OK – this is a football themed blog.  I do try and have my ideas from many sources, and those of you who follow me on Twitter, reading the 08:15 quotes entitled What I Learnt yesterday (#WILY) will know I pull ideas in from many and varied sources.  I think stories and metaphors are very transferrable – and Mr Klopp, Liverpool FC’s new and charismatic manager, is a veritable source of inspiration for me.  Also, as a Liverpool fan, I am excited at what he might help the club achieve.

He does feel more manager, day to day, than leader.  Maybe we just don’t see the long term visioning, the thinking the unthinkable, the 5 year aims and plans.  We see the instant, live reactions of a passionate and thoughtful man.

I think his most impressive traits are very worthwhile trying to emulate.  Here’s my take on his style:

1. Disarmingly honest.  Personified in Press Conferences.  The sports reporters feel notoriously extreme in their views, and rather biased.  Liverpool beat Chelsea at Stamford Bridge early in his time as the new manager.  “Are you going to win the league then?” His reply? “Are you crazy? I hope I didn’t understand the question. I have been here 3 weeks. You think after 1 win against Chelsea we can win the league?”.  Lesson?  Beware of optimistic expectations that are unrealistic.  It is best to nip these in the bud straight away.
2. Simple, clear thinking.  (See the photo and caption above).  That is not rocket science, at all.  But it transfers so well to any organisational situation.  If you are being successful, it is far easier to have a lot of lee-way and support for your most outlandish ideas.  If you are in turnaround, no one will release the budgets to you.  Sadly, that’s when you need more support.  Moral – ask big when you are riding the success wave!
3. He works on the team performance through motivating and supporting individuals.  He knows when someone has done something above and beyond.  He makes a bee-line for that individual at the end of a match, or even at half time.  And shows his delight by chatting, slapping on the back and cuddling them!  And guess what?  They perform better next time they play.  And the other players?  they try harder so the boss notices.  Is this transferrable to your situation?  If you say no, then leave the room this instant!
4. He is not averse to telling people off.  One of the Liverpool players – a star of two seasons ago – Daniel Sturridge, has been injured for most of the season.  “He must learn what a real injury is, and play though the pain sometimes”.  Yes, this really got up the superstars nose.  But guess what?  He is back now, and wants to prove his worth to the manager.  The rumour is, he also told the player he would be quite happy if he left the club.  That could go either way, but it worked.  Moral?  Don’t let poor performance become tolerated.  Your whole team will go backwards otherwise, and everyone will stop pulling their weight.

There is plenty more, and plenty to come, I feel. I have found some of his quotes very thought provoking and a bit different.  They have certainly helped me come up with some memorable What I Learnt Yesterday tips! Search for me on Twitter @canmencook, then look for the #WILY.  Every day is a school day – if you look around you and open your eyes and ears to taking lessons on board.

Enjoy!

We were on the Road – Aintree University Hospital, in Liverpool. 170 people in the auditorium.  Wow.

The panel?  Sir Ian Gilmore (Renal Czar; Advocate of minimum unit pricing for alcohol; holistic thinker) (sorry, health warning – my views of the event, as ever, not checked with organisers or speakers – sorry!).  Simon Bowers.  GP and Clinical Vice Chair of Liverpool CCG.(Clinical Commissioning Group).  Famous for a Panorama programme – “A day in the life of a Clinical Commissioner”.  Patient advocate.  Roz Gladden.  Local councillor.  Soon to be Lord Mayor of Liverpool.  Housing Officer originally.  And a bit into the joined up thinking that will be needed with Devo Liverpool coming along (probably).  Making sure the holistic approach will actually happen.

We were there the day after the Junior Doctors second strike.  Made some of Roy Lilley’s lines of questioning and provocations easy. They all felt that Trusts – who will after all pick up the pieces that any of the negotiators agree upon, are really caught in the crossfire. We are in danger of risking care to the patients by taking our eye off the ball, they argued. What people want at the front line is the freedom to drive up quality and safety. Through the day we had attended exhibitions of The Academy of Fabulous NHS Stuff ideas, under the auspices of Healthy Liverpool.  As Sir Ian said, Liverpool has made substantial progress – from a very low base.  But the number and quality of simple actionable programmes being showcased here is what is driving the successes, I think.

Roy Lilley and Panel

Some other quotes and highlights?  As ever, Mr Lilley was provocation personified.  “This is barmy – you haven’t put Healthcare into Devo Liverpool” (it will be in the next phase…). “The CCG’s can’t agree – so places like Aintree Hospital don’t know which pathways to use for discharging – because it depends where the patient lives”  (This does sound daft to me.  The locals call it “What colour is your wheelie bin?” Each authority has different coloured bins dependant on geography.  Roy lost some of the localism.  “The 3 CCGs go from out near the Woolly Backs in the south to posh Southport”  Woolly backs are the non city dwellers – who can see sheep from their gardens….).

Is it time to amalgamate the CCGs to be co-terminus with Local Authority boundaries served by the local hospitals?  Fewer meetings, less administration, and simplification?

There was a lot of discussion about the interface between medical and social care.  The Buurtzorg model of nursing (and cleaning, shopping, cooking, bathing and more) from Holland was mentioned again (Google it).  We do seem in a ‘full bed occupation’ stranglehold because of the interface between health and social care becoming a barrier rather than an enabler. The panel all agreed though that multi disciplinary teams residing in the Primary Care surgery improved communication and effectiveness.  And, an absolute truism, borne out of bad experiences, was never to cut Public Health budgets when money is tight.  It is a false economy.

Sir Ian remained optimistic.  Yes, we could see a time of working better together.  There is a lot of passion to make things continue to improve.  Perhaps the horrors of squeezed budgets and austerity at least foster innovation?  There does feel like there is both a vision for a healthier Liverpool, and opportunity to turn talk into action.

Saddest moment?  One of the contributors would not want their kids to follow them into medicine.  If you keep kicking people (from our Press to the Government) eventually people will give up.

I didn’t feel that after this meeting.  The place crackles with energy and positivity.  And much of the force of nature up in the north west is very copy-able.

I suggest you all check it out via the Fab NHS Stuff portal – and steal with pride from the Scousers!

This sounds like the start of one of those News of The World (remember that) stories that ends with “So we made our excuses and left….”

We were not at a house of ill repute.  We were in my home city, Liverpool, and Fab NHS Stuff- run by Rot Lilley (of NHSmanagers.net fame), Terri Porrett and Jon Wilks.  The repository of good ideas – www.fabnhsstuff.net – was on the road!

Roy and The Blonde

The exhibition – sharing centre of posters and people – was so invigorating.  And you know, Terri was right in her overview at the lunchtime talk.  Most people (she singled out nurses) put down their achievements – you know the “well, it’s only a little thing’,  and “it’s just my job” – and “I’m sure everyone is doing this already”. sort of comments.  And Lilley and The Blonde were here to tell everyone that they were wrong to down play the fab stuff.

The web site has had over half a million page reads in just less than 1 year (14th Feb 2015 – sort of links to Love your NHS on Valentines day?).  They get 1500 visitors a day.  Perhaps even the CEO of the NHS, Simon Stevens (Sir), and Jeremy Hunt, current Secretary of State for Health.

But why The Blonde?  OMG, she has transmogrified into an acronym!

B – boast about your idea, and big it up

L – little things matter.  It’s all about aggregations of minor gains.

O – Opportunity through sharing – but one of the audience suggested ‘Ordinary people doing Extraordinary things” Terri may change her acronym…

N – Never underestimate the importance of what you do

D – Determination – never give up

E – Energy – and by sharing, you can energise others

Roy then kicked the blonde off stage to amplify the ethos of The Academy of Fab NHS Stuff If you show what is good, show what good looks like, and share it, then the new owner will not only use the idea, they will make it better, and will then pass it on.

The NHS has to do stuff differently.  It is already remarkably inexpensive to run, and the envy of many other countries (Except for us ourselves…sad). If you keep kicking people, said Mr Lilley, then they will just want to go home, and be very disheartened. (He said ‘pissed off’, but I wouldn’t use that language…) . 70% of budgets now go to look after long term conditions.  When the NHS began (2 years after Roy was born) the average working man died within 2 years of retiring.  The spend profile need has changed remarkably.  Ironically, the austerity recession (personally, not sure Keynes would have approved…) does have the one positive of making us all far more creative.

There are zillions of great and often simple ideas out there that just need to be shared.  From ‘Hello, my name is….” to stealing ideas from abroad (Home Care via Buurtzorg in Holland) – and The Academy of Fab NHS Stuff is a splendid vehicle of dissemination.

Can’t wait to hear more this evening!

Stephen Dorrell was an MP for 35 years, and retired from House of Commons – did not contest – the last election.  There may have been a conflict of interest problem, as he was joining KPMG who were also bidding for NHS contracts.  He – as one would expect of a man who seemed properly full of integrity – resigned from the Health Committee he was (the first elected) chair of, six months before the election, as he was overlapping the old and new roles.

The Kings Fund by Night

This blog is my own personal views of a meeting at The Kings Fund in London, where Roy Lilley from NHS Managers.net pulls few punches and manages to pull a lot of the ‘what makes this person tick, and do what they do’ background.  It does help to see and feel where our movers and shakers get their own motivation.

Apart from the KPMG job, he is also the Chair of the NHS Confederation.  This to me (and the usual health warning – some of this is my own opinion!), looks like an organisation with almost too wide a wing span. “To be a system leader and a representative voice of its members, while giving direct support for NHS leaders giving best possible care to patients”.  Wow – laudable – but how?  Maybe for another day.  As a semi outsider, I didn’t quite get the remit…

He does come over as a genuinely nice guy, and highly committed to public service.  Yes, he does have a preference for marketization, and I sensed a bias towards ‘private is best’ (I don’t mean private medicine – just private companies creating better efficiencies and outcomes).

His background was in business – family business, in Uniforms.  So not just a career bag carrying politician.  Became a Minister of Health under Ken Clarke as Secretary of State.  The 1990 act, creating the Internal Market as part of it – the Purchaser Provider split (Purchaser became Commissioner more recently). This was one of the key themes of the chat.  One of the questions at the end was the costs of such a system.  The costs of actually having the split – administrating it, essentially, I assume – was 14% of the budget.  Those who work in multi national or Group organisations will recognise this.  Transfer Pricing and accountancy controls like Activity Based Costing all cost people, money and time to actually do them.  And to what end?  We just need more administrators and accountants to do it.  And they are going to make it opaque enough to ensure they keep their jobs, aren’t they?  Turkeys don’t vote for Christmas…I do understand that having budget responsibility is as good a way of focussing on efficiency as anything.  I think it is costly and too simplistic.  Outcomes Efficiency is the gold standard to me.  And I am sure we can never come up with the correct key performance criteria because it is much harder than looking at the input finances.  Just because it is hard to do doesn’t mean we shouldn’t try?  As Stephen said many times “What does good look like?”  And when we have that we share it – maybe through the likes of Fab NHS Stuff (got the plug in for Roy and The Blonde there…).  To change the mind-set, Roy suggested changing Commissioners to Brokers of Health Care.  Feels like re-arranging the deck chairs on the Titanic to me…possibly.

Devo Manc was exciting Stephen too.  He thought that this move (essentially giving all of the health and social care budget to the Local Authority) was as likely to have as much effect as Beveridge.  Hopefully positive effects – unlike Andrew Lansleys 2012 Act – (we will say no more here…).  The vision he offered – Holistic view of Health, Social Care, and all the agencies that stoke that fire – housing, schools etc. should be seen as a whole, not silos.  One of the difficulties is the money – who pays for it.  As Prof Brian Jarman said, 5% of the population pays for 70% of Public Health (I do hope I got that correct – I am sure Brain will correct me quickly if not!)  And one of the biggest difficulties, as Roy Lilley said, is where do we draw the line between means tested and not?  Free at the point of delivery?  But the majority are responsible for their own care costs now in Care Homes?  I think the Dutch Model (Buurtzorg) for more homecare could provide the bridge here.  And maybe we should still have Nursing Homes – NHS funded.  My definition of whether it is Care home or Nursing is if the Ward needs to be locked – then the patients are just that – long term patients, so their care should be at the point of delivery.  And we keep people out of care homes and out of Hospital by using the Buurtzorg model of home care.  Budgeting solved?

The obligatory Penderyn Welsh Whisky…

The vision for the future – Holistic oversight of Health and Social Care, like Manchester, with the centre (wherever that is) setting the standards, and the Broker/Provider split managing the budgets feels good.  The arguments will always be amongst the ideologies. What proportion of providers should be public and private, for example.  But, the overview vision feels good to me.

Stephen entered public service to be ‘on the field of play’, and to be someone who was ‘making the difference’.  I did get the feeling that this deeply held conviction was both sincere and is likely to continue for some time to come.