and there is still room for error with
interpretation. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">The
accepted wisdom that centres of excellence are the best way forward for specialist
services and that there can only be a limited number of these special units in
the UK means that some very tough decisions have to be made. None more tough
than selecting centres of excellence for children’s heart surgery.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">When
it comes to NHS units, the natural human reaction is the absolute opposite of
the NIMBY (Not In My Back Yard) response for unwanted local development or
activity. In fact – we are all most likely to be YIMBYs (Yes In My Back Yard)
for most NHS services on offer.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">But
patients, clinicians and parents must get real. Funds are limited, special
skills are limited and high tech equipment is too expensive to be used only
periodically. Specialist centres are the practical and cost effective way to
ensure that the very best of outcomes are achieved. Of course, it is so much
more convenient to take your child for life-saving surgery to a local centre,
but if the quality of that local centre is in doubt, however lovely and
committed the staff may be, then parents must take heed.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">It
is in this context that Sir Bruce suspended surgery at the paediatric heart
unit in Leeds last week. Initial indications from figures recently acquired
suggested that the mortality rate at the unit was unacceptably high. There was
an immediate reaction from clinicians and families refuting this claim but Sir
Bruce took, in my opinion, the only sensible decision that was open to him – to
temporarily suspend surgery. The spectre of Mid Staffs Trust where statistics
as early as 2007 that highlighted concerns were ignored (or even worse, covered
up) and 1200 unnecessary deaths later, action was finally taken, continues to
define the way forward for decision makers in the NHS. We simply cannot allow
another Mid Staffs horror to happen. In the same way that a car manufacturer
would be widely criticised for failing to recall vehicles with potentially
dodgy brakes, so must NHS managers police care facilities, review statistics
and act accordingly.<o:p></o:p></span></div>
<br />
<div style="margin-bottom: 0pt;">
<span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN;">A spokesman from the hospital Trust said: "<i style="mso-bidi-font-style: normal;">As we have stressed, the data and other information raise questions.
They do not provide answers. These are for the Trust's review to determine. It
must be right to put the safety of children first. It was therefore a highly
responsible step to suspend the service. We hope that Leeds will shortly be in
a position to restart children's heart surgery secure in the knowledge that
everything is OK."</i></span><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN;"> </span></i><i style="mso-bidi-font-style: normal;"><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-ansi-language: EN;"><o:p></o:p></span></i></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Sir
Bruce has quickly reversed his decision on the Leeds unit and paediatric heart surgery
will resume shortly as the figures have been proved to be erroneous and no
doubt the staff, patients and parents will all be relieved and delighted. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">This
reversal of decision also took courage. We must trust that the majority of
those involved in decisions regarding patient safety really do have the best
interests of those patients at heart. If we don’t believe that premise, and
that politics and personal grudges are creating bias and misinformation, then
the NHS faces an ever bigger challenge than we all feared.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p><span style="font-family: Times New Roman; font-size: small;"> </span></o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-38365472520949861552013-03-23T07:57:00.000-07:002013-03-23T07:57:46.226-07:00Commissioning – we must keep the fox out of the chicken coup
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">It
is only natural that the most commercially minded General Practitioners will
become actively involved in Clinical Commissioning Groups (CCGs). It’s also
logical that these commercially minded GPs will already have some involvement
with private companies delivering care to both private and NHS patients. There is,
I believe, nothing wrong with that, especially as we must not forget that GPs
are, after all, privately contracted to the NHS in the first place. This only
becomes a problem when GPs are given the power to choose providers for their
patients and may have a financial interest in one or more of the providers
being selected.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">According
to a recent report, more than a third of GPs on the boards of new NHS commissioning
groups in England may face potential conflict of interest in the commissioning
process. The investigation, undertaken by the British Medical Journal, estimated
that 426 out of 1,179 (36%) GPs surveyed who are in executive positions on NHS
Commissioning Boards have a financial interest in a for-profit health provider outside
their practice.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">This
entirely predictable predicament now has to be subject to guidance to be issued
by the NHS Commissioning Board. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">However
honourable and decent these GPs are, (and I have no doubt that most, if not
all, are) – to be faced with a choice of the best provider for a particular
treatment pathway, knowing that you have an intimate personal or/or financial
relationship with that provider can be at best challenging, at worst, impossible.
If you exclude a provider on the grounds of conflict of interest, you are at
risk of reducing appropriate choice. If you exclude a commissioning GP on the grounds
of conflict of interest, you may be denying a population of patients of an
expert opinion. Catch 22.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
am pleased to see a growing number of recruitment adverts from CCGs and Commissioning
Support Groups for pathway mapping, service redesign and cost reduction experts
to enhance the whole process and deliver an effective and independent commissioning
service. Considering the high proportion of GPs with declared private interests,
each CCG may need to appoint additional independent advisers to redress the
balance and maintain an impartial majority.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Ideally
– there should be an independent organisation to commission clinical services in
a region. <o:p></o:p></span></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Ah
yes – there used to be. They were called Primary Care Trusts, and they are due
to be abolished next month.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p> </o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-6814443343591715362013-03-16T08:50:00.003-07:002013-03-16T09:19:45.591-07:00As predicted – NHS reform is proving to be divisive.<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p> </o:p></span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Perhaps
it’s because I was brought up as the difficult middle child, but I love a good
spat – it gets issues out in the open and can often clear the air. If only it
were that simple with all the siblings of the complex NHS family, a family that
appears to be more dysfunctional by the day as the Health and Social Care Act
is implemented.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">No-one
could doubt<span style="mso-spacerun: yes;"> </span>the good motives of the
former Health Secretary Andrew Lansley as he formulated the transfer of power
to give General Practitioners not only the lead when it comes to commissioning of
services, but the key to around £60 billion. But as many of us are already
aware, the consequences of these changes are not all beneficial.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">As
predicted, GPs appear to fall into three camps. Those who don’t want all the hassle,
paperwork, responsibility of balancing commissioning with face to face patient
time and therefore vote with their feet through early retirement. The second
group are probably the silent majority who either take an active role in a
commissioning group because ‘if you can’t beat ‘em join ‘em’ or maybe take a lesser
commissioning role while trying to spend as much time with their patients as
possible. And the third, possibly more vocal and active group are those who favour
the changes, relish their new found spending power and appear to be planning world
(or at least UK) domination.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Those
GPs who embrace the additional responsibilities placed on their shoulders by NHS
reform are to be congratulated and supported and I have no doubt that many of
the clinical commissioning groups will do an excellent job in difficult
circumstances, especially when they have the good sense to bring in the
appropriate commissioning and clinical pathway mapping experts. But I fear that
the side effect of the bullish comments by, for example, the NHS Alliance could
do much to damage interdisciplinary relationships and ultimately the patient
experience and clinical outcomes.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Without
doubt, the priority for any health professional must be joined up care for
patients – literally from cradle to grave. Forgetting this awesome timespan,
let’s just focus on a patient needing some non-urgent care that may involve
some sort of surgical or specialist led intervention. In an ideal world, the clinical
pathway for the patient’s condition has already been agreed within the local
CCG and this pathway entails full cooperation between primary and secondary
care. But according to a letter to The Times newspaper by Drs Michael Dixon and
Chris Drinkwater and some of their colleagues ‘hospitals are dangerous places’
and they must ‘as an immediate imperative, shift all non-urgent care into the
community’ One could argue that this makes sense but it must be viewed in
context. Services can only be shifted into the community if the infrastructure creating
the desired capacity is there. </span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span> </div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">It
isn’t. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">The
letter goes on to mention the NHS Alliance Manifesto which is ‘<i style="mso-bidi-font-style: normal;">formulated by frontline doctors, nurses and
professionals in primary care’ </i>Manifesto? A <span style="mso-bidi-font-weight: bold;">manifesto</span> can be defined as ‘<i style="mso-bidi-font-style: normal;">a
published verbal declaration of the intentions, motives, or views of the
issuer, be it an individual, group, political party or government’</i>. This
very much suggests a group in isolation of the whole NHS family. The NHS
Alliance manifesto spells out some worthy aims but is positioned in a political,
territorial way. There is more than enough bad press about hospitals without such
powerful GPs proclaiming what dangerous places they are – just imagine how a
Times reader with a visit planned to hospital this week must feel?<i style="mso-bidi-font-style: normal;"><o:p></o:p></i></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Needless
to say, two days later, a response from a surgeon was printed in the newspaper
and he politely points out that one of the issues with non urgent care is that
over the years he ‘<i style="mso-bidi-font-style: normal;">has witnessed a
derogation of out of hours care, exacerbated by the GPs contract in 2004’</i>
and doctors deputising services are often ‘<i style="mso-bidi-font-style: normal;">staffed
by doctors who do not have requisite skills’.<o:p></o:p></i></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Fair
point well made.<i style="mso-bidi-font-style: normal;"><o:p></o:p></i></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">So
there we have it – just one small, but potentially significant spat between primary
care and secondary care siblings generated by the parent who didn’t think
things through when dividing the spoils of his inheritance.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">What
a sad reflection of a familial relationship that should engender the very best
for the patients in our care. It has generated some unwanted side effects for professionals,
trying to do their best for their patients but having to win ground and hold position all at the same time.<o:p></o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-75817733951121282032013-03-08T02:22:00.000-08:002013-03-08T02:22:08.763-08:00What a difference a week makes – not.
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">It
really is same old same old at the moment in UK health.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">David Nicholson hangs
on:<o:p></o:p></span></b></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">With
the tenacity of a desperate mountain climber teetering above a crevasse, the
Chief Executive of the NHS grips to his position. Insisting <i style="mso-bidi-font-style: normal;">‘I am the right man to lead the NHS’</i> his
performance at the parliamentary select committee hearing this week served only
to confirm that this man is either seriously lacking in a layer of human
emotion and humility, or is incapable of showing that he really does care.
Either way, this is not the type of persona that the NHS needs right now. Word
on the street is that he will be gone by August, so if that’s the case, why not
let him go now? Apparently he has a ‘tight grip on the NHS’. If his grip was as
tight on the organisation to achieve the right balance between quality and cost
as it is on his job maybe there would be some hope. This man ain’t for
shifting. No change there then<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Julie Bailey and Cure
the NHS continue to impress:<o:p></o:p></span></b></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">And
long may she continue to voice the concerns of millions. Speaking outside the
Houses of Parliament with her comments on Nicholson’s culpability, the
compelling Ms Bailey was, as always, calm, eloquent and convincing. Her late
mother, Bella would be proud of her – and so should all of us. Keep doing what
you are doing Julie and all your friends and colleagues at Cure The NHS.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">‘Billions in extra
cash fails to stop the rot in the NHS’ (Daily Telegraph)<o:p></o:p></span></b></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">A
report in the UK press this week told how Britain is slipping down the ranking
in public health, compared to other Western countries. Life expectancy is
increasing – which in itself could be depressing as our pension pots run out –
but we are now 14<sup>th</sup> in the list of 19. I would be more interested to
see a table listing quality of life and health and wellbeing – just being alive
doesn’t tell the whole story. But the key point is that spending has increased
from £46 billion in 1990 to £122 billion this year but we are not seeing an improvement
in the health of the Nation. The effects of a past generation of smokers, and a
new generation of the obese and inactive who eat junk food continue to pile on
the pressure for our struggling state funded system. How do we stop the rot? We
are still looking for answers.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt; letter-spacing: -0.75pt;">Jeremy
Hunt attacks 'complacent' hospitals (BBC)</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p></o:p></span></b></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Apparently
Jeremy Hunt, the Secretary of State for Health will announce during a speech today
<span style="mso-spacerun: yes;"> </span>that ‘too many hospitals are coasting
along, settling for meeting minimum standards’ He will ‘attack a culture of
"complacency" and "low aspirations", which he believes is holding
the NHS in England back’. </span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Mmm – so that
would be a culture led by a Chief Executive who has a ‘tight grip’ on the NHS?
So that’s another thing that doesn’t seem to be changing – the disconnect
between logic, good sense and NHS reform.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Change
for change’s sake is bad. Change to improve, innovate, rationalise and consolidate
is good. What a pity - it’s mainly the things that need to change that are
staying the same.<o:p></o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-17737556609303141902013-03-02T04:18:00.003-08:002013-03-02T04:18:36.398-08:00What a difference a year makes as NHS Reforms become real.
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">How
interesting… Michael Dixon, Chair of NHS Alliance and Interim President of NHS
Commissioners has warned that doctors </span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">would "start getting bogged down" in
dealing with competition and would end up taking their "eye off the
ball". He is concerned that the wording on competition in the Section 75 of
the Health and Social Care Act will mean that doctors could get "bogged
down" in the process of commissioning and distracted from patient care. <o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Reality is
really beginning to bite for a GP who has been a huge supporter of NHS Reform, which
transfers the shift of power to give GPs the majority of the NHS budget to
commission care and services. Dr Dixon has been a bullish proponent of GP led
commissioning and last year relished the new powers to be endowed on GPs, but his
ardour now appears to be waning. What a difference a year makes. Less than a
year even. Last May, I attended an NHS Futures Forum and struggled with Dr
Dixon’s enthusiasm for this shift in power. An extract of my blog that week
follows:<o:p></o:p></span></div>
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"></span></i><br />
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">May 18<sup>th</sup> 2012</span></i><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">‘…..</span></b><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Oh dear oh dear oh dear. I must be very careful how I put
this but Dr Dixon’s presentation fuelled my worst fears about the effect of
these NHS Reforms. He started his talk with ‘I am an independent contractor,
like a plumber’. ….</span></i><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">…..</span></i><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Michael is massively in favour of GP Commissioning and
leads a pathfinder GP practice. He was in my opinion (I must be careful not to
upset my lawyers) positively salivating at the prospect of complete control of
a big chunk of the NHS budget. I found his talk of a café in his practice, his
views on specialist representation and his apparent lack of empathy with
secondary care quite worrying……He made no secret of the fact that a desired
outcome of the reform and GP led commissioning was to migrate services away
from Hospital Trusts. He continued – and I quote, as near as my notes allow,
‘I’ll be moving stuff from hospital to my practice and I’ll get money for it,
therefore there needs to be total transparency’.<span style="mso-spacerun: yes;"> </span>Baroness Young (the chair of the event) was
brilliant as a devil’s advocate with her careful wording. She asked Dr Dixon
his view on the fact that many patients, especially those with long term
conditions do not wish to be ‘discharged’ from the care of their specialists to
be handed over to a general practitioner……I asked Dr Dixon if perhaps that
figure [that 30 -40% hospital admissions are avoidable] could be due to the fact
that patients couldn’t get in to see their GP and how would GP commissioning
improve this state of affairs. For a moment I thought he had morphed into
Andrew Lansley as the question was effectively side stepped. When I queried the
impression that he didn’t want specialists on ‘his’ commissioning board, he
clarified that he doesn’t want hospital specialists on the board who are
‘trying to protect their budget’.<span style="mso-spacerun: yes;"> </span>A
phrase that springs to mind includes ‘pot and ‘kettle black…….’<o:p></o:p></span></i></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Back
to the present…<o:p></o:p></span></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">There
is some merit in Dr Dixon’s demand that the wording of section 75 of the Health
and Social Care Act should be changed as it appears to encourage a scatter gun
approach to opening up competition for services which could be unsuitable for
private involvement either due to expertise, location or supply issues. Commissioning
isn’t easy. If it was, the NHS would be in a better state than it is. I would
much prefer seeing GPs looking after patients, directing their care and referring
them on to appropriate specialist services. But the nitty gritty of preparing
tenders, assessing responses and monitoring contracts is a full time job.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
believe that carefully managed competition in targeted service areas can be a
good thing for the NHS. But commissioning is a specialised, time consuming,
detailed and burdensome job. Being a GP is a specialised, time consuming,
detailed and burdensome job. How can GPs realistically be good at both? Dr
Dixon continued in his interview with Pulse magazine that offering the
tendering process for most NHS services to private firms could mean that the
reforms are ‘a complete waste of time’ and that ‘GPs will walk’.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Last
year, referring to his desire for autonomy and lack of interference, Dr Dixon famously
said <i style="mso-bidi-font-style: normal;">‘GP’s don’t want to be managed – we
want to be seduced’<o:p></o:p></i></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Fun
as seduction may be, it often results in consequences that aren’t always
positive. I am tempted to say ‘I told you so’. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Instead
I shall settle for ‘Be careful what you wish for….’<o:p></o:p></span></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p> </o:p></span><br />
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-34535614436272079732013-02-24T04:27:00.005-08:002013-02-24T04:27:53.466-08:00How to fix the NHS? Let’s start at the very beginning..<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">How
do you fix the NHS? A $64,000 question – or more accurately a £100 billion
problem. Out of bad comes good – we hope – and the Mid Staffs scandal must
surely be the turning point for change. The avoidable deaths of over 1,000
patients and the maltreatment of many, many more has got to be the trigger for
improved care, accountable management driving ownership and responsibility
among every employee of any care facility. We are all hoping that this must be
where the line is drawn – yet there are still examples of poor, even bad, care
happening now, today, this moment, in hospitals and care homes throughout the
UK.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">How
do we bring about change? The NHS has often been compared to the Titanic, both
in size and mortality, but the major issue is neither, it’s the speed at which
it can change direction that’s the problem.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">With
a nod to change management experts worldwide – where should the NHS start to
bring about this crucial evolution to balance technical expertise, cutting edge
medical treatment and good old fashioned basic care?<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Adopt a clear vision
and strategy:<o:p></o:p></span></b></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">In
theory – the Health and Social Care Bill should provide both. Andrew Lansley,
the former Health Secretary may have had a clear vision in his mind of how his
perfect NHS would look but he failed to translate this into a tangible and
workable strategy. It is now down to the new Health Secretary, the Department
of Health, Clinical Commissioning Groups, Hospital Executives and Monitor and
other organisations too many to mention, to make some sort of sense of a Bill
we are now stuck with. Clear goals (and forgive me, but maybe the odd target)
are called for.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Start at the top:</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt;"> <o:p></o:p></span></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">No-one
can now argue that the culture of the NHS needs serious attention. How do you
change culture? No apologies for repeating my favourite mantra – you start at
the top. David Nicholson must go. What a shame he hasn’t had the decency to
fall on his sword. You have had plenty of time to make things better Sir David,
and the 1 million plus NHS employees need to understand that performance management
is a vital element of a successful organisation. Nicholson has not achieved
what he is paid to do so he must go. Forget scapegoats – if someone doesn’t
perform well they either need additional training and guidance or they move on.
This shouldn’t just apply to the Chief Executive of the NHS – among the multi-layered
beaurocracy, especially in hospital trusts and PCT’s – there are
underperforming senior personnel who have been flying under the radar for far
too long. The NHS desperately needs good leaders – not just managers – leaders.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Involve every layer
and create ownership: <o:p></o:p></span></b></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">This
is where responsibility and accountability comes in. Every act of negligence,
cruelty or just plain incompetence is down the perpetrator. Every individual
involved in the delivery of care, whether as a porter, surgeon, nurse,
healthcare assistant or even ward clerk, makes a decision to be exceptional or ordinary,
kind or cruel, diligent or lazy, competent or incompetent. I am not so naïve to
believe that it is so simple. Toxic culture can turn good people bad. A caring
person can have an off day and let their standards slip. But they must realise
that blaming the boss, colleagues, economic environment, pressure or even ‘time
of the month’ is absolutely no excuse for lack of care. Badges noting name and
job title for ALL patient facing staff is a good place to start.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Communication:<o:p></o:p></span></b></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">A
care facility must make it absolutely plain to patients and staff which
standards are acceptable and how these standards will be measured. As changes
start, employee engagement is essential and it is only through ‘stakeholder
buy-in’ that real change can take place.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Reward good behaviour
and punish bad behaviour:<o:p></o:p></span></b></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Effective
change management is like good parenting.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Provide support,
mentoring and guidance for all staff:<o:p></o:p></span></b></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Effective
management is like good parenting! And leaders – don’t forget that managers
need support, mentoring and guidance too. This is appropriate at ward level and
board level.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Create measurable goals:<o:p></o:p></span></b></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">What
does good care look like? The 6 c’s created by the Royal College of Nursing (Care,
Compassion, Commitment, Courage, Communication and Competence.) are all very
well but what do they actually mean? Goals should follow the SMART principle -
Specific, Measurable, Attainable, Realistic and Timely. No more sound bites but
tangible monitoring. Patient and carer questionnaires, regular performance
appraisals, and ongoing training at the very least.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Empower all
stakeholders:<o:p></o:p></span></b></div>
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">'Nothing about me
without me’</span></i><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">
was one of Lansley’s favourite phrases. Yes – it is jargon but the principle
behind it is sound. Don’t just say we are giving patients and carers a voice. Make
it happen – at every stage of the care pathway. One of the most shocking
elements of the Mid Staffs debacle is the way that Julie Bailey, whose mother,
Bella died in the hospital, and many other relatives of members of Cure The NHS
were treated. Unforgivable. ‘Whistleblowing’ doesn’t just apply to staff, it
should be a given for all. But it should also be a last resort. We cannot rely
on whistleblowing to fix the NHS, but it must be an acceptable route for all
those with a conscience to follow. I hope that this will be one of the lasting legacies
of the Francis report following his enquiry into this hospital’s maltreatment
of so many patients. <span style="mso-spacerun: yes;"> </span>I long for the day
when whistleblowing is rare – not because it’s discouraged, but because it’s no
longer need. What a Utopian vision!<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">And
finally..<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Make sure that the
change is sustainable:<o:p></o:p></span></b></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">No
quick fixes – quick wins yes, but supported by long term, realistic plans. The majority
of care in the NHS is good, sometimes exceptionally so. But sadly, bad care is
more common than it should be and even worse, in some areas, accepted as a
tolerated norm. The process of change needs to ensure that we look on the first
decade of the 21<sup>st</sup> century as the bad old days of state managed
care, never to be repeated.<o:p></o:p></span><br />
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com0tag:blogger.com,1999:blog-7746061689746893784.post-85042325747864277952013-02-16T11:30:00.002-08:002013-02-16T11:30:50.269-08:00David Nicholson should step down as Chief Executive of the NHS
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Robert
Francis stated in his report following the Mid Staffs care scandal that ‘<i style="mso-bidi-font-style: normal;">what has</i> <i style="mso-bidi-font-style: normal;">been found to be wrong here cannot be cured by finding scapegoats’</i>.
<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Francis
may have a point, but that doesn’t mean that those who are actually to blame
for individual acts of negligence and cruelty should not be brought to book and
if appropriate, face criminal prosecution. What about the cultural breakdown
which has created ghettos that are literally unfit for purpose within our
hospitals and care facilities? One definition of scapegoat is ‘one that is made
to bear the blame of others’. Yes, the creation of scapegoats would be a bad
move, but fixing the NHS is not just a blame game, it’s about shouldering
responsibility and accepting individual ownership by staff at <i style="mso-bidi-font-style: normal;">all</i> levels. How can it be possible that
so many atrocities have taken place in facilities with an abundance of leaders
and managers?<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">What
creates a positive, productive and benevolent culture in any workplace? Good
leaders. Ultimately who has responsibility for the culture of an organisation?
The man (or woman) at the top.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">One
could ignore the unfortunate fact that the Chief Executive of the NHS, Sir
David Nicholson was interim chief executive at the health authority responsible
for Mid Staffs Hospital at the time that the high death rate at the hospital
was beginning to draw attention. But what cannot be ignored is his tenure at
the top job in the NHS since 2006. Nicholson has been ‘in charge’ for over six
years. As courage grows within clinical and support staff, more and more shocking
and frightening cases of poor management and substandard care are coming to
light. On your watch Sir David. On your watch.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Sometimes
the best person to fix a major problem within an organisation can be the Chief
Executive but more often they are not, especially if they’ve been at the helm
as the situation developed and worsened.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
started project management within the NHS four years ago and was surprised to
note that despite my dealings with senior clinicians, ward staff and hospital
managers, Nicholson’s name was never, never mentioned. Andrew Lansley, the Health
Secretary at the time was often pilloried, discussed and on a rare occasion,
even supported, but Nicholson was just a non-personality, absent both
physically and emotionally it would appear. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Let’s
give the Chief Executive the benefit of the doubt and assume that his low
profile meant that he was busy working behind the scenes rather than playing an
astute political game to protect his position. Anyone can be forgiven a little
self-protectionism. Up to a point.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">The
tipping point for me was watching Nicholson’s interview on the 6<sup>th</sup>
February following the Francis report. He came across as a cold fish, and he
said ‘….<i style="mso-bidi-font-style: normal;">At the time I apologised and in a
sense I apologise again to the people of Stafford for what happened, but
apologies are not enough we need action, we need to make things happen and right
since 2009 we have doing things in the NHS, we’ve been tackling healthcare
associated infection, we’ve been tackling stroke services…. Heart disease .…we’ve
literally saved tens of thousands of lives and the NHS is committed to that….</i>’
What an opportunity missed – this came across as a political speech rather than
a genuine concern for the patients lost and sympathy for their devastated loved
ones. ‘..<i style="mso-bidi-font-style: normal;">in a sense I apologise again’</i>
– cold comfort for the bereaved relatives. At the time I bravely (or maybe
foolishly – I really want to continue working with the NHS) tweeted.. ‘<i style="mso-bidi-font-style: normal;">Just heard the re-run of the Nicholson
interview. What an incredible lack of empathy and humanity. Shocking.’ </i>Needless
to say, this was much re-tweeted.<i style="mso-bidi-font-style: normal;"><o:p></o:p></i></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
have no doubt that Sir David does care, in his own personal way, but is he the
right person to lead from the front and introduce a new era of patient first? Charismatic?
Empathetic? Accountable? Inspirational? <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I
think not. </span><span lang="EN" style="mso-ansi-language: EN;"><o:p></o:p></span></div>
Finchers Consultinghttp://www.blogger.com/profile/02585633183853596999noreply@blogger.com1tag:blogger.com,1999:blog-7746061689746893784.post-31655559378827595442013-02-09T03:42:00.001-08:002013-02-09T03:45:08.549-08:00Should the Francis report recommendations replace the Health and Social Care Bill?<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><span style="color: #0b5394;">Robert
Francis QC strikes me as (in the words of my grandmother) a sensible sort of
chap. This may seem a frivolous start to any commentary on the Mid Staffs
report, especially considering the horrors suffered by not tens, but hundreds
of patients. But it is good sense that is needed to fix not only Mid Staffs,
but the NHS in general.<o:p></o:p></span></span><br />
<span style="color: #0b5394;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><span style="color: #0b5394;">This
highly significant landmark in the future development of the NHS has been
sublimely covered by the Health Services Journal and I am still absorbing the
key points. I particularly like the infographic ‘how the report will affect the
key players’.<o:p></o:p></span></span></div>
<span style="color: #0b5394;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><a href="http://www.hsj.co.uk/infographic-how-the-francis-report-affects-the-key-players/5054618.article?blocktitle=Most-popular&contentID=-1"><span style="color: #0b5394;">http://www.hsj.co.uk/infographic-how-the-francis-report-affects-the-key-players/5054618.article?blocktitle=Most-popular&contentID=-1</span></a><span style="color: #0b5394;">
</span></span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="color: #0b5394;"> </span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><span style="color: #0b5394;">But
for simplicity, I am including some top recommendations highlighted by the BBC
website:<o:p></o:p></span></span></div>
<span style="color: #0b5394;"></span><br />
<div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 18pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="color: #0b5394;"><span style="font-family: Symbol; font-size: 11pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">The merger of the regulation of care into one body - two are currently
involved</span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 18pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="color: #0b5394;"><span style="font-family: Symbol; font-size: 11pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Senior managers to be given a code of conduct and the ability to
disqualify them if they are not fit to hold such positions</span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 18pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="color: #0b5394;"><span style="font-family: Symbol; font-size: 11pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Hiding information about poor care to become a criminal offence as would
failing to adhere to basic standards that lead to death or serious harm</span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 18pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="color: #0b5394;"><span style="font-family: Symbol; font-size: 11pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">A statutory obligation on doctors and nurses for a duty of candour so
they are open with patients about mistakes</span></span></div>
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<span style="color: #0b5394;"><span style="font-family: Symbol; font-size: 11pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: EN-GB;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">An increased focus on compassion in the recruitment, training and
education of nurses, including an aptitude test for new recruits and regular
checks of competence as is being rolled out for doctors<o:p></o:p></span></span></div>
<span style="color: #0b5394;"></span><br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="color: #0b5394;">I haven’t assimilated all the information in this report yet but share
the view of so many – how could this have happened and why hasn’t anyone paid
for the ‘appalling suffering and abuse’ with their jobs?<o:p></o:p></span></span></div>
<span style="color: #0b5394;"></span><br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="color: #0b5394;">The Francis report addresses <i style="mso-bidi-font-style: normal;">‘patient
abuse and cruelty’</i>, ‘<i style="mso-bidi-font-style: normal;">corporate self-interest’</i>,
and ‘<i style="mso-bidi-font-style: normal;">administration remote from the
service at the front line’</i> He goes on to mention a <i style="mso-bidi-font-style: normal;">‘reluctance of those with the power to do so, to intervene urgently to
protect patient’s interest’ </i>and the <i style="mso-bidi-font-style: normal;">‘institutional
culture’</i> is quoted as culpable.<o:p></o:p></span></span></div>
<span style="color: #0b5394;"></span><br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="color: #0b5394;">I agree with Francis when he says that what is wrong cannot be cured by finding
scapegoats. However in my opinion, that shouldn’t mean that those who must
shoulder some blame should stay in post. From the ward to the boardroom – the key
players and perpetrators should face the consequences of their action or
inaction.<o:p></o:p></span></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="color: #0b5394;">Cruelty and abuse was undertaken by human beings with free will. No-one
made a nurse ignore a patient’s cry for help. The lack of conscience in a
senior manager viewing their own professional ambitions and putting patients’
needs out of mind was a personal choice. Those with the power to intervene chose
to ignore damning statistics and the pleas of distressed relatives.<o:p></o:p></span></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="color: #0b5394;">In order to change culture, the top needs to lead by example. Anyone
with some authority needs to think patient. Commissioners, chief executives, ward
sisters and clinical leads must demonstrate that they care – in every sense of
the word. They care about doing a good job, they care for the people whom they
treat, they care for their colleagues and they care about outcomes. I
absolutely agree with Francis when he recommends improvement in recruitment,
training and education of clinical teams. I also agree that there should be one
regulatory body monitoring care and standards.<o:p></o:p></span></span></div>
<span style="color: #0b5394;"></span><br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="color: #0b5394;">Let us not forget that five other hospitals with above average mortality
rates are facing investigations so Mid Staffs is not the only bête noire. I am
a feisty, educated woman who understands how to play the system to get the best
care, but even I have witnessed, and experienced at first hand a nurse being
mean and a doctor ignoring my wishes. <span style="mso-spacerun: yes;"> </span>So
what chance would a vulnerable elderly patient stand?<o:p></o:p></span></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="color: #0b5394;">The complex top down reorganisation as prescribed by the current NHS reforms
will do nothing to address the care crisis faced by the NHS, but the
recommendations by Robert Francis might just do it. Accountability,
responsibility and honesty should be the NHS mantra. <o:p></o:p></span></span></div>
<span style="color: #0b5394;"></span><br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="color: #0b5394;">What a pity that so much effort and resource has been applied to
implementing Lansley’s Bill when the time and money could have been better
spent addressing the real care crisis in our much loved, but nearly broken,
state funded system. It just makes sense really - doesn't it?<o:p></o:p></span></span></div>
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