I’m sorry.  It is a bit childish, isn’t it. National Institute for Health and Care Excellence is no laughing matter. Originally, just the proper NICE acronym – in 1999 – “The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care”.  Laudable.  Then the remit changed in 2005 – after merging with the Health Development Agency, “we began developing public health guidance to help prevent ill health and promote healthier lifestyles. Our name changed to the National Institute for Health and Clinical Excellence”.  Proper Health Service, rather than a sickness service (which has always been my gripe with NHS as a name – more fixing the sick than stopping them getting sick first).

Yes, another health chat, with Roy Lilley being chatter in chief.  These are my reflections having watched on Periscope (easy to download onto your pad or phone) last week (I’m moving, hence a bit tardy!)

Another great way of seeing the whole thing is via the Academy of Fab NHS Stuff You Tube Channel – click anywhere on this coloured bit to take you to it.

Do you sometimes wonder why anyone ever gets to want to be interviewed – by anyone?  If your organisation is in crisis, the first thing any Crisis Management Organisation suggests is never appear live, or you will be hung out to dry.  Well, the insults started early.  I was already thinking “Why put yourself through this?”

“You were described once as having less personality than a paper clip”.  Well fielded by the Knight of the Realm…”Yes. Paper clips are useful.  That was how you rebooted your phone, remember? I took it as a extraordinary compliment…”.  The softening up is always so nice from Roy – and you learn a lot about how the person formed to fit the high ranking role they are now in.  Always so pleasing to see that many of the people Roy interviews are actually long term NHS stalwarts, and many jumped into the organisation at teenage or new graduate input.  Andrew Dillon was no exception.

His trail was blazed with moving from unit to unit to hospital – and they all seemed to close after he left…except The Royal London.  I’m sure it was just coincidence – but Manchester and environs may have heaved a sigh of relief as he took the M6/M1 route to London.

There was lots of political interference and ‘leaning on’ from Big Pharma.  An early spat involved a Flu treatment from GSK – Relenza, I think?  The Rapid Assessment system (cost benefit analysis linked to clinical utility – or maybe more complicated than that?) resulted in a ‘no’ from NICE and the head of Glaxo demanding to see the PM (Tony Bliar, star of recent 1.5 million word historical document), I assume to ask for some part of Andrew Dillon’s anatomy?  (Head?).  It certainly seemed to get them known.  There was a lot of flummery and anger about pulling investment and people out of the UK (this sounds awfully familiar), but that didn’t seem to happen.

Reforms create pluses and minuses – winners and losers.  The Griffiths Report (1983 – wow…feels like yesterday – and the link is to an HSJ 30 years on review).  One thing that both Roy and Sir Andrew agreed on was regretting the demise of The Firm within hospital specialisms. Teams always seem to have the prospect of fulfilling the promise of better results – better care, lower morbidity and mortality.  (Prof. Michael West’s work when at Lancaster, for the Kings Fund – super set of slides here – “A positive organisational climate is associated with low and declining levels of patient mortality”  Good to know?)

Maybe that’s what it boils down to then.  NICE remit and objectives felt a little bit ethereal and ephemeral to me – I still couldn’t fully describe what it was all for. I got a bit lost in the enormity of the scope of the remit. So I asked Roy Lilley. “It puts a rationale behind the use of resources”. I like it!  Maybe, like most of the super talks I have been to or watched remotely in the past year of the Health Chats with Roy, they have proven to me that, yes the NHS is a behemothic highly complex beast.  But some of the fixes are simple in essence.  Like getting back to The Firm as the central structure with ward rounds and teaching and learning and team work and support and job satisfaction and better outcomes and more effective use of resources and and and…

We just need to stop messing about, and start taking action, not just talking about it.