What does innovation mean for the NHS?

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

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

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

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

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

Innovation in the NHS SHOULD be:

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

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

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

‘Innovation is not the same as reform.’

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

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

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

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

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

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

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

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

How will history judge Andrew Lansley?

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

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

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

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

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

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

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

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

NHS reform doesn’t come cheap

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

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

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

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

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

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

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

But…

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

It’s all nonsense really isn’t it?

 

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

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

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

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

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

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

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

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

Our Olympic legacy isn’t just about sport and fitness

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

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

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

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

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

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

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

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

Are the Olympics good for your health and wellbeing?

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

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

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

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

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

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

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

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

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

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