Listening – Matt Hancock and Roy Lilley

You do sort of vaguely know the persona of a fairly new Secretary of State for Health.  Don’t you?  Or you at least have an opinion?  The last one was there for ever, and seemed to be ensconced for ever.  Came over very well at Health Chat a couple of years ago.  I’ve seen the politician more than once on TV – a good performance on Andrew Marr, I thought.  But what makes him tick?  The back story is always what we hope for when Roy Lilley calmly digs deep.

The RSM lecture theatre was packed.  200, and many more on Periscope. (If you want to view yourself, click through here – free to watch).

Everyone wants a piece of a Secretary of State.  One of the youngest FabNHS Ambassadors managed to interview him before the main event!  She asked him “If you had my sixth form friends here now, what would you say to them to seek a career in the NHS?” A very full answer.  And you can hear the passion, conviction and sincerity.  That is easy to spot if it is fake.  And I was heartened to see that it really isn’t. (Not sure if tech will work – but you could hit here and I hope it does!)

Just an hour – it’s a bit busy being a cabinet minister at the moment.  It surely must frustrate them all as one thing dominates the agenda as we speak.  But Matt Hancock does seem to be getting things moving, just perhaps slightly more slowly than he would like?  Usual level of jibe from Roy about going to a posh school.  He also went to a Further Ed college.  Good service return, I thought.

Why politics- when you could have got a good job (yes, we are used to Roy’s style…).  As is very often the case, a youthful experience created that.  A sense of injustice engendered when his parents small business almost stopped existing whilst awaiting payment from their only customer who had been caught in recessionary pressures themselves. Cheque arrived on the Wednesday before closure would have happened on the Friday.  Not just the family, and their home, but a dozen employees too.  And no fault of their own.  Out of their control.  He first became an Economist at Bank of England.  Swiftly realised economic change decisions were made up the road at  Westminster.  So driven towards that.

Interesting family business too – software design. Their piece is data management of Post Codes. When you look up a postcode on line, it is their software that does it.  This sort of experience may be useful in his current role…

I liked his focus on big issues rather than Lansley style micro managing and imposition without consultation ( in my view).  He was very impressed with the people in the NHS and the results they achieve.  But the fact that they are undervalued really seemed to annoy him. There is a need to change morale through better leadership.  Sometimes simple things can help, like taking catering back in house at his local hospital.  Better food for both patients and staff.  Everyone happier.  And feeling valued.

Before we delved too deeply into policy, I think we had an insight into the ministers NHS drive.  The NHS is there for everybody.  The 1.3 million employees, in all the jobs and professions (not just the doctors and nurses) have one main overarching aim – to save lives.  There aren’t many jobs with that level of reason for being.  He wants everyone empowered to make sure the whole NHS and social care is the best it can be.  The NHS team members are duty led and are driven by their duty of care.  And if they feel undervalued, then it is his priority to help address that.

All this came over as both part of his core value set  and was very sincere.  He really did come over as passionate about the role and the influence he will be able to have.  I felt it was very real – cynics amongst you may mock, but I really don’t think you can fake that level of commitment.  It bodes well.  He seems to relish the challenge, which is good for all of us?

But it is an immensely wide brief, as we know.  Some highlights, with potential to become lowlights….

1. The Money: well yes we are talking about getting back to funding growth growing again at historical levels of 3.6%.  As Matt pointed out, this means it will grow from £115 billion today to £148 billion in the fifth year of the funding plan.  And there is the rub – same percent off a higher base, more real money?  Healthcare inflation is higher than normal life inflation though?  And we didn’t get too deeply into Social care and the ageing population. (Except a Green Paper due before April).  The positive is that the funding was for 5 years, not a year at a time.  The money graph has at least changed direction, with his push.  He touched on debt, and the prospect that the unrecoverable debt (possibly 1/3rd of Trusts?) may be taken out somehow.  Just a hint that PFI debt was in his sights.  I do hope so.  He also wanted people to work at breaking even with the annual funding provision.  But the 5 year deal means at least people didn’t have to plan for unrealistic payback schedules of less than 1 year.  He understands economics, spreadsheets and business plans.  Hoo-ray!  Getting people to make sure the cash flow is right, and worrying less about the balance sheet.  Other things waste the money resource.  The aim is to have fewer Pilot schemes, and more finding out what works and sharing it and rolling it out. (Akin to FabNHS ideology?).  They both discussed prevention as an obvious strategy, to get ahead of the demand curve.  If we can get the capital versus revenue argument switched, there is a better chance of balancing the health economy.  And getting the flow balanced is actively motivating for all.
2. “Digital. It’s a mess. Discuss”. (Roy being a bit in yer face, I thought!).  Most interesting thoughts here were around sharing of data. A lot of the legacy contracts means the 4 major providers (?) of systems for GP land seem to own the data and will not share.  He has already made sure that new contracts don’t have that.  There must be a way of making the old contracts open?  Could it be as simple as asking the contractor to be open and share the data, or they will not be awarded any new contracts anywhere within the NHS or social care? When you’ve got them by the wallet, hearts and minds usually follow.  Just an idea…. That’s before we get into Interoperability.  After another sensitive interruption, as we got into whether the 10 year plan was a set of hopes or a real action plan (the protagonists begged to differ, but carried on anyway – even though Matt did say that he nearly swore at that point!).  Faxes were brought up. “But they work” said Roy. “So do pigeons – but I think we have progressed.”  Good answer – which got both laughter and applause.  The data migration to interoperable systems may still be the biggest roadblock?
3. “Why have a plan with no workforce plan within it?”  That feels like the implementation part of the 10 year plan.  Training takes time, of course.  We may need to have different types of people.  Nurse apprentices seem to have become more difficult with the introduction of the Apprentice Levy.  But many hospitals have started training their own doctors nurses and more possibly, as they became despondent of waiting for Health Education England to get their house in order.  Matt also seemed to be in favour of doing things differently – like changing the Primary Care model to include both types of model.  The digital, machine learning algorithm led GP at hand style, as well as the traditional format.  High Quality access is still the aim, it is all about horses for courses.  Same meat, different gravy?  It also sounded like technology could be central to all this. Getting NHS England, Improvement and Digital into one amalgamated entity seemed to be part of the process thinking.

Far reaching, thought provoking and very enlightening.  I’m still unsure what NHS X was all about (some research needed here!). What I am sure about is that the Secretary of State will make a difference.  He already is doing so.  His background and core values seem very congruent with today’s needs. I came away feeling very positive. There is still so much to do, of course. But suddenly, it doesn’t feel quite so scary.

been there, got the t shirt!

The usual NHSHealth chat health warning here – these are my views and reflections. They may differ from yours if you were there, watched on Periscope or will view later.  If you want to see the whole chat, for free, please click though here. 

Samantha Riley

(it is free to watch)

Data is good! Data is King? Well, Samantha Riley head of Improvement Analytics at NHSI was described by Roy Lilley as the ‘data doyenne’.  Her passion was and is data and using it.  She is a bit of a standard bearer for a possibly misunderstood set of skills.  And she had a very interesting back story – which is Mr Lilley’s tried and tested way of us getting to know the person behind the job title.  We often need that, as job titles very seldom tell you about the day to day, and the long term aims.

Let’s get my preconceptions out of the way.  A science head, a people and strategy heart and MBA biased towards information use.  So I arrive at the Periscope recording of this session with these thoughts ringing in my ears:

1. “What gets measured gets done”.  A quote from the seminal treatise “In Search of Excellence”, (Peters and Waterman, 1982))
2. We tend to measure what is easiest to measure, not what is going to give us the best information set to inform decision making and action
3. Data is useless unless you turn it into usable information
4. Having got useful information, what do people do with it?  Does it actually inform decision making and create an action plan that is put into being?

And finally:

5. How does Sam Riley’s team make sure the data and information they feedback to people isn’t just met with stony faced blank resistance?

I remember my Uncle Fred’s job at Plessey in Liverpool.  He was a Time and Motion Engineer. So, a pawn of management, and hated by the workers!  The ultimate middle management position. The aim was fine. Gather data, work out what it means, and use it to create an action plan to improve processes in both efficiency and effectiveness (which are different, of course). He still remained the punch bag and source of panic and fear.  And as soon as they knew they were being watched, people did things differently.  I suppose experience taught him to look past that. But the job feels so similar in problems as Sam’s does now!

Let’s look at career highlights:

• A women in a mans world – computer Science degree.  One of two women on the course that year. More interested in people than machines, so moved on.  Majored on visual presentation of data.
• Charity role – Concern Worldwide. Ethiopia. Definitely people focussed!  Co-ordination of all Admin. Good old spreadsheets!
• Into NHS. Research Co-ordinator at a London hospital.  Many clinical trials happening. Ostensibly looked on as an income stream, from Pharma companies.  Her data found they were bleeding costs, mainly due to the extra burden on lab testing.  Data meant they could argue for more money from the pharmaceutical companies.  Result…
• Joined the famed Management Training Scheme within the NHS. Other luminaries?  Simon Stephens. Mark Britnell.  There are more….and if it creates visionaries like that, who stay loyal within the NHS, who cares if it is inward looking and NHS originated?
• Modernisation Agency.  Placements at St Georges. Community Trust.  Data showed they could keep people in hospital for a shorter time. Push them out ASAP.  Unintended consequence?  They burst the community budget.
• Brighton Acute Trust.  CEO, Dame Marie-Anne – described as very inspirational. A ‘management by walking around’ advocate.  Firm and Fair.  Much team building and spending time together.  Team pub on Friday Lunchtime.  Working lunch.  Back to office then stayed late. Head of Patient Access.
• Improvement Partnership for Hospitals.   A new three letter acronym.  Statistical Process Control – SPC – more in a mo!

A couple of Sam’s core values emerged during this, which I think are key.  She found new recruits though interviewing for attitude and team fit. She then trained them for the required knowledge and skills. It is too hard to train attitude – some would say impossible.  Amen to that.  Secondly, the focus on team work and team worth.  If you didn’t fit, you didn’t stay. Simple.

As you can see, a lot of the jobs had ‘improvement’ actively in the title, or as a core aim of the role.

We did have the usual sparring. Inspection is useless intoned Roy.  A politicians answer from Samantha. She didn’t answer at all. But I tend to agree with Roy.  “Targets are all out of the window now aren’t they?”  Again, ignored.  That wasn’t in her bailiwick, so didn’t need to be answered.  “Now we’re getting to it. The Friends and Family test. What a waste of time.”   Sam answered this time.  No, she said, the data was very positive, but the patient comments were amazingly powerful as staff motivators, far beyond the occasional note and box of chocolates.  I thought that was possible, but not as instant as a thank you and note – and chops from the patient and family.  Roy told us as a Trust Chairman, they found it easy to fiddle the results.  Ask the patient immediately after their successful procedure, preferably when still woozy with anaesthetic, you always got positive results.

And I suppose that’s the problem.  If you have targets, that’s what gets done.  Even if 4 hours blanket target for getting through A&E is plainly daft as every condition is different in its level of emergency need.  Would we have so many people in ambulances waiting to get into the department if the clock didn’t start until they cross the threshold?  Targets create inappropriate unintended consequences. End of.

I did get a bit lost in a plethora of TLA’s. I suppose all industries have them.  But when you put together an IT and informatics led support function and the NHS itself, you really are in TLA heaven!  Or hell…(three letter acronym, in case you had forgotten).

But SPC got me.  I’m not going to define or go into detail. Samantha didn’t.  And doesn’t when she or her team are presenting the results of their research.  It’s the numbers and info that count not the how they got them.  But here’s the difference, and her aim in life now.  Red Amber Green – the RAG system is very widely used. Saw it last night on BBC report on this years purported winter crisis in hospitals.  RAG against targets, which are externally imposed in a simplistic way, and not based on patient outcomes.  Most of them are simplified to two points on a graph.  You can only draw a straight line between two points.  And people respond to the Reds because that’s ‘the cosh they are under’ – as Roy said.   Sam’s mission is to get more data so that we have proper graphs.  That’s my essence reading of SPCs.  7 points means you have a proper graph, and you can then be controlled and step back and do much less firefighting and more real fixing?  If I’m wrong Sam, please tell me!  It does feel like it makes SPC a more reliable early warning system because it fixes on trends rather than one off blips.

Yes, it’s not easy.  All along Sam kept telling us how people take the data personally.  As we are talking, for example, named clinician patient outcome data here, I am not surprised?  But let’s look at their method. When presenting to a board they are never judgemental. No fingers are pointed.  It’s up to the board to use the information.  And they will support them.

It’s all about giving the boards and others a better understanding of the data, to make better use of it to make proper action plans that will make a trans-formative difference.

Her mission includes training boards and NEDs and others how to make better use of the data.  My biggest concern is this is a great start.  But Sam’s team are too thinly spread.  They can analyse, present, train a bit, but then they have to move on.  I’m not sure they help with action planning from that data, and defining the outcomes that will show the strategy has succeeded?  Maybe there is an obvious link to The Fab NHS forum of great practical ideas that are already proven to work?  We don’t need to reinvent the wheel.  Samantha Riley’s team can present the results to show where people are now.  The boards can then seek ideas for actions from the likes of FabNHS.net.

My opinion? Perhaps we just need to move from data being created to feed the National offices beast.  To interrogating it to inform our strategies.  We are overwhelmed and drowning in usable data.  What we need is for more of it to be turned into usable information.  That to me needs not to be poisoned by targets.  It needs to be led by patient outcomes.