Lilley:Swindells Health Chat.

Lilley Swindells

Can you feel the love?

If you weren’t there, last Wednesday, you missed a treat. The Kings Fund in London hosted a very moaning and summer cold full of it Roy Lilley, and a combative Matthew Swindells.  Roy was doing the man-flu thing (“I’ll say goodbye Phil. I may not make it to when we next meet…”). And Matthew being hit between the eyes many times, but fighting hard, explaining suavely, articulately and succinctly.

The virus was making Roy even more – how can I put it – skewering than normal.  “I’ve never heard such a bullshit title in my life….what the hell do you actually do?” OK, like all great interviews, dressed as a chat, don’t let that avuncularity confuse you!  It is rather good at actually pulling out what makes these folk tick, and what it is in their back story that got them there.

I was interested to hear anyway.  You may disagree with my conclusions, and the health check here is to admit they are solely mine, and you may have interpreted differently (watch here on the NHS managers You Tube site, if you want to check!). It is a helluva title! “National Director: Operations and Information”. The answer?  “I manage Big Systems”.

Started in Supplies. Had myriad jobs Patricia Hewitt’s team when she was Health Secretary. Brought in the Smoking Ban. Did it in summer, to lessen the prospects of social unrest!  “Can’t smoke inside and it’s raining….I think we should riot…”

Matthew seemed to move through a number of jobs before he ended up, after a stint in management consultancy, as IT Director. So not buying computers, but directing the infrastructure changes needed.  It did feel like a great grounding for his current long titled role…

Finally, I must say, I am continuously rewarded with a warm glow from every Health Chat I witness.  Matthew was typical.  Forthright, solidly committed, well connected, full of ideas, articulate and rather fine at arguing his corner.

As ever, the quotes and questions should give you a good flavour for what makes him tick. Starting with some Twitter highlights:

#LilleySwindellsHC we r ramping up training but we have never trained enough & relied on 30% trained abroad – now we need 2 train 50% more

#LilleySwindellsHC aim for 90% bed occupancy to enable flow u need to have 3 empty beds on the ward – less than 3 beds u have to take action

#LilleySwindellsHC stop working in silos,work as health economies so focus on delivering the budget & outcomes but find better ways 2 do it

What do you do asks @RoyLilley Matthew says he is a man who manages complex stuff #LilleySwindellsHC – he started as a supplies manager in NHS

Workforce is the single biggest challenge for the #NHS says @mswindells talking to @RoyLilley in #LilleySwindellsHC

‘Buurtzorg’ allows nurses to act as a ‘health coach’ for their patients, advising them on how to stay healthy

#LilleySwindellsHC do we need NHSE & NHSI asks Roy? 2 areas NHSE & NHSI work together for Urgent & Emergency Care 1 voice & have joint appnt

This is as hard as it gets but we don’t have £ for reform as it’s all put to clinical activity #LilleySwindellsHC-discussion targets in A&E

Neat; very human-centric. @picardonhealth points Canada to the Netherland’s “Buurtzorg” or “neighbourhood care.” – (Click here to find out more)

Matthew says NHS is great at innovation but still pitiful at sharing and spreading #FabStuff #LilleySwindellsHC

The role of management; to create the time and space for good people to do great things.

#LilleySwindellsHC – talking about the need for more central guidance for STP’s

Are we at the point when people desert #NHS primary care in favour of a @babylonhealth type service? asks @RoyLilley #LilleySwindellsHC

 

Do you get a feel for an amazingly deep and thought provoking 90 minutes? (If you want to see the whole thing, click through to the You Tube on NHSManagers.net.)  Here’s my highlights, and opinions:

Is it just about money? Should we be aiming to have our health spend reverse its trend, and move up to the European average of GDP investment? ( And I do think of it as investment, not spend or cost). Would it be frittered away in inefficiency and over spending? Would the outside contractors scent the smell of easy profit, and slurp deeply at the magic money trough? At the time of largesse, the best chief execs did fix their operating processes.  They did have a positive business style mentality.

We covered A &E problems – and how Flow could help, and has and can and should. Making A&E everyone’s problem, means everyone is involved in fixing it.  How simple is that?

Local solutions are both welcome and totally to be encouraged and embraced. Both our protagonists agree that we are good at that.  What we are “totally crap at, is getting people to share – just tell us what you’ve done, how you’ve done it and we will copy and fit it to our local situation”.  Spreading the good ideas has been pitiful. (Go to FabNHS to see some things you could copy! Roy Lilley and team practice what they preach). We do have to go beyond talking possibilities, to taking action.  If your action list doesn’t have  a verb in each sentence, then it is a wish list, remember.

Let’s have a few more quotes. Some of these are from Matthew, some Roy. And some from other tweeters. And I couldn’t keep up, so I have no idea which are which.  Give credit to them all!

  1. Do we need more central direction? Are STPs equivalent to leadership organisations? My view? At least the centre should set the vision – big picture, not detail. Trust the locals to know what will work for them.  And get out of the way…
  2. Changing structures does not change behaviours. Ain’t that the truth!
  3. Good management makes it possible to have great medicine. Love this!
  4. Management costs are 1% of NHS costs. This is tiny compared to most ordinary businesses. But try telling the Daily Mail that. Even though their own costs are proabably nearer the 7% average
  5. A&E hold ups? Maybe need to stick to having 3 beds free on every ward so we can get people through more quickly? If you are 95% bed state, then you have no wiggle room. How do this? Reduce the stay in hospital by 10%. Share best practice. Maybe have a Socail worker embedded in discharge team? Maybe have Buurtzorg nurses or neighbourhood nurses making Social care  provision and helping people stay at home and get back home quickly? I think we need to scrap our district nurse system, personally, and do something completely differently.  These nurses need to be empowered to do lots more than they do now. Not sure what, and need your help to make it happen.
  6. We need to ramp up training. NHS has always not trained enough! We need to guarantee the stay ability of our European workers.
  7. We need to make it as attractive as possible to stay in your NHS job. Workforce numbers are our current most pressing problem.  Keeping people is the first and easiest way to help fix this.
  8. Operational Connectivity is uniquely easiest to fix locally. Forget about a central fix.  Just do it , and tell others how you did it.
  9. Do we need NHSI & NHSE? ….discuss…. ( there are 3 vowels to go…)

OK – I repeat some items because they did keep rearing their ugly heads, and I wanted to get my views in too.  But their is still deep concern.

My main fear remains – is this particular huge and hairy problem – making sure the NHS remains as free as can be for all, equally, rather than being denuded to become a poor service for poor people – is it really possible to square all the circles?

I am unsure.  I do know a lot of hugely committed people are doing so every day – and they are being well led by many, and well managed by the majority, day by tiring day.

The Sponsors

Protagonists and Sponsors – IMS Maxims (& Salix Consulting)

Chris Hopson NHS Providers

Chris is Chief Exec of NHS Providers.  This is their Influencing Strategy outline from their web site (see here for web link):

“NHS Providers’ policy development and influencing work is focused on promoting and protecting our members’ interests against a backdrop of a rapidly changing health and social care system, and an extremely challenging financial context.”

Their members include the vast majority of NHS Providers. It is the membership organisation and trade association for NHS acute, ambulance, community and mental health services that treat patients and service users in the NHS.

A health warning first. Roy Lilley’s Health chat at the Kings Fund with Chris Hopson had a health edge. Roy had managed to mangle an ankle by tripping out of a black cab in London. He crumpled in a heap. The taxi driver (“gawd bless ‘im”), said “how are you?    (not good) “Would you like me to take you to a hospital?” (yes). But I don’t think Roy expected him to charge £15 for the lift! ( maybe we are not blessing him as much now…..)

This means Roy was in pain. And tie less for the first time I can remember (watch the whole event here, if you want to – see if you agree with my biases:  see NHS Managers.net You Tube channel.)  I expected him to be even harsher in the cat and mouse game of this cosy chat.. It was as eviscerating as normal. And as ever, if you know Roy, he gives people a harder time if he likes and respects them, I think.

But I have to say, the way they were chatting was quite depressing. This was a week before the amazing election result / the predictable election result ( did you like that?). We talked money, staff, STPs, CQC, CCGs, and the fact that it was all going to hell in a hand cart.  There were lighter views. But, I remained depressed at the prospects for the NHS throughout the event.  And honestly? I don’t think we should be that fearful.  I will return, but just for once, I think I may have to give you far more of my ideas and views, if that’s OK, on top of the overview of the event.

We were in the midst of Election Purdah….which doesn’t really apply to the NHS itself, as Roy politely pointed out.  We have become more and more fearful of these sort of suggested rules, I worry for democratic debate.

Let’s look at the highlights:

  1. STPs : are they damaged below the waterline already? There was a suggestion from Chris and Roy that the level of public connection and involvement was not at the right level to make it stick.  My view? Get it on Facebook, and Twitter and have public presentations from the people involved, and present it on periscope or google live, and just get the ball out there, not in the long grass.
  2. Chris also talked about the fact that the NHS people themselves are doing a grand job. Roy interjected with Mid Staffs debacle having an long spectre hanging over everyone and everyone’s thinking still. Roy and Chris begged to differ over Foundation Trusts and runaway deficits in our NHS budgets. There feels like there may have been a lot of pressure to cook the books, prior to calling an election (surely not?). It does feel like there may have been ‘arms up backs’ to make things look OK. The first FTs seem to have been featherbeded with extra funding to make sure they worked.  And that sort of actuarial massaging is still occurring. My view? It’s healthcare, not a market.  And there really is no such thing as a free market.  From banking to the media, from oil to internet based organisations, the big control the little.  So let’s get the market out of healthcare in the UK.  But let’s add in business strategic thinking, otherwise we will never get spend under control. And everyone has to be involved and empowered. Except the politicians.  Set the budget yes, but get out of the way and let the people who do it, do it.
  3. Safe staffing. Chris talked about the 8:1 ratio, and argued, rationally, that this may not be sensible in every ward, every acute mental health trust, or wherever.  He suggested that we should let the local experts sort it.  That is the people on the wards, and all who are hands on with the patients.  I agree.  Matron led organisations need to be the norm! Sadly, we may not have enough nurses for the matrons to make sure they have enough people to cover patient needs adequately and safely. Chris said national framework staffing levels should be a guideline.  Why is it legally set in California, said Roy….I’m unsure, personally…
  4. Health education England have written that we may have a shortfall of 60 000 nurses. We still have over subscription for nurse training places, even though there are no Nurse Bursaries any more? (It is now 3 applicants per place, not 6.) Depressing bit came when both participants talked about the prospect of many European workers leaving for home.  I think this may change once Brexit gets less nebulous and we all know where we stand.  Why should it be really different than before we were in the EC?  I personally am very pro Europe, but anti EC…and I don’t think anyone knows what will happen.  Uncertainty though really doesn’t help long term planning.
  5. Election Purdah raised its head again.  Roy tried to get Chris to come down in favour of one side or the other.  He played the ball straight back.  He said the only way to be sensitively influencing all sides equally was to be even handed. So Jeremy Hunt, Jon Ashworth and Norman Lamb were all involved.  As all could be involved post election…
  6. We often talked about pockets of the NHS at the forefront of positive thinking and actions (Salford, Northampton, Northumbria, Frimley, Devon, and many more). Maybe we do just need to let the guys do it themselves? Just let them go, and do it?

Politicians don’t want us to use real evidence based reality to inform.  I would love PFI to be removed from all of Chris’s membership organisations day to day reality.  I bet this 2% of the whole budget occupies 50 % of management time in some Trusts?

There were many other interesting stats chucked into the conversation – have a look here…but if you want my two favourites, here they are.

Once we are 70, we start having the potential of increasing our demand on the health service.  We need to make sure the education on exercise and eating is inculcated from junior school.  We are living longer, but maybe less well?

70% of our lifetime healthcare costs come in the last 6 months of our lives.  Are we over medicalising death? Perhaps we need to start having the good death mentality, and let nature take its course – and save both dignity and money at the same time.

I think I still feel depressed at the negativity and extreme worry portrayed by both participants.  But madly, as a very annoying optimist, I want to let our amazing NHS teams be just that.  Teams.  Powerfully excited.  They need to be supported, thanked, enjoyed, celebrated and kept alive.  I think maybe Roy and Chris both feel that can happen, but will it be allowed to happen?

Politicians? Just leave them alone to get on with it.  I trust them rather more than I trust you.  And the NHS may well be ‘running hot’, but it is still running despite partisan politicking tinkering at the edges.

Thanks Chris and Roy.  You worried me. But made me think.

Professor Henry Mintzberg

Henry Mintzberg, OC OQ FRSC (born September 2, 1939) is an internationally renowned academic and author on business and management. He is currently the Cleghorn Professor of Management Studies at the Desautels Faculty of Management of McGill University in Montreal, Quebec, Canada, where he has been teaching since 1968

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Evening, Prof….

Ok – that’s the WikiPedia background.  Now onto meeting and listening to the man himself:

They say you should never meet your heroes, for fear of disappointment. I met Henry Mintzberg, erstwhile management thinker and writer during my OU MBA course, in print, and was always fascinated by his thinking. I was lucky enough to meet him in person at two meetings at The Kings Fund in London.  The first was under the auspices of The Institute of Healthcare Management – an intimate affair with lots of question space. The second meeting was an NHS Health Chat, with Roy Lilley interviewing Henry. (Film of the meeting available here)

I wasn’t disappointed.

Much of the Profs work has started out very simply. “All I did was get down on the ground and saw what was going on. Then just wrote that up.  My findings were always just the patently obvious, but no-one was doing that”.

Healthcare has always been part of his research interest.  His latest book “Managing the Myths of Health Care” is as provocative as the title suggests. Anything that says after just a few preliminary pages, that Health Care is not failing, but succeeding, expensively, and we don’t want to pay for it. So the administrations, public and private alike, intervene to cut costs., and therein lies the failure”.

His thinking is always nuanced, not in extreme ideological positions.  There is great debate on Globalisation in the worldwide political sphere as we speak.  It is black and white, good or bad, as far as most report their views.  Henry?  “I’m for and against it”. I needed to listen more closely ( and as with all my summary blogs of talks, I may miss things that you would hear differently. And I will allow my opinions to the fore. So, this is not a report, it is a view…).

The myths were discussed a lot in this chat. Especially the ‘not failing’ view, but just succeeding expensively. The chat then veered into how organised or not organised health care is.  With the rejoinder that it is very easy to reorganise for short term patch up of problems.  Anyone can do that.  The book then goes onto how do we reframe the whole.

John Stephens and Henry Mintzberg

Henry with Simon Stevens, NHS England

His stories and observations drive his thinking and opinions.  More than for most of us. And he is still learning. Outsiders can give some ideas, but insiders need to drive change.  Budget constraints provide focus, sometimes.  Those in middle management can feel constrained and demoralised (ain’t that the truth!). Quotes abounded too.  “If you have responsibility, you don’t need accountability”.  He made the case for looking for causes (whether problems in an institution, or a health care issue), rather than cure.  In the main, I agree.  We still have a National Sickness Service in the UK.  Health promotion is in the mix, of course, but always feels like the poor relative.

Fascinating tangent on measurement: in his hometown of Montreal he asked his local hospital chief why they measured so much?

“What else do you do when you don’t know what’s going on?”.

We’ve all heard paralysis by analysis…and Henry’s line was a chapter title “Analysis:analyse thyself”. My line is “You can disappear up your own analysis”. And, another favourite, “you don’t fatten a pig by weighing it”.

What is efficiency? As soon as you use a word like that, it isn’t neutral.  We measure what is measurable.  I think we measure what is easy to measure, distorting what is not measurable.  It may mean we cheapen what is really important.

Good enough, or World Class? Best, in a competitive situation, may not be good enough. Too low a standard, as prof said! Good may be your best.  Every person to be their best? Is that how we get to being more than good enough?

And what vehicle to make that happen? Collaboration, versus self interest, may be easy to say.  He talked of Communityship, a refocus on society.

In the evening session, softly interrogated by Roy Lilley, we learnt a bit more about why Prof Mintzberg was so against ordinary MBA programmes.  (A show of hands proved a good 25% of his audience were MBA graduates). “Wrong people taught the wrong things at the wrong time.  You don’t learn to swim in a classroom”. Most of the grads there were mature students originally, so that takes care of wrong people wrong time.  But I agree with the supposition that function expertise can be learnt – marketing, strategic planning, finance – but not hands on people skills.  University of life for that, I feel. His triangle of Art, Science and Craft, standing for people and soft skills, analysis, and expertise, rang true for many. To improve the selection of managers, he suggested those they have managed before should input into the process.  Blindingly obvious, but rarely done?

Simplifying the message was a core theme repeated often by the Prof.  So I will do the same:

  1. Why do we obsess about data and analysis? We only measure what is easy to measure, not what is truly important.
  2. Stories and anecdotes are your company culture
  3. Remote control management fails, every time, over hands on, getting down on the floor
  4. Management is what we do. He is not a fan of leadership (Hurrah….I always fell out with the writings of Warren Bennett over this.  We all do both.  One isn’t better than the other).
  5. Everyone has something to input. Hierarchy can stifle that.

Finally he said that Healthcare is a calling, not a business.  If we can just do that, with everyone aiming to think how can I get better at my job today, and keep the crass business models out of Health, then we can let Communityship flourish.

Just a final thought.  US healthcare costs 11.5% of GDP.  U.K. is 6.3% – and is universal.  Just experienced the NHS at its best at a minor injuries unit in Tewkesbury, on a Sunday. Triaged and fixed in 45 minutes.

I know where I’d rather live.

Helen Stokes Lampard, Chair RCGP

Helen Stokes Lampard

“It was a fair fight for the position. Four candidates. I won.”  We expect Roy Lilley’s chats to be rather more combative than fireside, but that was a fairly typical response from Helen.

Not only chair of the Royal College of General Practitioners, but one day a week partner in General Practice in Lichfield, And in her spare time, Governor of the Birmingham Women’s NHS Trust.

Where did it start? A penchant for science, led by role model who was dad, in Swansea who taught science. Excited by Dentistry, through another role model who she stayed with one long vacation. She made the job sound very enticing. (Funny how a lot of role models and influencers are passionate about their work…). Salutary first underachieving at A levels was a useful life lesson, and St Georges beckoned after the second attempt. “Why not Welsh medical school?” “Family would have loved it, but as a teenager, I wanted to be far away!” House jobs through a swap, back in Wales.  Then a fun serendipitous turn of events….a penchant for research led to a PhD (so a proper Doctor!), which changed gynaecological screening in the UK. This led to joining an unusual (but shouldn’t be?) training scheme.  Half GP trainee, half academic research.  Then later in Birmingham, added in learning to teach soon.

I only give all the background because it does inform the view of the person, and how they have got there.  Although this is always my personal opinion, you can watch the whole interview free, clicking on here for the NHS Managers.net YouTube channel.  But I really got Helen’s passion, drive, intelligence and vision. Motto of the RCGP was repeated a few times. “Scientific knowledge applied with compassion”. Anyone can trot out platitudes, but I got the feeling she not only meant it, she lived it.

As ever, we learnt as much about Mr Lilley’s foibles as the chatee…”Why women’s hospital…we don’t have men’s….”  “What about getting me an old geezer GP – I’m not seeing a woman!”.  Then a bit more banter level “You fell out with the builders at the new office, 30 Euston Square?” “And we won the dispute”. I was really enjoying the instant replies.  NHS was castigated as a non family friendly employer.  Crèche spaces as rare as rocking horse droppings.  This moved us nicely onto that nights publication of the RCGP manifesto – out long before the political parties have managed theirs for the election.

The theme and main thrust of the evening was around is General Practice about to wither away? A simplified 6 part plan to save the NHS loomed over the audience (embargoed until midnight that night, but we kept getting sight of it as Roy continued to be naughty!).

(You can see the Manifesto here)

The election should not just be about Brexit.  The entire population needs healthcare. And everyone has a story, opinion and bias about “our NHS”. Here’s my notes on the 6 steps to save the NHS.

  1. Fund primary care so the GP 5 year forward view can be delivered
  2. Support euro and overseas employees, healthcare and allied professions.
  3. Extend GP training to 4 years from 3. They are “expert medical generalists”, and the job is more complex than ever. Cheaper in long term.
  4. 5000 more GPS by 2020
  5. A new return to work initiative for nurses, mental health professionals and pharmacists to join the multi faceted teams needed for evolving general practices
  6. Sort out the spiraling costs of GP indemnity insurance – yes, if mistakes happen, sort it, but not ambulance chasing.

See the whole here, but I like the simplifying.

70% of NHS costs are people.  We cannot just make the savings asked for from efficiency of the 30%.

What else for the future?  More remote consultations? Maybe it has to be “good enough” for some situations? I do feel one size doesn’t fit all.  And we all have different needs for different conditions  ( notwithstanding maggots in the scrotum, which Roy quoted twice, from Mormon a west end musical…don’t ask…). Maybe Skype, or apps like Babylon, or Face Time, or just the mobile phone, or near patient testing can help some people sometimes? Best quote of the night ? Roy: “There’s no silver bullet here, but maybe there is silver buckshot”. Primary Care Home is being successful in some places.  Sustainability and Transformation Plans (STPs) occasionally left GPS out of the solution – until hospitals told some of the local planners not to be daft. We do need to grow the wider GP team.  We do need the holistic approach of Primary led, secondary fixers and social care support to become fully dovetailed and smoothly transitioned. There need to be more new ways of working, and GPs tend to be active early adopters.  It feels like Helens vision around recruiting, retaining and returning of all the allied healthcare professional teams will help drive it all forward rather than over a cliff.

Some other great ideas about social prescribing, the tripod of social care, primary and secondary care, GP in A & E, other folk appropriate to the patient need (paramedic in out of hours triage, for example).

It was an evening full of hard hitting practical do-able ideas that were not scary or mad or just talk.  It feels like we just need the powers of persuasion to make the talk stop and the action start.  Helen Stokes Lampard is highly persuasive innovative and very hard to ignore.

Whoever wins the election, please be aware she will come knocking…and won’t take no for an answer.

Sir James Kingsland, GP. In conversation with Roy Lilley.

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Smiling, happy people – James Kingsland GP, OBE & Roy Lilley

Another day, another health-chat?  Well, maybe not – this really grabbed me at the beginning…

And you know I really do like quotes!

“A doctor with a stethoscope and a Cheque book achieves more than a doctor with a stethoscope”.

Excellent.

This is my summary, opinionated as the participants, of the chat between Roy Lilley of NHS mangers .com fame, and Dr James Kingsland, OBE, erstwhile GP, innovator, practical realist and has been there and got the T shirt…

Serendipity and overtly specialised secondary care made him join a GP Training Scheme. Specialists vs. Generalists. Or, as James put it Generalists vs. partialists! Thanks from us all to the ENT Consultant who referred one of their patients to a Dermatologist and James realised he could deal with it, and didn’t need the cost and upheaval of transferring care. Thank you, whoever you are…

Trained at Liverpool. Still a partner in Wallasey (posher bit, on Wirral peninsula, over the water from Liverpool. Scousers call the inhabitants “woolly backs”, due to them having sheep in fields near them…).  He became senior partner at 30 due to two retirements and then an untimely death…

We had the angry tour through the endless, meddlesome reforms (including the sensible swipe at Lansley madness). There was much discussion about perverse incentives built into the systems. About some good nuggets of utility on some of the sweeping changes.  Fund holding could work if you used it right. This was the start of what has evolved into Primary Care Home (Roy…”yes yeah – we’ll get onto that later…”). We did.

I chatted to James afterwards. He took great pride in being the only GP who Mr Lilley has never manage to insult. This acted like a perverse incentive of course, and Roy’s gloves were off.

Here’s the start, just 3 minutes in if you are going to watch the you tube player repeat of the event…(click here for that)

“How many GPS do you have then?” “4 partners, 2 Associates and 2 or 3 in training at any one time”. “So you’ve got 10, 12 thousand patients?” “No, 6000,” “well, no wonder you can offer such access – you’re over doctored! That’s outrageous”.  “Why is immediate access outrageous?”.

I warmed to him.

The model works. It pays, whether it is over- doctored or not.

(Here’s an article explaining it – from James: it is on his LinkedIn page – you may need to be a member: Understanding The Primary Care Home just click on the blue bit…)

Is the NHS being so bottle-necked because of lack of Social Care? It’s possible, but also possible that a system that saves 4% of its budget through business efficiencies, year on year on year must be doing something that needs to be copied?

It is the change fatigue that James’s way of working and thinking is attempting to stop. Keep the organisational memory, so that we can keep the good and add to it. So simple. But you have to be confident that the willing are following you.  It’s the people who make it happen.

Societal change does have to be catered for, of course. And I still contend that there is no one size fits all solution.  That goes for individuals too. Our own healthcare needs keep changing from immediate need for an acute episode, where we will be happy with any healthcare professional. To a longer term condition that requires a little more TLC and continuity – when we want our main professional partner to keep a watch on progress.

Is there a difference between accountable care organsations and Primary Care Home? Is Primary Care Home just really the Buurtzorg idea (click here…I think Burrtzorg should be rolled out over the current UK…see RCN view here), but amplified beyond fully featured nursing care (including prescribing and referral) to include all health care professionals?

I like the empirical approach. If it works then do it and get the evidence during practice, not as a trial. Polish, don’t start small and hope scaling will work.

Is it simple? Maybe it is.  The model as described is what most patients thinks is what happens in their surgery anyway? The triage system at reception (first contact…either physical or electronic or phone), means the patient is directed to the right sort of health care professional, first time, every time. Now Roy expressed shock that untrained staff were given such responsibility. I say, get over yourself, Roy! It is working. It needs new skills inputs and protocols and algorithms. But if it works, why knock it? The partners will still be the ones who go to the GMC or jail, if it all goes wrong, so they must feel confident.

You need horizontal integration of the various professions – which can include some secondary care personnel. You do need a coalition of the willing, the committed, the trusting, the excited.  And a bit of size for muscle.  30 to 50 000 patients. Back office savings, then. And of course, a bigger Cheque book goes with size.  I say horizontal rather than vertical because it is a flat interlocking model of different professional healthcare people picking up leading the individual patient needs at the exactly correct moment.  What’s not to love?

Sometimes you just have to believe.  Start empirically and with organisational memory to build on, not chuck away. Then check and refine in practice.

Then you have a winner…and I think James Kingsland is certainly one of them.

 

 

 

 

 

 

 

Jonathan Ashworth MP, In Conversation – with Roy Lilley

Jonathan Ashworth, MP, Shadow Minister of Health.

Jonathan Ashworth MP

NHS Managers meeting at The Kings Fund in London. Jon was in conversation with Roy Lilley  (NHS managers.net). This is my opinionated summary – so if you disagree, check out the You Tube recording, and e mail me! I wasn’t able to get there, but watched on line.  It was a fascinating chat…

Roy Lilley had to allow a breaking news story in – this happens occasionally.  Jonathan had arrived from grilling of Jeremy Hunt in House of Commons regarding 500 000 letters and reports from patient test results that had been discovered in a warehouse. As far as all were aware, no patient safety issues had resulted from the non delivery of reports and letters…as far as they were aware. Interesting legal phrase, I think. Anyway I sometimes wonder if the privatisation of some of the support services only gains a cheaper result, not a better service, in many cases.

Then straight in with the usual Lilley kicking. “Your a good looking bright young man – why waste that on politics?” Good top spin serve, down the centre line…hit straight back to the questioner. “You are a cynical old goat…”.  Audience on side…

This member of the audience was even more onside with the next 20 odd minutes of personal stuff. “You had a difficult upbringing…”. I don’t remember if Roy actually said anything whilst Jonathan told us about his alcoholic father, who wasn’t violent, but who died of his condition ?is that what we say? Addiction? Illness? What? Died two months after not returning from Thailand for Jonathan’s wedding, because he might have been an embarrassment at the event. It was gut wrenching. Watch it if you can, and see if you can stay cynical, and not cry.

(see the You Tube here:  whole event on line)

It is not why he went into politics. Always was addicted from pre-student times, through student politics at Durham, then into researcher for Labour Party and successful by election winner in Leicester. Never done a real job, as Mr Lilley opined…but he was there with his heart, wanting to help change the agenda of government and to get things done. Like helping to support children of alcoholics. Like actively intervening with Sugar Tax and maybe minimum alcohol unit pricing.  His aim is to change policies.  And will feel his time well served if he can do so.

Main experience was gained in the Whips office (we had a Corbyn aside regarding not toeing the line) then Cabinet Office team, Treasury with Gordon Brown, concentrating on economic policy, before landing in Health. As Roy told us he had seen 16 Secretaries of State for health, and perhaps he would be the 17th (maybe not in 2020 was the rejoinder after that…)

He was scathing of the PM who, he suggested, has no interest in the NHS.   That was interesting. Then we got into a bit of blather about Stabilising the NHS, needing more money, STPs helping to aid the transformation, not just frittering the money away on reducing short term problems like waiting lists (so seeing no long term changes).

Most of this was pretty text book stuff to me, and felt rather at odds with the very open start.  Then, we gained a golden nugget of an idea.

“We need to stabilise the relationship between the clashing cultures of local authorities looking after social care, and health being in the Trusts domain.” A potential solution was proffered. How about nationally agreed eligibility criteria for Social Care? Then, overseen by the OBR or similar, the clashing culture wouldn’t clash. 23% of people who used to get local authority support don’t any more after years of austerity measures, Roy informed us. 900 000 people, possibly.

Much of Social care is rationed and or means tested. I personally think we should be putting the Buurtzorg model of looking after people at home as much as we can could help us discharge people more easily from hospital as Ellis as keeping more of them out of there in the first place.  In Holland (where it began) hospital occupancy is about 80%. What are we? About 90 to 93% depending on where you are. Click through and check it out. Thoroughly honest and honourable rising star, I thought. The Portable Eligibility Criteria idea may need a bit of wordsmithing, but hey, you’ve got to start somewhere. We will be seeing more of this man, I feel sure.

5 things you need to do as a CEO

Image result for David Astley OBE

David Astley, OBE

“to survive (and thrive) as a CEO”. That was the sub-title…from an evening with  David Astley, OBE, Non Executive Director at Cambridgeshire and Peterborough STP.  And more…see his LinkedIn profile here

Interesting to note a Liverpool accent in the speaker. Instant kinship for me, as an exiled Scouser. Turns out he went to the same school as me too.  Alsop Comprehensive in Walton in Liverpool. Isn’t networking fascinating?

I’m going to try to sum up David’s talk – and as ever, it will be embellished with my opinions and views, for which I don’t apologise!

What was most enlightening was the simplicity of the ideas and thoughts from his experience. I suppose that what’s experience is for. To give you the confidence to keep things simple.

I think a lot of the themes were designed for those who want to be a Chief Exec in the NHS, so I have to say, the specifics may be well, specific. But the 5 major thought thrusts are very transferable, as I hope you will see.

  1. Is it the career for you? OK, in healthcare, the specific motivation maybe to help to provide safe, effective patient care. Any chief exec needs to expose themselves – you need to be visible. Especially when the going gets tough. It’s even more important to be in there with your teams and staff when the 5 h one T hits the fan. As a public servant though, you are part of the fabric of the community. It is slightly different than being in a business to business organisation.
  2. If this is to be your ‘final’ job, don’t peak too soon. Time your run for the top well.  I counter that with the fact that there is no such thing as ‘the best time’.  And how long will you stay in position?  Some Chief Execs have been very long term in post – 20 years plus. But the average stay is now 20 months. And 20 percent of posts remain unfilled. Not good. David sold it as such a fulfilling job, but for some reason the pressure or lack of support for Chief execs, or the continuing bad press makes it hard to find the right people and to keep them. Maybe this difficulty will be part of the solutions offered by the nationwide Sustainability and Transformation Plans (STPs). I suspect the NHS part of the STPs will learn a lot from the clever back office sharing, partnership and collaborative working, and (heaven forfend) sharing of CEOs that the local government side, who are now budget holders for Social Care have had to do in the last 8 years… Another point David made is that once you have been a Chief Exec, it is hard to go back into the ranks.  Looking at David though, he has carried on in exciting Non Executive Director posts, and heavy involvement in his local STP group. Sounds like a positive bit of giving back to me…
  3. What do you want to be known for? As a CEO in the NHS, you need to remember that you are in a patient care role. All chief execs should remember what their organisation is for. You need to understand yourself – be self insightful. (In my experience, people who move up into management and leadership roles tend to have that ability to both know their good points, their gaps and be analytical enough to create the fixative action plan to sort it and improve.)  Learning from others is another key to focusing on what you want to be remembered for. You need to be honest, and to be you. Staff will notice instantly if you are not authentic. Best to just be you at your best. Don’t try to be anyone else – just be you. Everyone else is taken, remember. David insists that the time of the Heroic Leader is over. Is it time for the Servant Leader? Your job is as simple as being the helper – just make sure you clear the rocks from the runway. Get the right people doing the right things and get out of the way…trust and a bit of humility will go a long way.
  4. Be Flexible.  David didn’t say a lot more than that about this. Perhaps doesn’t need much embellishment!
  5. When the going gets tough…One of my first bosses said that anyone can be a good news manager. The only reason you get paid more to fix the bad news. As an NHS Chief exec, you can imagine the sort of calls you may get ” The Daily Mail is running the story about our trolley waits…they want an interview…”. You need to show a lot of bravery, resilience and understanding especially when you are thinking if you have a job to return to in the morning. You can be very swiftly exposed…and it is how you fix it is how you grow, and keep your refuting growing!

Other great one liners:

  • remember to say thank you. The little things (hand written notes, saying thanks, public praising). Little things have a big effect.
  • When the bell tolls perhaps before you want it too, hope to get out with smiles, claps and thanks…remember you can be the wrong person in role at the wrong time…be honest and brave and move on.
  • In NHS Trusts one of the most important relationships is between the Chief exec and The Chair. It seems to work best when it isn’t too cosy, but that they respect each other.

The Institute of Healthcare  Management – The IHM seems to be heading in the right direction and having this sort of presentation, where someone who has been and still is at the sharp end shows it isn’t rocket science, is powerfully life affirming and confidence building.

You are not alone…

(If you want to join, or find out more – click through here)