Is it just Spring or is there a sniff of U turn in the air?

So far, Andrew Lansley, the UK Secretary of State for Health, has been resolute in his determination for forge through the NHS reforms, giving control for 80% of the annual budget to general practitioners. He has appeared to suffer from an unusual form of selective deafness and maybe some word blindness too, by ignoring the verbal and written concerns by those in the know.

Earlier this year, in an unprecedented move, eight highly respected and knowledgeable leaders from organisations such as the British Medical Association (BMA), and the Royal College of Nursing wrote to The Times criticising the speed and scale of restructure using language such as ‘potentially disastrous’ and ‘extremely risky’. This, and many other pleas to reconsider have been ignored and as the weeks and months have passed, the momentum of criticism of the health bill has grown.

Lansley faces a vote of no confidence at a special representatives meeting of the BMA this week and now six major health bodies have rejected the government’s new voluntary ‘responsibility deal’ on alcohol. Organisations such as Alcohol Concern and The Royal College of Physicians say they were ‘brought to the table too late’ and that there needs to be a clear strategy on alcohol to replace the ‘lack of clarity’ with the recent initiative. Still, we get the feeling that these voices, growing in crescendo, will continue to go unheeded.

But now we have the Liberal Democrats, at their Spring Conference, voting overwhelmingly to pass a motion criticising the reform proposals. Finally, words are being spoken in a tongue that the government understands. No interpreter needed. The language of politics. But is this going to be too little too late?

GP’s and primary care providers HAVE embraced this change – some because they felt that they have no choice. Yes, some are enthusiastic and gearing up for the major change. Why wouldn’t a group of people given the opportunity to increase their influence and income be keen to give it a go? But secondary care and the hospital trusts are still in real danger of being disenfranchised.

And my point is? Now that it could be politically desirable, Lansley may have to reconsider some of his plans. But the wheels are already in motion – to try to unravel the changes so far could be even more damaging than allowing them to continue.

I am put in mind of the time I tried to teach my daughter to drive. I wasn’t very good at it and at one point we approached some traffic lights just as they were turning red. I wasn’t at all helpful and told her to stop too late, by which time we were in the middle of a busy junction – with the car blocking oncoming traffic as it started to approach. I wasn’t sure what would be best - to tell her to reverse and go back to where we were or to put her foot on the accelerator and try to speed our way out of trouble. I continued to dither and opted for neither and chaos ensued. She had told me that I needed to change my approach on instruction and I hadn’t listened. (Needless to say, after that episode all lessons were undertaken by an expert)

My advice to Andrew Lansley? Listen. Don’t just listen to GPs, listen to all interested parties. Then make a decision, stick to it and find a way to adapt your reforms to encompass what you hear. Give us some clarity on how commissioning will work. Reassure us with concrete direction to ensure that hospitals and secondary care will be protected and innovation nurtured. And then maybe, just maybe, you will start to like what you hear.

Today, the Prime Minister’s spokesman said ‘There are not about to be significant changes to the policy’ but then added that MPs and peers would have the chance to debate and ‘if necessary’ amend the Health Bill

If there is any type of U turn, we need a clear strategy, supported by those all along the patient pathway, with definitive plans and not just platitudes and soundbites.

 

NHS Expo 2011 - day two

I attended both days of the ‘Innovation for a healthier future’ event encompassing several alter-egos. As a healthcare commentator – anything to do with the future of the NHS is rich fodder. Innovation in health is an exciting and very necessary element of patient care. I was also researching opportunities for the likes of me – change managers and business consultants with health expertise. And last but by no means least, it was a great networking opportunity to catch up with old friends, including a university pal whom I hadn’t seen since Glam Rock first graced the airwaves!

This event has provided a wealth of material for my blog and I shall share much of this over the next few weeks but in the meantime would like to give you my overall impression resulting from the presentations, seminars and discussions.

This current spate of NHS reforms will stifle innovation: My view on this first conclusion is unequivocal. This could have short, medium and maybe even long term effects in reducing the UK’s capability to climb up the World Health Organisation’s rankings. There is no incentive for GP consortia to fund new treatment initiatives and in order to gain Foundation status, Health Trusts will be forced to cut costs. They may have to gamble on innovation in the hope that they can gain commercial advantage for their investment.

GP Consortia are in danger of becoming expensive versions of Primary Care Trusts: I attended some very interesting seminars regarding practice based commissioning and pathfinder GP consortia. The commitment and passion by these practices cannot be doubted, but they are the first to admit that they are on a very steep (and potentially expensive) learning curve. Many will need training in leadership, communication, pathway mapping, stakeholder engagement, bidding and negotiating to name but a few essential skills.

The patient pathway will become unbalanced. As GP’s make commissioning decisions, their default position will naturally to increase investment in primary care at the expense of secondary care. Yes, scalable services nearer a patient’s home in a community setting are an excellent idea. But we will still need centres of excellence for complex imaging (and interpretation) and surgical or medical interventions. One GP mentioned during his presentation that they had made some ‘quick wins’ with cost saving commissioning decisions which funded more equipment for their practice. I’m concerned that the hospital consultant voice may not be heard.

Patient ‘power’ must be very carefully handled. Andrew Lansley’s soundbite ‘no decision about me without me’ is becoming a very hackneyed mantra and is open to misinterpretation. I wonder whether we may face ‘healthcare by Wikepedia’ or even worse, newspapers like the Daily Mail (a right wing tabloid  in the UK) will direct patients to demand certain treatments which may not even be appropriate for them. Many presentations at NHS Expo concentrated on the patient voice and as one wise speaker noted – it must be a two-way dialogue.

All of these issues can be addressed. As widely reported, the speed of change is mind-boggling but somehow, thought leaders and change managers working with the NHS need to stop looking to the politicians for the answers and get on with implementing therestructure in a way that minimises these risks.

NHS Expo 2011 - day one

‘Innovation for a healthier future’ is the theme for the two day event which started today in London. The hottest gig in town though was the first keynote speaker, Andrew Lansley (UK secretary of state for health) and the title of his presentation was ‘How the modernisation plans will encourage innovation to drive up quality and value’

I have read many transcripts of Lansley’s speeches and viewed webcasts but this was the first time I had seen him perform live. (I was pathetically looking forward to this – must get a life).

I nurtured the vague hope (see previous blog) that this speech would be different. After all – the title wasn’t ‘My plans for the NHS’. Been there, done that, bought the T shirt. But after a promising but brief start, one minute and 56 seconds to be precise (as I said – I must get a life) Lansley launched into exactly the same rhetoric as the live webcast for the British Medical Association on Monday. The only difference was that every few minutes he incorporated the word ‘innovation’ into the text as a nod to the theme of the occasion.

He is an excellent orator and quite credible but as with so many politicians – didn’t actually answer a single question to my (and I suspect the majority of the audience) satisfaction. Several hospital consultants asked very pertinent questions about funding. One asked how to move forward with innovation if the GP commissioners won’t fund certain service initiatives. We didn’t really get an answer on that one. Another asked about quantifying patient feedback. Someone from a PCT asked about a telehealth innovation that the GP commissioners wouldn’t fund. Lansley suggested that a conversation between the PCT and commissioners would resolve that.

One audience member stood up and said he was ‘very excited’ about the reforms’. I shall let you guess – was this excited member of the audience:

a)     Hospital Physician

b)     Pharmacist

c)     Hospital Manager

d)     GP

No prizes for answer d)

But enough of the sarcasm. In Lansley’s defence – he spoke passionately about thrombolysis treatment for stroke but interestingly failed to mention that the national stroke strategy that initiated these improvements was created in December 2007 long before the word ‘coalition’ played a part in the political landscape in the UK.

He spoke very sensibly about the fact that change is uncomfortable and this is where I see the greatest opportunity for innovation. Innovation of approach.

As with so many events like this, it is the coffee break conversations that are so valuable. And my overwhelming impression was that healthcare professionals now accept that these reforms are going to happen whether they like it or not. This newfound ‘power’ for GPs could also be a huge burden and the real challenge will be to get everyone along the patient pathway to work together and agree best practice.

As I made my way home this evening I pondered that despite my well documented reservations about the reforms – as a facilitator and trainer in clinical pathway mapping – I think I’ll continue to be pretty busy for the foreseeable future.

NHS reform: plenty of questions – where are the answers?

Albert Einstein’s definition of insanity is ‘doing the same thing over and over again and expecting different results’

On that basis, my marbles are clearly under threat as tonight I tuned in to the replay of yesterday’s webcast of an interview with Andrew Lansley, UK secretary of state for health, at the British Medical Association. At least my grip on reality has not entirely escaped me as I had the good sense to choose dinner with friends last night rather than tune in to the broadcast live.

Did I really expect the sound bites to be different this time? I must confess I didn’t listen to the full recording as I heard nothing new. As far as I could ascertain, the very first question posed to Lansley ‘what do you think of the reaction to the bill so far? never actually got answered. He immediately launched into the mantra – ‘Patients at the heart of everything we do…nothing about me without me…focus on outcomes…..transfer of responsibility into the hands of front line physicians…… ‘

My concentration started to waiver. And yet, I kept the faith and carried on listening, still hoping for a real explanation of how patients making care decisions can possibly make sense, how outcomes are different from targets and how GPs can carry the burden of an £80 billion budget. The next question, apparently posed by a third of the listeners, was a particularly good one – ‘where is your evidence for going through with this reorganisation?’ I don’t think there was a definitive answer to that either.

So I gave up and watched the football instead. At least you normally get a different result each time you watch a game.

But I fear the men in white coats may well be coming for me soon. Alas tomorrow I am attending the Healthcare Innovation Expo in London and will be there, bright eyed and bushy tailed, ready to listen to the keynote speaker… Mr Andrew Lansley. And I’ll be hoping for some clarity and specifics.

Will I ever learn?

The spirit of the NHS

Vince Lombardi, the legendary football coach once said ‘The achievements of an organisation are the results of the combined effort of each individual’

The combined efforts of the neuroscience departments of The Royal Free Hospital were very much in evidence on Thursday evening. A pub quiz was organised by the stroke coordinator, Kerry Thompson and her colleagues, to raise funds for Headway, a brain injury charity. Around a dozen noisy teams were very ably controlled by the master of ceremonies, a handsome TV star, Jeremy Edwards.

We occupied a private room in an old fashioned English pub, the food was good, the wine and beer even better and the atmosphere great fun. As I struggled to help my friends answer a range of challenging questions I realised a couple of things:

Firstly – I’m rubbish at pub quizzes. I thought that David Bowie was 62 years old (he’s 64), that Napoleon died on Elba (it was St Helena) and had no idea that dendrology is the study of trees! What makes me even more of a hindrance is that I give the impression that I know what I’m talking about so it’s even more annoying when people believe my wrong answers!

Secondly – and much more important – I felt privileged to be part of an event filled with such energy for a worthy cause. The quiz teams were made up with doctors, nurses, therapists, administrators, and hangers-on like me – all who are associated with the Neurosciences services at this NHS hospital that was founded in 1828 (another question I got wrong) ‘to provide free care to those of little means’.

These NHS employees had all done a full day’s shift and are passionate about their work, their patients and are clearly a cohesive, caring team, (who also know how to have a good time of course). The evening was a great success and several hundred pounds were raised.

Of course, the combined efforts of these teams amounts to so much more than organising a pub quiz. There were also representatives from other London hospitals and stroke networks and the progress made in Stroke care in the capital has been stunning. London now leads any other major city throughout the world for thrombolysis (life and brain saving treatment for stroke patients).

When I recently finished a project with the NHS, I asked one of the service directors what she thought would happen as a result of all the planned changes. Her reply was a touch wistful but held some optimism ‘I just hope that the good people will stay, and make these reforms work somehow’.

An evening with these fantastic people and the spirit running through the event is cause to believe this could be true.

How to alienate your audience in one easy lesson

For those of you unfamiliar with Robert Kiyosaki’s ‘Rich Dad Poor Dad’ series of books, they provide inspirational instruction on changing your mindset on wealth and work. Kiyosaki writes with an energetic, warm, non confrontational style so when I, and two friends went along to a ‘Rich Dad’ education seminar, we expected much of the same.

This was a free seminar, understandably geared to promote Rich Dad training programmes and we were prepared for a bit of a sales pitch. What we weren’t expecting was an assault on our senses.

I am particularly interested in soft skills, and have no doubt that methods of communication and personal interaction have a huge impact on health and wellbeing in the workplace. With this in mind, I was prepared to be an enthusiastic member of the audience, with both my professional and personal hat on.

The speaker (presumably a franchisee of the ‘Rich Dad’ brand) started in an engaging manner but as the two hours wore on, managed to offend and/or bore at least half the audience. The ‘I’m a multi-millionaire who doesn’t need to work’ bit was fine. The ‘here are the pictures of all the holidays I had last year and my big house’ was OK too. Even the sales pitch for the undoubtedly excellent three day training programme was acceptable at the start. There were also some useful nuggets about how muddy thinking stops people moving forward and how you need to be specific with your goals.

But then he started shouting to emphasise a point. So loud and aggressively that several of the audience members jumped, startled. At one point, the speakers from the sound system started buzzing and he turned to them and screamed ‘shut up’. If he hadn’t seemed so angry it would have been funny.

As the two hours continued, the sales pitch became like a tirade, suggesting that those who didn’t plan to sign up were fearful losers. I was aware at this point that the speaker was unsettling the kinesthetics (those whose primary learning style is feelings) and the auditories (listeners) by the assault on their senses. I suspect they were among the many who left before the end.

The person sitting next to me passed a note saying ‘I feel I’m being told off!’. I was immediately transported back to my school days, and feared I may be sent to the corner for speaking in class!

Then this aggressive judgemental speaker delivered his killer line ‘It is a sin to be poor in the UK – it’s not a sin to be poor somewhere like India, but no-one has the excuse to be poor in the UK’

If changing my mindset means I become a heartless, dispassionate individual, then I’d rather go without the trappings of wealth.

Note to self: use this as an example of ‘how not to present’ at your next communications skills training session.

Note to reader: Be aware when you present, how best to engage your audience, and keep them on side. And please don’t be put off Rich Dad Poor Dad by this story, Kiyosaki’s books are good

Note to Robert Kiyosaki: I know that some of the people who present your seminars are great, I met a couple of them a few weeks ago, but please be careful who you choose to represent your very powerful brand.

Time to give bad behaviour in football the elbow?

‘Wellness in the workplace’ covers many aspects of health and wellbeing for employees. Bullying and violent behaviour in most organisations results in instant dismissal and each organisation has a duty of care in keeping their employees safe from harm

So why should football be any different? Last year, the sporting fraternity was divided as John Terry, a very able England captain, was relieved of his duties for an admitted affair with a colleague’s ex-partner. Phrases such as ‘responsibility to fans’ ‘unsportsmanlike behaviour’ and ‘bad role model’ were bandied around with gusto.

And yet here we are, just a few short-memory months later with Wayne Rooney, arguably the most famous footballer in the UK, blatantly elbowing an opponent in the face and getting away with it. (I won’t mention his previous well publicised misdemeanours with prostitutes – oops - just have). Televised coverage of the weekend match clearly shows Rooney, playing for Manchester United, shoving his elbow in his opponent’s face, away from the run of play. The referee saw this incident and awarded a free kick, but no censure for the perpetrator, not even a yellow card. His boss, the equally famous Sir Alex Ferguson played down the unsportsmanlike behaviour saying ‘There is nothing in it’

In the same weekend, Ashley Cole, another England ‘star’ has allegedly ‘shot’ a youth training scheme youngster in the leg with a powerful air rifle during a training session. An air rifle? At a football training ground? Pointed at a young man?  Health and safety in the workplace? It would appear not. Carlo Ancelotti, the Chelsea manager said ‘Ashley made a mistake….it would be very different if he had not said sorry’. So Cole will play in the crucial Premier League match tonight.

As my regular readers will know, I am a massive football fan and a Manchester United season ticket holder. But right now I feel thoroughly ashamed of the English game that I love so dearly. We strive at work to reduce bullying, to improve the wellbeing of our staff and to nurture a culture of benevolence and kindness. Yet these obscenely paid ‘role models’ continue to get away with bad, violent behaviour. The sort of behaviour that can threaten life and livelihood. Cynical, violent acts should be rewarded with a red card and match bans. What a terrible message this is sending out to the public at large.

Dangerous behaviour should result in suspension. As far as the off pitch sexual shenanigans, I’m not really interested as it doesn’t effect the wellbeing (normally) of the team mates.

Come on English football – clean up your act. Health and Wellbeing on the football pitch and on the training ground are just as important, and a lot more public, as health and wellbeing in an office.