Lord Philip Hunt

Lord Philip Hunt, Shadow Deputy Leader of House of Lords, and former Trust Chair 

So here we are again at one of Roy Lilley’s Health Chats.  As you can see from below, I managed to get Lord Hunt to accept one of my books, and to pose with it!

Lord Hunt, Roy Liley & a cook Book

Philip Hunt and Roy Lilley admire my book!

Why was he being there at The Kings Fund?  Apart from the above, he is also Shadow Health Spokesman.  That’s good enough for me…

I had half hoped that Roy Lilley’s avuncular yet barbed style might have morphed into a Paxmanesque routine. How many times would he ask “So, what is Labour’s Health Policy?”

Was I disappointed? Only slightly. Three times was enough.. but it is amazing how you don’t need to be barbed to get some deep insights, and the occasional, “Did I hear that right?” moments.  As always – a health warning here – these are my own views and opinions of the event, and if you were there, you may interpret differently.

NHS Managers.net - and Lord Hunt

Calm before the questions!

He’s been around a bit. Baron Kingsheath (a bit of OK Birmingham), was on a sit-in with Jack Straw as Students Union President back in 1968. It seemed important at the time. Then on to an Iron ore mine in Australia (but as a dish washer in the surface canteen). Been there at a lot of the changes (and there have been a lot) in the NHS.

What always impresses me with the folk who get there – really at the top of their profession, pulling the levers and making things happen, is their sensitivity and ordinariness. But then you get the twinkling intellect – the memory for names, places and what happened – and the absolute passion.  Philip added a dry sense of humour and self deprecation to this mix.

It was the names and anecdotes that hit home for me.  Frank Dobson (so good that Blair sidelined him into standing for London Mayor) – was so different as Health Secretary.  He praised people (heaven forfend…).  He made the service make waiting times come down to a position where it wasn’t worth having private medical cover.  Astonishing. Now they are increasing exponentially.  I wonder if the government has any contact with private health care providers?  Sorry, becoming a bit cynical…

Some other powerful quotes: “…Enforced marketisation”.  I loved that.  And any organisation that has had Activity Based Accounting, or ever cross charged to another part of their organisation will know all it does is cost bureaucratic money.

“Why is the NHS supine in the face of the ludicrous things it is asked to do?”   What a great question.  I suppose there is no leader, no head, no General to turn to, to complain.  Maybe the Trusts and the GPs and the Junior Doctors (such a dismissive nomenclature), should start saying NO?  Maybe just to ask for forgiveness if they screw up, rather than forelock tugging begging for permission to do what they know is right?  “There are a litany of new demands placed on them which are very removed from reality”.  Amen.  Start handing stress back to the rightful owner, you local leaders…and let the central guys sweat.  Or just work with The Vanguards, and cut all the others out.  Maybe only pay for your CQC inspection if you firstly concur, and secondly that their suggestions for improvement actually work.  (What do you mean they don’t make suggestions?  Why pay then?  You wouldn’t pay an external consultant unless their report gave you suggestions?) (That bit was just me ranting, like Roy does occasionally (!) about the CQC and others…)

Lord Hunt was slightly more circumspectly political when the Junior Doctors strike ballot surfaced. No real advice to the other Hunt, but I think there was a glimmer of sparkle in his eyes which I read as ‘serves you right for being so negative and condescending’.  I may be wrong….

Devo-Manc was discussed as a good idea, but will the money really follow? (and if everything is devolved, and we stay in Europe – will we really need 650 in The Commons, and the 850+ of their Lordships?).  Contentiously, the prospect of Social Care being means tested did surface too.  I got the feeling Philip thought it inevitable – and it is happening by stealth anyway.  The Dilnot suggestion for limiting the amount you spent on your Social Care was in the Conservative manifesto, but conveniently dropped once they got in against their own odds…

I have a simpler suggestion.  Means Test all social care, and let the local authorities do that.  But if your mum is in a Nursing Home – as they used to be called – then that should still be NHS funded.  How do we decide it is nursing care?  Simple.  If the ward or home has to be locked, because your mum may walk out and harm herself, then that is Nursing, and should be NHS funded.

Lord Hunt quietly talked of the madness of allowing GPs to look after £80Bn of funds when they look after the governance of it themselves.  No public involved.  No real accountability.  He just quietly dropped that in, as is his style.  If you weren’t there you missed the musings and war stories of a fine man.  I just wish he wasn’t Shadow.

Another report from a Roy Lilley event!

Samantha Jones, Chief of the Vanguards – that was last weeks NHS Managers chat with Roy Lilley and Samantha Jones at The Kings Fund in London.  Here’s my blog – we can learn a lot from the folk at the top and sharp end of NHS change and reform…And here is Sam herself….

But the title sounds like the sort of thing you might see in a sword and sorcery series.  I don’t think Sam would be flattered by that, but hey, Game of Thrones has been very successful for Fox…

You may have heard of Vanguards. As ever at a Health Chat at the Kings Fund with Roy Lilley, you do expect an awful lot of the background to how the person got to “today” because that informs what they are now trying to do.  And why they are well suited to it…or not.

Sam is well suited. She doesn’t do detail. So she lets the people at the sharp end make things change. She said her job is just to create the space so that can happen.  If only all the micro managers out there could see that is the only way.  Not the best way. The only way.

As ever, a health warning. This is my own views of what I experienced at The Kings Fund on  29th October.  You would have a different take. Read it as such.

So what are Vangurds for?  We’ll get to that soon.

Background? Roy’s first question was about her children when young. If you were there, you understand the context. But her answer was fab. “I wondered why I’d said yes to this interview, and I am definitely wondering that again now”. And then when Roy kept interrupting (he gets excited), she cut him dead with “I am still speaking”. Not, you notice “can I finish please” nor “I’m sorry, you are interrupting”. It was the far more assertive statement of fact, which meant Roy had to shut up, and that was mainly because there was a guffawing cheer and applause from the assembled! She must work in committee like that?

Loads of her mentors and bosses had given her space to “do stuff”. She continues that philosophy in her daily work.  I don’t know all the names she dropped into the conversation, but the CEO of the NHS? At the time was Duncan Nichol? (Sorry Sam – this got lost in translation from my notes!) Anyway, she contacted him as a management trainee to ask to shadow him for a week.  And he said yes. So there she was in meetings with Stephen Dorrel who was health sec at the time. After every meeting, what did the CEO do?  He sat her down and asked her what she had seen, and what would she do differently.

And that’s what the Vanguard programme is all about.

It is bottom up.  It asks end users and front facing and coal face people what they would do.  Here’s an example from her previous job.  The hospital was going to hell in a handcart. No panicking imposition of rules and regs from above. She cancelled all normal meetings. Got everyone involved in ‘fix it gatherings’.  Lots of front line staff came in. Senior team …not allowed to impose.  Hard for them…but hey, results and change happened.  As she said, the fish rots from the head down.  Change needs to happen from the bottom up.

A porter said that patients who had died were not being treated with dignity.  The transportation module (usually a galvanised steel coffin box) was not big enough and looked terrible, especially to the other patients and the relatives, I assume.   The porter was shaking and scared to verbalise this. Sam held his hand while he said it all again when asked why. Then she said to him “ok, you redesign it”. And that is what happened.  And that is what the Vanguard movement is all about.

It is about letting the local people sort their own stuff out.  And to get everyone who is involved In that care model, locally, to get involved.  And then to share the ideas and methods widely.

It will break down silos.  It will stop the stupidity of falsely applied budgeting getting in the way of patient care.  It will be cheaper.  It will be safer.  It will be more efficient.

And it will put patients first.

About time we had a passionate Chief Exec of the NHS who was like Samantha Jones.  Been there, done lots, got the scars, has the passion and wants to make things better for every patient in the NHS.

I loved her attitude.  And I know she will make a difference.

If you want to know more about New Care Models and how the Vanguards are indeed at the vanguard of change, then click on this report from NHS England.


It is also there in the 5 Year Forward View – Sam published her new Care Models sub set in March, looking at the Care and Quality gap: