Nick Adkins – Health Chat

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The Kilted, Bearded man and a suited dude

Nick Adkins, Health Chat.

Digital Evangelist. That was the first description. All around great guy. Beard and kilt and pink socks? Read on!

An unusual Health Chat. Still Roy Lilley chatting and digging. Still one interviewee we would get to know more. But, out of London! Leeds, to be precise. The audience did have a spattering of other digital experts, and some of the acronyms were beyond my ken, but we got the meaning. And we had a young person to ask the youth level questions at the end. Amelia Tickell will be in Roy’s succession planning I am sure! Already a Fab NHS ambassador, once she leaves school and gains life knowledge, the world will be her lobster…

As ever – this is my take, so check the you tube out in case your views are different.

Have a gander at the one hour session. Click here. It started like one of the star wars films. Had a few giddy moments. And the second interviewer. Plus a grim story and call for help at the end. To bring hope dignity and joy to Rodos refugees, fleeing Syria and living in a building given up by locals in Greece. All the bits do link. Mainly through attitude. And belief in focusing on the good.

“Love more, fear less, say yes”. Nick had one of those life changing experiences, at the Burning Man gathering in Arizona Desert. Yes, there’s music. But mainly you learn about you by surviving one week in very hot and very dry days and very cold nights.        80 000 people. Many of them find out a lot about themselves and about others. He was impressed by the level of gifting and generosity. Food (including coconut ice cream – no idea how!). Ideas. Hugs. Positivity.

He had started in Memphis Tennessee (yes, music central for Elvis fans). Mum tells him his first phrase was saying “Mommy no sing” whilst she tried to lullaby him…Went up to business school in Nashville. Selling tech to health care organisations in USA. He liked Clinton health reforms and Obamacare. Realised the whole thing was designed broken, though. The Casino healthcare culture isn’t going to be voted on by its owners, Medicare and Medicaid? Turkeys and Christmas come to mind. Nick Adkins said he would have The NHS in preference. Describing the 13000 households who drive policy – 0.1% of households – as being rather like Game of Thrones. Except they have one throne, not 7 as in the TV series. And they control the lobbyists. He is a Bernie Saunders admirer – usually denounce as madly extreme socialist in his own country, although we might listen and hear a Lib Dem style of thinking. Tax the richest, support health care for all, and then reduce the price and cost of running their dysfunctional system. $ 3 trillion was mentioned. Is that really the cost involved? Anyway, you see where the man is coming from.

He returned from his life changing Burning Man week in the extremes of that Arizona Desert seeking to sell his original entrepreneurial venture selling into Health Care. New start up – a non-profit organisation. The #PinkSocks (Twitter handle – go look…) movement went alongside this. Still in the digital space. Forget tech fro a bit. That’s the vehicle. The people bit is an organically growing global movement, whose main secret is gifting. He did a TED lecture on the pink socks, not as he thought they wanted – more about his tele-medicine start up. That idea feels sound – ensuring the integrity and safety and security of your on line conversations and video exchanges with anyone (especially in healthcare) such that any real attack would cause the items to destroy themselves. It did sound a bit Star Trek. They went to HIMMS (Health IT Conference) in 2015 and by serendipitous exchange of views about pink socks (which he and business colleagues wear and show off) started a Twitter storm via photos with Prof Eric Topol. All the other big cheeses from all the other major players suddenly wanted to chat to them.  That’s the power of positive social networking. Maybe giving and gifting 55 000 pairs of pink socks and the photos of them becoming powerful endorsements of cross pollination, and happy positive thinking had a hand in it.  Although Nick didn’t say this, ‘as you sow, so shall you reap’ springs to mind from The Bible. And my dad’s “the more you give, the more you’ll get” both seem apposite quotes for what is happening here.

(And The Topol Review on the digital future in Healthcare UK is here )

People want to do the whole thing. When he talks with the tech guys they often want to just take his idea and make the programmes themselves. But does the chef making the perfect sweet want to buy 20 acres to sow the sugar cane to harvest and process it? Or does she just get sugar delivered, and let the experts do the making?

I liked one other story. Because life isn’t all just sweet. Imagine you have a stunning cone of beautiful ice cream in one hand, and you’re contemplating that first taste. But realise that your standing in some very smelly dog mess. What do you want to focus on? The love or the crap? If you focus on the positive, realise that you have so much hope in your life, it doesn’t make the crap go away. But it helps to lessen it’s effect. It needs the positivity to ripple. Most people who you prefer to be involved with want to hug you, not hurt you. If we aim to do that thinking at least once a day, and have ‘awesome conversations in real time’, then we will ripple wide and loud, with the connections drowning out the deep fakers.

Our youth wing, Amelia Tickell asked how to make the movement more prominent in the future. Nick said forget the future. You can only live in the now. “Don’t miss it. If you live in the now, you will change the future”. Story of sending socks to first graders in El Passo. Mexican border. Been in someone’s fake news, I think? The teacher made photos and vids of the kids – social media heaven!

And it isn’t about the pink socks. They just open up the conversation prospects. You’re not a stranger anymore. He thought we should get off our phones more. “We are so connected we are disconnected”.

The ethos feels very like The Academy of Fab Stuff, sharing great ideas throughout the NHS. And the final film piece was for Roy’s visit to an ex London nurse who became a Franciscan monk. He is now helping to run an unofficial, locals supported Syrian refugee camp in Rodos. Watching that, you do realise, as Roy said, just how lucky we all are. Little things are big things. A toothbrush and toothpaste, a gifted water melon or whatever can just bring some hope, dignity and joy.

The whole message of the session was Nicks organisational mantra. “We are centred around passion. Empathy. Caring. And connection”.

You should make time to watch this. And look up this absorbingly interesting man. And view the Rhodes refugee film. And if you aren’t moved, then I will be very surprised. Links below:

The #lilleypinksocks health chat

The Academy of Fab NHS Stuff

Rhodes Refugees

To find Nick on twitter – Pink Socks movement – #nickisnpdx or just type in Pink Socks !

Health Chat ; Rashik Parmar MBE

This was the advert from The IHM to get us to go to this health chat!

Rashik Parmar

“Rashik Parmar is a Fellow of IBM, the leader of IBM’s European technical community and an IBM Distinguished Engineer. He was previously President of IBM’s Academy of Technology and has spent his whole career immersed in technology and artificial intelligence”.

OK – yes, we hoped for insight.  And we did get it.

(And if you want to view the recording of this chat – click here – to see if you agree with my take on it!)

Could he perhaps just give us a bit of a steer on and IT Road map for the NHS? That’s what the IT people usually say. Road map. How pleasantly old fashioned! But what about all that new fanged stuff? Machine Learning and Artificial Intelligence? Always just AI now of course…

Backstory is always the fascinating parts of these health chats with Roy Lilley. And Rashik was no exception. Born in Africa, Mombassa, parents from India. Terrorised at ‘a level you can’t imagine’ as Indians in a foreign land. Carried cash bundles always to pay off threatening locals. Pushed out and ended up in Leeds, following an Aunty from a year prior. Family always held that belief that you had to become a doctor – everything else was a failure. But his careers teacher said he wasn’t bright enough for that route. 1978 was early to decide to go into computing. But that he did, and managed to get A level course in Computer Science at a night school, sourced by a teacher at school. Hope he or she remembers! Decided on Imperial over Cambridge (the only choice then?), because the 3 year course did everything from Silicon to make the chopping, to Coding itself. And he always wanted to understand the A to Z of what he was talking about. Stood him in good stead when he got summer jobs at IBM in Leeds. But an aptitude test and 4 interviews for a summer job says a lot about IBM searching for talent early – or just arrogant??! 1984 now (not prophetically appropriate)  – still pre Internet of course.Desk tops had only just arrived. The 20 young visitors we had from Windsor Girls School must have wondered what this ancient history story was all about? More of them later.

What’s the next big thing, asks Roy. We get smaller and faster – but that’s just progress not ground shaking? What about AI and machine Learning? Rashik did point out that you can do very little on a day to day basis without Technology intervening. Even turning on a tap involves many interfaces further down the line to open the right bits of the reservoir and piping and to look after the water quality. We don’t see it most of the time unless it goes wrong of course. He bemoaned SciFi writers for making us believes ruff and systems were already here, not just a figment of imagination.

He told a story that became a good focus for us all. 80 year old picked up from her care home to go for routine out patients appointment. Saw doc for 5 minutes. But had 3 hour wait first. Then was taken to the wrong pick up point for her ambulance home. Not looked at or questioned for 10 hours. No food, no interaction, no one cared.

And there’s the rub. We want the shiny new tech to cure cancer. But let’s be honest. Tech can’t do the full brain and emotion yet. And maybe never will. But it can a really shine in the mundane. Routine work is what it will help with most, in all types of organisation, not just the NHS. The business case in the old lady’s case should be iPad or similar all talking to each other all along the patient pathways. The best part of £600 had been spent on that 5 minute out patients appointment. Only the cleaner asking what she was doing still waiting fixed the situation. Amelia Tickell representing the next generation and her school friends from Windsor wondered if AI at the mass produced robotic level could have helped her. Not today, Rashik said. But companion bots are being introduced in Japan – driven by a total lack of Carers workforce. People though talked and confided more in a cat robot than humanoid…fascinating! She also asked about what should people study the STEM subjects. His advice was fab. “Do what matters to you. Being good is far more important than followed the trend.

Roy did get into population health and peoples data. And big brother watching and admonishing you for that bag of crisps…but we don’t want to be told, we want to be informed. Now I felt we were getting there….

Other highlights?

  • Should we regulate engineers? There probably does need to be an Ethics and Conduct code.
  • Algorithms are always biased to serve the needs and prejudices of the community they are serving.
  • 11 to 15 % of the data we have is plain wrong. It needs cleaning first. (And sad we don’t know exact figure!)
  • The NHS has a huge bank of talent and is very lucky to have them
  • Only 3% of clinicians are comfortable using AI

Let’s expand that last one. Training – e learning – helps when you need to get people tuned into cyber security. It will take huge efforts but hey, perhaps we can do the same with leading edge GPs? Gotta start somewhere!

Machine learning process was fascinating. 3 equations:

Data+ analysis –> information

Information + context –> insight

Insight + action –> Outcome

 

And to put this into action? You need different skill sets:

Squirrels – to capture and understand data

Owls – to use the data and provide its context

Foxes – the mathematicians, to create the machine learning algorithms.

Weaver Birds – (tiny birds who build the biggest nest to court their mate) these are your data engineers

Hawks – to oversee ethics and legality

 

No one person can run the project. All skill sets need to be covered.

My final view? No, I agree we can’t abdicate to AI. But we can force it to help with mundane, so we can have time to do the people bits better. The spectrum of skills is a fascinating area. Can we do it? Do we have a choice? As was said more than once, the future comes a lot faster than you think…

There was so much more to this chat. Go watch it. Click here. Fascinating. The future is now. We just need to centralise the project and do it.

 

 

 

 

 

Ruth May – Health Chat

Ruth May

Ruth May, Chief Nursing Officer, England

Ruth May Health Chat – With Roy Lilley, nhsmanagers.net

 

Chief Nurse, NHS England. On the Board. Reports into Chief Exec, Simon Stevens. I wish I’d been there to take in the atmosphere. It’s not bad on Periscope (link here to view the whole – well worth it!). This is my take after viewing the event.

 

Roy Lilley felt a bit more belligerent, in your face and more intent on disagreeing then normal. I’ve been to nearly all the Health Chats. My hunch is that if Roy thinks the job of the interviewee is crucial to the NHS being a haven of excellence and to continue to get better, he is even more passionate than normal (and he is pretty passionate anyway, as you will have witnessed). Ruth May gave as good as she got – and there was a lot of support from the audience, which did sound like it had a number of very interested nursing warriors in it!

Nursing was in the family. She went to gain experience of nursing  after A levels. Degree later – MBA in Hospital Management. We had the graduate chat – do nurses need a degree, really? She knew that was coming, and sort of ignored it. “We need to have graduate level conversations”. End of. Then another humdinger. Being accepted as a woman in senior role? She knew that was coming. Recounted a story when she met the then Health Secretary, Virginia Bottomley. Ruth’s boss in the gratuitously demeaning and condescending way that us thoughtless men sometimes manage said “where’s the little girl gone…”. Virginia came back in at the end of the meeting and said to Ruth “Don’t let that happen again”. And I’m guessing she hasn’t?

2 years as a theatre nurse, Frimley Park to St Albans/ Hemel Hempstead before the transition to management. She wanted to be at the leading edge. And to still be clinical. I got the feeling she thought it was crucial – people tell you a lot more if you wear the uniform with pride too, and get your hands dirty. You keep the door open.

I get the impression Ruth learned as much from working with excellent bosses and leaders, and she stole their methods and ideas with much pride. I contend you learn as much from bad leaders – you know you would never do it like that seems to be a stronger learning for me. But I suppose it says a lot about her mindset that many of her learning examples and her current experiences were all couched in the positive.

Ruth’s number one priority is workforce. She knew that question was coming, too. How do we stop people leaving? How do we get people to come back? How can we be more flexible? How do we stop people moving from hospital nursing to primary care – where the shift work is much less onerous? How do we stop 20% of newly qualified nurses leaving almost as soon as they are graduates? Should we really be stealing overseas nurses from their home countries?

And that wasn’t all the question areas!

Roy banged on. “We don’t want business cases, we want action. You’re the Chief Nurse. Go to the Board and tell them”. OK. There’s no magic thing you can do. No really instant fix (except getting returners to consider coming back via Mumsnet , which sounds like an excellent idea). But sharing best practice can turn the megalith around. Churn of nurses is now 11.9%. Lowest it has been for 4 years. This chat was on Ruth’s 137th day in post. She has already got 5000 extra clinical placement places for nurses for this Septembers intake. 168 Trusts have signed up. It’s the biggest increase ever.

The flexibility issue exercised both the protagonists a lot. It appears that some people just push the boundary well. One of the many software packages for working out the rotas is called Allocate (others are available…). Milton Keynes worked with the software people and made it more flexible. Roy contends that this makes sense to be a national solution – a nationally worked out piece of kit that is then provided more cheaply? Makes sense to me…

The flexibility issue is there even in other areas – like training of new nurses. Why have the only graduate course starting date in September? Surely there could be intakes in January and March or whatever too? And what about the Apprentice Levy? £2 bn. is tied up in this. Why do it? When an apprentice has to be supernumerary on the ward, so it doesn’t really help with cover and rotas. Ruth could just go to the Board and ring fence the training budget and make a special case for the apprentice levy?

 It all sounds so easy in a chat…

Ruth’s other priorities are about pride in the work and celebrating success. Make everyone proud to be a nurse – so more likely to stay? 2020 is going to be the year of the nurse. Should there be a national nurse uniform? This audience thought so. One job. One linking sense of belonging. One enormous proud workforce. Simon Stevens has often stated that we want the NHS to be the best place to work for. I think Ruth’s level of priorities, including a very strong collective voice will help this to become a reality.

There were lots of great questions – what about the 55% of nurses who work outside of the NHS? What about Community nurses? What about primary care nursing? You’ll have to watch the recording to get to these answers. But the last question was from Amelia Tickell, who had started the show too. “When I go back to school, what can you say to the question why should I become a nurse?”.

“It’s an amazing profession, where you are with people at the most profound moments of their lives. At the start, at times of illness and at the end. That to me is priceless”

I can’t really add to that. Thank you Ruth.

 

Victor Adebowale, CBE

Lord Victor Adebowale, Health Chat

Image result for Victor Adebowale

“I’m just a lad from Wakefield…I didn’t expect to be in The House of Lords”. Roy Lilley as ever, dug deeply into Baron Adebowale’s life history. As ever, you can discover a lot about the drives and aims of anyone by looking at their journey to being in that chair at a health chat. Victor Adebowale fitted the precedent well!  If you want to view the whole chat, click here for a free recording.  You’ll get your own insight there. As ever, this is my take on the event, so will be biased, of course.

He is a pretty imposing character.  Forthright, bright and imposing. Still seemed a little nervous at the start, but that settled pretty darn quickly.  The cross bench membership in the Lords sounded a bit mad.  It was a job application.  Sometimes called “people’s peers”. Although that is a lazy journalistic shorthand, it sort of describes what the job is. Victor told us he had to have a proper and quite scary interview, then forgot about it until he was summonsed to the House about 6 months later. Weirdly wonderful, I thought.

Family from Nigeria. Mum trains there as a nurse, under UK training auspices. Dad was a doctor. The incipient racism of the time meant mum had to redo all the training when they moved to the UK in the early 1950s (pre Windrush), and dad couldn’t really get to be a doctor here.  I suppose that did help to force Victor down that path of wanting to make sure we have a more equal society. There is still the problem of privilege – really smart poor kids being overtaken by less bright rich and connected kids, just because of the school on the c.v., and the network. Most poor kids stay poor, and as parents then have poor kids.  I personally was very lucky in mid seventies to be the first in my family to go up to Uni. Victor described being lucky too, reading applied biology at NE London Poly (now Greenwich Uni). He just said he was a bad student! He left, but was still driven by that model of a highly stratified society, where it is hard to jump from one station to another.  The inbuilt inequality builds walls.  I get the feeling that Lord Adebowale is very driven by wanting to knock down those walls.  Check out the recording to see if you get that feeling too…. CLICK HERE.

During the Thatcher years, he moved into a Housing co-op, in Newham London. Inequality here was a long waiting list for housing and lots of empty property. The fight continues, as social housing is still seen as a blight and the Housing Acts are not making things easy.  As he said, the legal and planning experts reside in the private sector, so can reduce their commitment to social housing in new build areas with that clout.  We’re about 20 minutes in, and Vic casually asks Roy after this exchange “we are going to talk about health?”.  Yes, I thought, you will, but it is so useful to find,out what makes you tick through the simple (in essence) mechanism of getting your back story.

So we moved onto his dreadlocks.  Great responses here…I did think he might get annoyed,mouth he didn’t . “Look. It’s just hair. No, I’m not rasta.  It is just the most efficient hair style.  Anyway, as a 6 foot 4 black guy – you can wear what you want, including your hair!” Humour is always useful! “Be yourself, because everyone else is occupied”. No, he didn’t really get reggae always, and preferred Iron Maiden and Mahler….

Chief Exec of Turning Point now. As well as a peer of the realm.  There was a lot of discussion about charity versus volunteering versus Social Enterprise (which is how Turning Point is set up). So, there is an asset lock and no dividends can be distributed. But it is definitely a limited company style set up. Turnover of £120 million. He prefers his staff to be paid.  It sounds not for the faint-hearted, working with those with mental health substance and alcohol abuse.  But they compete in an open market for their contracts.  He firmly is of the opinion that being a social enterprise gives them more freedom. They are a business, and proudly so.  Roy did have a bit of a push at salary levels, especially Victors itself. When he was on Desert Islands discs,the same line of questioning had happened. “I could do your job”, he said to Kirsty, “and your salary is more than mine – but I bet you couldn’t do mine…”. The lazy vernacular of asking hey someone gets paid more than the prime ministers salary don’t get it.  The PMs package is estimated at £5 or 6 million a year. The main house and country residence aren’t bad perks…but personally, I’d not really like either job!

Best line? “I get paid 14 times my lowest paid staff member. And that will always be the case.” I think it may be time to get that into our legislature somehow.  Otherwise, how are we ever going to have a fair and open society? Just saying….

He wants to be able to employ the best talent and best minds.  The best brains in the world may cost £1 m a year – but the investment may really pay off?

He was on the board at NHS England when the junior doctors strike was raging. He feels that they could all earn more elsewhere, but they are driven by vocation.  They love the values of the NHS, because they align with their own. You do get what you pay for. We shouldn’t exploit them – we should be thanking them every day.

Interestingly, he had joined NHSE as it was set up as part of the Lansley reforms – even though he had told the interview panel that he was very against the reforms. He still got the job. Good for them!

The thorny topic of Workforce Planning was dug over. He was quite happy for Dido Harding to be doing “yet another” (Roy quote) report. “Don’t,kick it until you see it”, was the Barons response. I’m like Roy, as I tend to prefer taking action not talking action.  But we shall see.

It will remain our very own elephant in the room at the NHS. Victor and others will be pushing the same way most of the audience feel is right. Making it such a fab place to be and to work that you not only want to stay, you want to rejoin if you have left.

Great session all – thanks.

Nikita Kanani MBE

Nikita Kanani – Acting Director of Primary Care for NHS England – interviewed with Roy Lilley at the Kings Fund recently.

Where do you start? What an amazing, full on, vibrant and challenging Health Chat. I watched a recording on Periscope – you can too. Click on this link – it is free!

So it wasn’t just Roy Lilley being provocative at this event. Nikki batted most things back faster than the ball had come to her. Highlights? Number one has to be the thought that Roy will be prescribed Zumba classes if Nikki can just arrange that bit of social prescribing for him. Now get that image out of your head, and get back in the room!

I wasn’t there, so don’t know the audience make up. I’m guessing, as Nikita Kanani is Acting Director of Primary Care at NHS England, as well as being a practising GP in South London, that there were a lot of GPs present. I’m just guessing, as a lot of the times Roy was pushing hard about the GP contract and BMA getting too good a deal and why not use more tech and AI systems –  I did pick up some harsh intakes of breath. In France, they have protests. We have tutting and heavy breathing. I prefer it here though…

We had vested interests in the room, yes.  But anger is just another name for passion and commitment?  There will be another plan (wait for it).  And as the protagonists concurred, the agreed newly hatched GP contract is arguably more important than the NHS Long Term Plan. Certainly, if you get the first contact right (and we all agreed it really doesn’t have to be a GP), then the rest of the plan looks more attainable and deliverable. For only 9% of the budget. 93% of first contact is in Primary care.  Blooming bargain, mate!

It was wide ranging, this health chat. We started with a tangent into Community Pharmacy.  Mainly because her mum and dad still do that, after being refugees from Uganda, escaping from Idi Amin.  Could the role be extended? Certainly feels so?  If they could prescribe more? Only a handful can and do, I believe?  Patients sometimes expect a prescription?  And the pharmacist has to tell them to go to the GP surgery, to get the same diagnosis as they have already made, to write a prescription for the pharmacist to dispense? OK, I am being very simplistic here, and there are immense hurdles to overcome (legal and vested interest?).  But unless we have this sort of disjointed thought pattern and proposal, will we ever get through the GP access problems?

It seems Nikki was destined for a leadership role from early career.  And as Roy says, when you see clinicians who want to be managers too, they are often excellent leaders.  The usual, house jobs, surgery and medical- and loved all the disciplines. Loved being part of a coherent, focused and powerful team.  An aside here – she misses that in General Practice, as you do tend to feel more exposed with less support? Having said that, I’ve heard junior docs in hospital service complain that they don’t feel part of a team.  You hear the nostalgia for the way it was.  s this hearsay or ubiquitous?  You practitioners will have a better fix on that than I.

It was the leap of faith from having a great Consultant, and being in a hospital where the deputy chief exec used to have ‘drop ins’.  She was ranting and complaining to him about patients being in the wrong place, so he said why not come and work with us?  Would that still happen?  I do hope so…what a great way of getting change happening quickly.  And it served to stop her complaining!  Nikita suddenly had to make things change.  It’s all about stopping just talking about it, and actively taking action.  This is probably why Roy ranted once or twice about yet another report being commissioned and published, when two had happened already and were perfectly acceptable as the baseline for an action plan, and action? They made up a job title “Service Modernisation Lead”.  Sounded like she then did a crash course in management techniques – LEAN, Prince 2 Project Management, and more. Gantt charts coming out of her ears…

First thing they did?  Front Door Flow – and added a Rapid Assessment Team, to make sure the patient was directed to the right care at the right time.  That was back in 2005. Her reputation seemed to grow quickly.  Hospital Control Team was next. And creating Clinical Decision Units with a Care Coordinator.  Yes, all sounds obvious and becoming normal now.  It wasn’t then?

The path was so rapid to her current role, Acting Director of Primary Care at NHSE.  Although a 6 month post, not substantive, she made sure the job was openly recruited or it wouldn’t have felt correct.  I liked that.  When you view the recording of the chat, you will see why I might have got things in the wrong order.  Nikita’s excitement commitment and speed of thought means you do miss things!  She worked in the PCT whilst on her GP training. Frowned upon, but she doesn’t really care if things feel right.  DoH with CCGs (2012/13), loved having the budget and accountability.  But austerity made the job harder. She described it as the best and worst of jobs.

Let’s get some highlights of the ensuing ‘where are you today’ discussion.  I will add in my usual proviso and health check that some of the comments may be my views creeping in.  Sorry…

  1. Looking at in-patients in any hospital. 1/3rd should be in there. 1/3rd should be at home. 1/3rd shouldn’t be there at all.  Scary, isn’t it?
  2. “Why do GPs miss a lot of diagnoses?” (Roy question, out of the blue).  “They do a spot a lot”.  Fine reply!  Early diagnosis of cancer?  We come out well on treatment, but badly on early enough diagnostics?  Could having the James Kingsland NAPC at Home style, or Sam Etherington’s local do everything garden centre with health centre annexe (I’m simplifying the offering, OK?) – perhaps make swifter diagnostics work better?  The diagnostic hub concept?  Get it out of hospital and into local walk in that day standardisation?
  3. Not enough GPs – and maybe there never will be.  Maybe there never were?  If up to 60% of those who see their GP didn’t really need to see any GP, then what could we do about it? If the biggest impact on people’s well being are the three pillars – have a fulfilling job, have someone to love, and have a safe place to live – what has a GP got to do with that?  Maybe it is social prescribing.  Maybe it is having the change of attitude in the patients that they want to chat to, see on their phone, have an algorithm exchange first, see any health care expert appropriate to their clinical and emotional need at that time would mean that the GPs could then concentrate on the people who really need their type of intervention.  Most patients know already, I think.

There’s no magic bullet, both Nikki and Roy agreed. But she does have a people plan to roll out in 2019 /20.  20 initiatives and projects. That’s a lot.

I am going to watch this space with interest. The audience sounded like they are going to as well. We were all energised by Nikita Kanani as a total force of nature. The journey will be fast and furious. If you weren’t there, have a look at the recording, and see if you want to get on the bus too.

I know that I will.

(if you want to see the health chat recording – click here )

Roy Lilley, Nikki Kanani and IMS Maxims sponsors of the Health Chats

Prof Marcel Levi

Click here to see the Health Chat broadcast

Marcel Levi – CEO UCLH
Well. We were promised an evening of conversation with Roy Lilley at The Kings Fund to give us an insight into what it’s like running one of the major NHS Trusts in the country. Roy did so himself in the past and that experience gives him a head start over most interviewers (although the Health Chats tend to feel somehow less confrontational than Humphries). We found what made Marcel tick. And I think that’s why University College Hospital seems to be trotting along quite nicely.

A rounded figure, I think. Firstly though, the final words said “thanks for being enormously frank and open”. He is Dutch. I’m sorry, I have never met anyone from The Netherlands who isn’t straight, forthright honest and startlingly open. Marcel Levi lived up to his countries genotype well, and then some.

He maybe CEO of one of the major Trusts in Britain, but he still manages to do a doctor shift or two. We got into his methodology here quickly. It’s all about style and MBWA. If you are going to do Management By Walking Around, then it’s quite useful to be hands on a little too? He did suggest that most of the the first 5 minutes when he was in the room or in the team was quite stilted, as everyone knows who he is (which in itself, is a huge positive), but then nurses start being very honest and straightforward. Junior doctors were faster. And students? Mega straight, instantly.

But is he a doctor or manager? “Both” is the easy answer. He still feels more doc than manager. The style and outcomes of both jobs are very similar. Like outpatients or managing – a 1 to 1 meeting, 20 minutes, dig for the problem, work out how to fix it (together sometimes), then work out how to monitor progress. So both disciplines help each other and dovetail well.

Dad was a doctor then hospital director back home in Netherlands. He knew he wanted to be a doctor as a young boy. Started at home. After qualifying, moved onto projects at University Medical centre. It was small enough in Amsterdam for him to know 75% of the staff names . As Roy said, that’s great, but far more important that the staff all knew who he was. And that I suppose is the key point.

He’s been around. Blimey, he has! Italy, USA , Belgium, Germany. Roy wanted to know if we were just too possessive, rose tinted, and precious about “our NHS”. Marcel thought not, interestingly. He prefers the Social Solidarity model, where the well support the ill. Loads of ideas for trying to curtail the overuse of ‘free services’. I liked the £15 fine for those triaged out at A&E who should have seen their GP. I enjoyed the empowering the patients idea, to get them to self check (near patient testing kit for warfarin then patient changes their own dose, is a perfect example). Good example too of a newer more expensive set of dugs for anti-coag being overall cheaper because there are no monitoring costs.

A bit of discussion on Commonwealth fund data and UK coming out low down the league on outcomes. Every time I hear this argument, the result is the same. We are just not comparing like with like.

Some other highlights? PFI? Government could pay it off. If it has decided to stop future contracts, then why are old ones ok now? Daft. And I bet every board meeting just has it on the agenda every darn meting if they are saddled with a large debt?

Loads of the main focus was on doing things differently. Not tied to a tired old Lansley model of privatised is best (Carilion anyone?).

Start with the patient and work backwards. There’s a worldwide shortage of all strands of healthcare professionals. So we have to do things differently. Train our own? Yes. Loads of great HCAs? Train and upgrade them, quickly. Co-payment? Maybe only logical way forward. It’s already happening in Social Care. Let’s get real here! (That’s my view…sorry…). Triage at the hospital gate – who may refer you to a GP for free, or if you want to wait 4 hours, then pay £15.

And let’s get thorny…IT interoperability. Yes, it will take time…but they are on their way. but would you start here with a blank sheet of paper?
Can I make a simpler suggestion? The machine learning algorithms will suit many a time pressured worker. But so will every smart phone owner being allowed to keep their own medical data, and let them decide who to show it to. With password break ins allowed by HC professionals. Why not? Why not? We can be trusted!

There’s lots of simple stuff we can do in between time. Ask Marcel. They have their own Bank Nurse. And very little agency spend. Primary Care Home will help fix much too. As could something similar to the Buurtzorg model from back home for the Prof?

Do you know – there’s more to see on the recording. But it really feels like there area lot of small things that could make a big difference. And a lot of big ideas that could do just as much. And guess what, it is happening already…

if you want to watch (it is a good cuppa builders and a hob nob!) click here

Matt Hancock, Secretary of State for Health – Health Chat

Listening – Matt Hancock and Roy Lilley

You do sort of vaguely know the persona of a fairly new Secretary of State for Health.  Don’t you?  Or you at least have an opinion?  The last one was there for ever, and seemed to be ensconced for ever.  Came over very well at Health Chat a couple of years ago.  I’ve seen the politician more than once on TV – a good performance on Andrew Marr, I thought.  But what makes him tick?  The back story is always what we hope for when Roy Lilley calmly digs deep.

The RSM lecture theatre was packed.  200, and many more on Periscope. (If you want to view yourself, click through here – free to watch).

Everyone wants a piece of a Secretary of State.  One of the youngest FabNHS Ambassadors managed to interview him before the main event!  She asked him “If you had my sixth form friends here now, what would you say to them to seek a career in the NHS?” A very full answer.  And you can hear the passion, conviction and sincerity.  That is easy to spot if it is fake.  And I was heartened to see that it really isn’t. (Not sure if tech will work – but you could hit here and I hope it does!)

Just an hour – it’s a bit busy being a cabinet minister at the moment.  It surely must frustrate them all as one thing dominates the agenda as we speak.  But Matt Hancock does seem to be getting things moving, just perhaps slightly more slowly than he would like?  Usual level of jibe from Roy about going to a posh school.  He also went to a Further Ed college.  Good service return, I thought.

Why politics- when you could have got a good job (yes, we are used to Roy’s style…).  As is very often the case, a youthful experience created that.  A sense of injustice engendered when his parents small business almost stopped existing whilst awaiting payment from their only customer who had been caught in recessionary pressures themselves. Cheque arrived on the Wednesday before closure would have happened on the Friday.  Not just the family, and their home, but a dozen employees too.  And no fault of their own.  Out of their control.  He first became an Economist at Bank of England.  Swiftly realised economic change decisions were made up the road at  Westminster.  So driven towards that.

Interesting family business too – software design. Their piece is data management of Post Codes. When you look up a postcode on line, it is their software that does it.  This sort of experience may be useful in his current role…

I liked his focus on big issues rather than Lansley style micro managing and imposition without consultation ( in my view).  He was very impressed with the people in the NHS and the results they achieve.  But the fact that they are undervalued really seemed to annoy him. There is a need to change morale through better leadership.  Sometimes simple things can help, like taking catering back in house at his local hospital.  Better food for both patients and staff.  Everyone happier.  And feeling valued.

Before we delved too deeply into policy, I think we had an insight into the ministers NHS drive.  The NHS is there for everybody.  The 1.3 million employees, in all the jobs and professions (not just the doctors and nurses) have one main overarching aim – to save lives.  There aren’t many jobs with that level of reason for being.  He wants everyone empowered to make sure the whole NHS and social care is the best it can be.  The NHS team members are duty led and are driven by their duty of care.  And if they feel undervalued, then it is his priority to help address that.

All this came over as both part of his core value set  and was very sincere.  He really did come over as passionate about the role and the influence he will be able to have.  I felt it was very real – cynics amongst you may mock, but I really don’t think you can fake that level of commitment.  It bodes well.  He seems to relish the challenge, which is good for all of us?

But it is an immensely wide brief, as we know.  Some highlights, with potential to become lowlights….

  1. The Money: well yes we are talking about getting back to funding growth growing again at historical levels of 3.6%.  As Matt pointed out, this means it will grow from £115 billion today to £148 billion in the fifth year of the funding plan.  And there is the rub – same percent off a higher base, more real money?  Healthcare inflation is higher than normal life inflation though?  And we didn’t get too deeply into Social care and the ageing population. (Except a Green Paper due before April).  The positive is that the funding was for 5 years, not a year at a time.  The money graph has at least changed direction, with his push.  He touched on debt, and the prospect that the unrecoverable debt (possibly 1/3rd of Trusts?) may be taken out somehow.  Just a hint that PFI debt was in his sights.  I do hope so.  He also wanted people to work at breaking even with the annual funding provision.  But the 5 year deal means at least people didn’t have to plan for unrealistic payback schedules of less than 1 year.  He understands economics, spreadsheets and business plans.  Hoo-ray!  Getting people to make sure the cash flow is right, and worrying less about the balance sheet.  Other things waste the money resource.  The aim is to have fewer Pilot schemes, and more finding out what works and sharing it and rolling it out. (Akin to FabNHS ideology?).  They both discussed prevention as an obvious strategy, to get ahead of the demand curve.  If we can get the capital versus revenue argument switched, there is a better chance of balancing the health economy.  And getting the flow balanced is actively motivating for all.
  2. “Digital. It’s a mess. Discuss”. (Roy being a bit in yer face, I thought!).  Most interesting thoughts here were around sharing of data. A lot of the legacy contracts means the 4 major providers (?) of systems for GP land seem to own the data and will not share.  He has already made sure that new contracts don’t have that.  There must be a way of making the old contracts open?  Could it be as simple as asking the contractor to be open and share the data, or they will not be awarded any new contracts anywhere within the NHS or social care? When you’ve got them by the wallet, hearts and minds usually follow.  Just an idea…. That’s before we get into Interoperability.  After another sensitive interruption, as we got into whether the 10 year plan was a set of hopes or a real action plan (the protagonists begged to differ, but carried on anyway – even though Matt did say that he nearly swore at that point!).  Faxes were brought up. “But they work” said Roy. “So do pigeons – but I think we have progressed.”  Good answer – which got both laughter and applause.  The data migration to interoperable systems may still be the biggest roadblock?
  3. “Why have a plan with no workforce plan within it?”  That feels like the implementation part of the 10 year plan.  Training takes time, of course.  We may need to have different types of people.  Nurse apprentices seem to have become more difficult with the introduction of the Apprentice Levy.  But many hospitals have started training their own doctors nurses and more possibly, as they became despondent of waiting for Health Education England to get their house in order.  Matt also seemed to be in favour of doing things differently – like changing the Primary Care model to include both types of model.  The digital, machine learning algorithm led GP at hand style, as well as the traditional format.  High Quality access is still the aim, it is all about horses for courses.  Same meat, different gravy?  It also sounded like technology could be central to all this. Getting NHS England, Improvement and Digital into one amalgamated entity seemed to be part of the process thinking.

Far reaching, thought provoking and very enlightening.  I’m still unsure what NHS X was all about (some research needed here!). What I am sure about is that the Secretary of State will make a difference.  He already is doing so.  His background and core values seem very congruent with today’s needs. I came away feeling very positive. There is still so much to do, of course. But suddenly, it doesn’t feel quite so scary.

been there, got the t shirt!