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  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.

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