Lord Carter Health Chat – reflections

OK. I’ve been on holiday, and just catching up on Roy Lilley’s friendly chat with Lord Carter.  (You can watch the whole thing on the NHS Managers.net You Tube channel by clicking here )

Patrick Robert Carter, Baron Carter of Coles, otherwise flagged as “Lord carter of Bog Rolls” by Roy Lilley.  I think Roy may have swallowed too many pieces in Private Eye for his own good…but I do understand good procurement can save a lot of wasted cash, so why not simplify it to the bog-rolls metaphor?

It is bigger than that, of course.  The interim report and the final report (here) is about operational efficiency varaitions across English acute hospitals.  I’ve heard Roy say many many times that all we have to do is show people what good looks like, and they will do it and maybe do it better.  It was quite strange to not see Roy’s lips move (and any who know him realise this probably only happens when he is asleep…), but I heard almost exactly the same words falling from Patrick’s lips.

Here’s my favourite sentence from the Executive summary of The Carter report (as it will always be called.  “Operational productivity and performance in English NHS Acute hospital: Unwarranted variations.” – is more of a mouthful, but does provide a neat summary of it’s own, as a report title should!)

“We conclude that there is significant unwarranted variation across all of the main resource areas, and although we found many examples of good practice, no one hospital is good at everything. resource areas, and although we found many examples of good practice, no one hospital is good at everything.”

One of my constants beefs about the contagion that is report writing is that is what many will remain.  A report.  Not an action plan.  Not helpful.  Not going to change anything.  Why could and should this be any different?  There’s the same pressures in other health care systems.  As Lord Carter said in the report, the NHS ranks as the best value health care system in the world.  Guys – he is on the same side as you!

His work life seemed to revolve about being the go-to person when something is very broken. Wembley stadium anyone?  I suppose we should have noted the project may be late when the Australian workforce started betting on the due dates being missed!  But he got in there and helped sort it.  He was also on the bid team for the 2012 Olympics – and I’m guessing the IOC would welcome some help with Rio now.

Already some of his attitudinal philosophy was spilling out. “There are a lot of good policy decisions (plans to the writers mind) being made.  Execution is often boring and bad.  Attention to detail and keeping at it are key”.  “Keep the confidence of the politicians, and get the money right”.

I loved the simplification thinking.  “What does a good rota look like?”  This really isn’t leading edge and scary – it’s day to day and practical.  “Most people respond to data”.  Don’t you love that?  Other questions on what is the appropriate level of care, which varies by ward, by hour, by specialisation.  Not a blanket “6 patients per nurse”  or whatever.

Some randomly disjointed thoughts – but all allied to simple management:

  • Everything is about management
  • It’s how you run a business
  • We need to deal with local conditions
  • Just need hospitals to spend the money right
  • Acute hospital is the dominant partner in the system (and don’t forget that, please, I say!)
  • We need basic information that people we are talking with will respect
  • We need to pool and share data
  • NHSI (i.e. Not Monitor) need to be sitting down with Trusts and help them to switch to better buying

The NHS is a noble cause.  I just get the feeling that Lord Carter’s approach has identified the right bottoms to be kicked, as well as giving a super charge to the sharing and using of great methodologies and ideas.

Let’s just get the data, share what good looks like, and let them – the front line – get on with it.  Can it happen?  Yes.

One last statistic of the night.  The live feed trended on Twitter.  Roy has never managed that himself, so I suspect was deeply jealous!

(And one other place for sharing great ideas? – Lilley, Jon and the Blonde have a very fast growing forum: The Academy of Fab NHS Stuff. Go see)

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