Nikita Kanani MBE

Nikita Kanani – Acting Director of Primary Care for NHS England – interviewed with Roy Lilley at the Kings Fund recently.

Where do you start? What an amazing, full on, vibrant and challenging Health Chat. I watched a recording on Periscope – you can too. Click on this link – it is free!

So it wasn’t just Roy Lilley being provocative at this event. Nikki batted most things back faster than the ball had come to her. Highlights? Number one has to be the thought that Roy will be prescribed Zumba classes if Nikki can just arrange that bit of social prescribing for him. Now get that image out of your head, and get back in the room!

I wasn’t there, so don’t know the audience make up. I’m guessing, as Nikita Kanani is Acting Director of Primary Care at NHS England, as well as being a practising GP in South London, that there were a lot of GPs present. I’m just guessing, as a lot of the times Roy was pushing hard about the GP contract and BMA getting too good a deal and why not use more tech and AI systems –  I did pick up some harsh intakes of breath. In France, they have protests. We have tutting and heavy breathing. I prefer it here though…

We had vested interests in the room, yes.  But anger is just another name for passion and commitment?  There will be another plan (wait for it).  And as the protagonists concurred, the agreed newly hatched GP contract is arguably more important than the NHS Long Term Plan. Certainly, if you get the first contact right (and we all agreed it really doesn’t have to be a GP), then the rest of the plan looks more attainable and deliverable. For only 9% of the budget. 93% of first contact is in Primary care.  Blooming bargain, mate!

It was wide ranging, this health chat. We started with a tangent into Community Pharmacy.  Mainly because her mum and dad still do that, after being refugees from Uganda, escaping from Idi Amin.  Could the role be extended? Certainly feels so?  If they could prescribe more? Only a handful can and do, I believe?  Patients sometimes expect a prescription?  And the pharmacist has to tell them to go to the GP surgery, to get the same diagnosis as they have already made, to write a prescription for the pharmacist to dispense? OK, I am being very simplistic here, and there are immense hurdles to overcome (legal and vested interest?).  But unless we have this sort of disjointed thought pattern and proposal, will we ever get through the GP access problems?

It seems Nikki was destined for a leadership role from early career.  And as Roy says, when you see clinicians who want to be managers too, they are often excellent leaders.  The usual, house jobs, surgery and medical- and loved all the disciplines. Loved being part of a coherent, focused and powerful team.  An aside here – she misses that in General Practice, as you do tend to feel more exposed with less support? Having said that, I’ve heard junior docs in hospital service complain that they don’t feel part of a team.  You hear the nostalgia for the way it was.  s this hearsay or ubiquitous?  You practitioners will have a better fix on that than I.

It was the leap of faith from having a great Consultant, and being in a hospital where the deputy chief exec used to have ‘drop ins’.  She was ranting and complaining to him about patients being in the wrong place, so he said why not come and work with us?  Would that still happen?  I do hope so…what a great way of getting change happening quickly.  And it served to stop her complaining!  Nikita suddenly had to make things change.  It’s all about stopping just talking about it, and actively taking action.  This is probably why Roy ranted once or twice about yet another report being commissioned and published, when two had happened already and were perfectly acceptable as the baseline for an action plan, and action? They made up a job title “Service Modernisation Lead”.  Sounded like she then did a crash course in management techniques – LEAN, Prince 2 Project Management, and more. Gantt charts coming out of her ears…

First thing they did?  Front Door Flow – and added a Rapid Assessment Team, to make sure the patient was directed to the right care at the right time.  That was back in 2005. Her reputation seemed to grow quickly.  Hospital Control Team was next. And creating Clinical Decision Units with a Care Coordinator.  Yes, all sounds obvious and becoming normal now.  It wasn’t then?

The path was so rapid to her current role, Acting Director of Primary Care at NHSE.  Although a 6 month post, not substantive, she made sure the job was openly recruited or it wouldn’t have felt correct.  I liked that.  When you view the recording of the chat, you will see why I might have got things in the wrong order.  Nikita’s excitement commitment and speed of thought means you do miss things!  She worked in the PCT whilst on her GP training. Frowned upon, but she doesn’t really care if things feel right.  DoH with CCGs (2012/13), loved having the budget and accountability.  But austerity made the job harder. She described it as the best and worst of jobs.

Let’s get some highlights of the ensuing ‘where are you today’ discussion.  I will add in my usual proviso and health check that some of the comments may be my views creeping in.  Sorry…

  1. Looking at in-patients in any hospital. 1/3rd should be in there. 1/3rd should be at home. 1/3rd shouldn’t be there at all.  Scary, isn’t it?
  2. “Why do GPs miss a lot of diagnoses?” (Roy question, out of the blue).  “They do a spot a lot”.  Fine reply!  Early diagnosis of cancer?  We come out well on treatment, but badly on early enough diagnostics?  Could having the James Kingsland NAPC at Home style, or Sam Etherington’s local do everything garden centre with health centre annexe (I’m simplifying the offering, OK?) – perhaps make swifter diagnostics work better?  The diagnostic hub concept?  Get it out of hospital and into local walk in that day standardisation?
  3. Not enough GPs – and maybe there never will be.  Maybe there never were?  If up to 60% of those who see their GP didn’t really need to see any GP, then what could we do about it? If the biggest impact on people’s well being are the three pillars – have a fulfilling job, have someone to love, and have a safe place to live – what has a GP got to do with that?  Maybe it is social prescribing.  Maybe it is having the change of attitude in the patients that they want to chat to, see on their phone, have an algorithm exchange first, see any health care expert appropriate to their clinical and emotional need at that time would mean that the GPs could then concentrate on the people who really need their type of intervention.  Most patients know already, I think.

There’s no magic bullet, both Nikki and Roy agreed. But she does have a people plan to roll out in 2019 /20.  20 initiatives and projects. That’s a lot.

I am going to watch this space with interest. The audience sounded like they are going to as well. We were all energised by Nikita Kanani as a total force of nature. The journey will be fast and furious. If you weren’t there, have a look at the recording, and see if you want to get on the bus too.

I know that I will.

(if you want to see the health chat recording – click here )

Roy Lilley, Nikki Kanani and IMS Maxims sponsors of the Health Chats

Prof Marcel Levi

Click here to see the Health Chat broadcast

Marcel Levi – CEO UCLH
Well. We were promised an evening of conversation with Roy Lilley at The Kings Fund to give us an insight into what it’s like running one of the major NHS Trusts in the country. Roy did so himself in the past and that experience gives him a head start over most interviewers (although the Health Chats tend to feel somehow less confrontational than Humphries). We found what made Marcel tick. And I think that’s why University College Hospital seems to be trotting along quite nicely.

A rounded figure, I think. Firstly though, the final words said “thanks for being enormously frank and open”. He is Dutch. I’m sorry, I have never met anyone from The Netherlands who isn’t straight, forthright honest and startlingly open. Marcel Levi lived up to his countries genotype well, and then some.

He maybe CEO of one of the major Trusts in Britain, but he still manages to do a doctor shift or two. We got into his methodology here quickly. It’s all about style and MBWA. If you are going to do Management By Walking Around, then it’s quite useful to be hands on a little too? He did suggest that most of the the first 5 minutes when he was in the room or in the team was quite stilted, as everyone knows who he is (which in itself, is a huge positive), but then nurses start being very honest and straightforward. Junior doctors were faster. And students? Mega straight, instantly.

But is he a doctor or manager? “Both” is the easy answer. He still feels more doc than manager. The style and outcomes of both jobs are very similar. Like outpatients or managing – a 1 to 1 meeting, 20 minutes, dig for the problem, work out how to fix it (together sometimes), then work out how to monitor progress. So both disciplines help each other and dovetail well.

Dad was a doctor then hospital director back home in Netherlands. He knew he wanted to be a doctor as a young boy. Started at home. After qualifying, moved onto projects at University Medical centre. It was small enough in Amsterdam for him to know 75% of the staff names . As Roy said, that’s great, but far more important that the staff all knew who he was. And that I suppose is the key point.

He’s been around. Blimey, he has! Italy, USA , Belgium, Germany. Roy wanted to know if we were just too possessive, rose tinted, and precious about “our NHS”. Marcel thought not, interestingly. He prefers the Social Solidarity model, where the well support the ill. Loads of ideas for trying to curtail the overuse of ‘free services’. I liked the £15 fine for those triaged out at A&E who should have seen their GP. I enjoyed the empowering the patients idea, to get them to self check (near patient testing kit for warfarin then patient changes their own dose, is a perfect example). Good example too of a newer more expensive set of dugs for anti-coag being overall cheaper because there are no monitoring costs.

A bit of discussion on Commonwealth fund data and UK coming out low down the league on outcomes. Every time I hear this argument, the result is the same. We are just not comparing like with like.

Some other highlights? PFI? Government could pay it off. If it has decided to stop future contracts, then why are old ones ok now? Daft. And I bet every board meeting just has it on the agenda every darn meting if they are saddled with a large debt?

Loads of the main focus was on doing things differently. Not tied to a tired old Lansley model of privatised is best (Carilion anyone?).

Start with the patient and work backwards. There’s a worldwide shortage of all strands of healthcare professionals. So we have to do things differently. Train our own? Yes. Loads of great HCAs? Train and upgrade them, quickly. Co-payment? Maybe only logical way forward. It’s already happening in Social Care. Let’s get real here! (That’s my view…sorry…). Triage at the hospital gate – who may refer you to a GP for free, or if you want to wait 4 hours, then pay £15.

And let’s get thorny…IT interoperability. Yes, it will take time…but they are on their way. but would you start here with a blank sheet of paper?
Can I make a simpler suggestion? The machine learning algorithms will suit many a time pressured worker. But so will every smart phone owner being allowed to keep their own medical data, and let them decide who to show it to. With password break ins allowed by HC professionals. Why not? Why not? We can be trusted!

There’s lots of simple stuff we can do in between time. Ask Marcel. They have their own Bank Nurse. And very little agency spend. Primary Care Home will help fix much too. As could something similar to the Buurtzorg model from back home for the Prof?

Do you know – there’s more to see on the recording. But it really feels like there area lot of small things that could make a big difference. And a lot of big ideas that could do just as much. And guess what, it is happening already…

if you want to watch (it is a good cuppa builders and a hob nob!) click here

Matt Hancock, Secretary of State for Health – Health Chat

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!

Data is King!

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:

  1. 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

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.


Magic Morecambe Bay

Image result for Morecambe Bay university hospitals photos

An unusual NHS Health Chat. Roy Lilley chatted cajoled and interviewed a whole set of the movers and shakers in “Magic Morecambe Bay University Hospitals”. Described in the invite as ” a Christmas Feel good story” – just to entice us to visit or watch on Periscope! And if you want to do that CLICK HERE. It’s well worth the look…

The background wasn’t mentioned too much – as in the history and problem areas – and to be absolutely fair, I had forgotten which “scandal” ( as all the tabloids call them) was which. The story was broken in 2010, and some commentators traced the gestation back to 1998. Lots about a new computer system called Lorenzo Data management system, introduction of which created problems. 14000 patients not followed up. The investigations and reports seemed to point the finger at a lack of governance and leadership in the Trust. Maternity and Emergency care were also singled out as major areas for improvement. I wasn’t there – that’s all I can glean from a quick search.

But I bet the 4 people who Roy interviewed knew in far more detail…

With that sort of spotlight, what do you do? Do you run away, ignore it, curl up and die or what? As has been said very often, it’s not how many times you get knocked down, it’s how many times you get up that counts. And boy, did they get up and fight.

My overview? I think they decided, as a team (and that is absolutely key) to not just fix things, but to be the best.  Especially in the areas that had been problems.

Turning around the pendulum when it still appears to be accelerating towards self destruct is no mean feat.  And to then become the good news Christmas Celebration focus for NHS Health Chat 2018 – well, who needs the CQC?  (I know Roy – it’s them again…). This might be the best surrogate measure of successful turnaround humanly possible?

It’s hard to imagine a team that were saddled with more luggage than this group had inherited.  But they really seemed to take the rebuilding prospect as an exciting challenge, not a bear trap. One big thing that stood out for me was that everyone complimented the team ( from patients to Roy Lilley!) on the Birthing Centre.  Not maternity unit, you notice.  The Birthing Centre.  Words are so important, aren’t they? Suddenly we are focused on Mum, Baby, Dad and family.  The maternity staff are there to help make the experience as wonderful as possible.  Described by many as being more like a Spa at a nice hotel, than being a hospital maternity unit.  And remember, this after it being singled out as a major area of under-performance, and patient safety problem unit.

What did they do? ” The community helped us to design it. Especially people who had lost kids.”  I am loathe to write “it’s not rocket science”. But it isn’t.  You know what though? Having the guts to hit it face on and do it and not assume you are the experts and having the humility and teamship and positivity to just do it that way – that’s beyond rocket science.  That takes vision and guts.

Have a review of the examples on periscope of the data management and records system.  The detail will mean a lot more to you who work day to day in the environment.  Here’s what I saw though.

Firstly, the vision.  “Sharing data is the right thing to do”.  And everyone knew that was “conceptual until it becomes real and live”. Yes, fine – fine to have the vision.  But talking action is not taking action.  This team knows that.  The next thing was that data sharing was part of The Integrated Care Community. GP records, ward level pharmacy, Care Homes, Social Services, Mental Health and even local government.

What helped this to actively happen? We are looking at the holy grail here – one version of truth.  A visible record shareable with trusted people.

  1. Long culture of engagement with the GPs – and guess what, you get buy in then.  Who knew?!

2. An overall strategy and a plan, to get to less paper and the single electronic patient record.

3. They had good people to bring on, ex Shipyard workers whose skills were very appropriately transferable.

4. A top team and hands on management who had a focus, every hour of every single day to bring all the parts together.

5. Embraced modernism – happy to go with the likes of MyGP – which helps in hands off triage of patients and many are sorted and reassured very early in the process. All this helps to keep the back end of secondary care free of patients who really don’t want or need to be there.

6. There was trust building in the Trust.

7. The data is there, real time so any problems are visible and fixable, not hidden and forgotten.


Fab.  A blended approach with no sacred cows and a bedrock of team belief that anything was possible and eminently fixable.

There were many wow moments with the data use.  And they do get lots of visitors to The Bay.  Not just because it is a splendid northern town.  People want to steal the best bits with positive pride and thanks.

There was also a day to day example of using technology to create efficiency, better patient care and happier staff.  Fixing 3 problems it’s one fix? Interested? Tablet PC ordering of meals! Solves 3 things

  1. Patient gets the right food, not what was ordered for the previous occupant of that bed.
  2. Saves nursing time at a stroke
  3. Saved £50 000 in wasted food – so Kitchen and Accountants love it too!

Remember, this all started with lurid headlines and accusations of low level performance.

Do we always need such a calamity to make us sit up and fix stuff? We shouldn’t do. But it certainly helps give a huge push.  It usually means we move from problem to middling.  Now Morecambe Bay University Hospitals and all the healthcare services in the area are beacons for others.

Now, could thisis powerful team help mould their solutions nationwide? Possibly. But each Regional need is different, probably.  Maybe that’s the best size to fit our solutions to?  Interesting thought from Roy Lilley.  Where did Regional health Authorities go? Can we send out a search party?

Team work success was perfectly personified in this celebration. Thanks to all.


The FabNHS Awards 2018

Admiral Lilley, HMS NHS, inviting people aboard!

It’s a special year, as we all know. 70 year-iversary, for our NHS. And at the FabNHS awards, we even had one of the fabulous acts who called herself Nigella Bevan (Nye, of course) just for the occasion!

You should have been there.  You could have been there! An astonishingly powerful evocation of all that is good about our NHS.  Moving stories.  And it really was all about sharing.  It really isn’t worth trying to hide good ideas.  They need to be stolen politely, then put into action.  That for me is what The Academy of Fab NHS concept is all about.

It was a session that felt, to my mind, all about feelings.  If we can’t have seriously deep feelings within the NHS, where can we expect the joy of emotion to rear its head?  Because emotion and passion and engagement and commitment and vocation are central to what everyone does.  Including, those like me, who are not employees, but users and helpers in the service.

I sat next to someone who I’d never met, like you always do at these events. And she was so passionate about a lot of things.  Let me share.

Firstly, we chatted about the gender pay gap.  And a bloke (not me) said how difficult it was to say anything at all about the subject or his views, without it becoming or at least sounding, a bit condescending.  I totally agreed. As did my neighbour.  And she went on to say how there wasn’t a pay gap based on gender in the NHS.  The system and procedures meant there were pay scales for the level of job you were doing.  Regardless of sex.  Yes, historically more men (currently) were in some of the higher paid jobs.  But this was consistently being diluted over time.

She was a Physio. Never wanted to be a nurse, even though that was the way you were pushed at school.  No one seems to know that there are about 400 different job roles and career pathways within the NHS.  Regardless of sex. Fascinating insights.  And as always happens at emotionally powerful events, we got seriously into deep and meaningful conversations.  Fab stuff.

It just got better and better. The stage acts were fabulously evocative of the theme for the event – 1948 and rationing (corned beef sarnie for our lunch.,!). What with a stunningly mad hula-hooper, who called herself Annie Bevan, daughter of Nye, just for the day. To the gentleman juggler, to the off the wall magician (who I assume was paid the same as the male performers)!

The 1948 theme continued…

And superb, evocative singers…The Femmes.

And in between we had the awards – and as ever, all who had been nominated, or even entered, were totally the winners too.

Let me just give you the background story behind how each of the awards got their title.

Rosa Parks – For a team brave enough to reject modern conformity

Four Candles – For people who have listened and responded to feedback – not like Ronnie Corbett!

5127 – As fiercely determined and just refusing to compromise as James Dyson did with 5127 prototypes

TNT – for Tiny, Noticeable things – a touch, a smile – a small act of caring having an explosive effect

Mary Poppins – Chosen by children and young people

Hartley Larkin – Just getting done what needs to be done (Like Hartley did to get the launching gate widened the night before the HMS Victory was launched, off his own bat)

Penguin Award – Not jut one person – The teamwork and team-ship award

Fab Change 70: Individual, and Organisation. – especially for the anniversary. The awards were for energy, leadership and vision.  Ideas into Action

Picalilley Award – Every week Roy Lilley and Terri Porrett chose an idea that particularly resonates with them.  This award was for their overall favourite of the year.

We also had two special additional awards from Roy Lilley himself, for people who had specifically oiled the wheels for him and the Fab NHS team.

The great and good were there to join in the thanks.  Simon Stephens, Dr Phil Hammond, Ed Smith, Professor Jane Cummings.  And that was just the people I came across – there were probably many more…

Here’s the link to see who were the category winners.  But let’s keep this very simple.  Everyone there felt like they’d won.  Whether they were a nominee or not.

My sister has a wonderful expression for how I felt at various times during the proceedings.  “It’s a happy-hankie moment”.  Thanks sis. You are absolutely spot on.

You can’t bottle it.  But you can imbibe the atmosphere.  And just draw on the positivity and absolute love in the room.

If you couldn’t be there, well at least know how amazing it was.  80% of the attendees and awards winners were female.

It was lovely and powerful and smiley and solidly positive.  No, it will never get on the news.  It’s not negative enough.

But get this.  When all around you may feel like it’s falling apart, these awards really made you realise that they aren’t.

We still have each other. And we still have our NHS.

(And I haven’t even mentioned Dr Phil Hammond’s linking of men’s facial features and the appearance of their scrotum…you had to be there…)

Thanks to Roy Lilley, Terri Porrett and Jon Wilks as well as all the sponsors.  None of this can happen without you.  And certainly none of it would need to happen without the amazing number of truly fabulous ideas being put into action every day in and around the NHS.

Farewell Old Billingsgate Market…




Ali Parsa CEO Babylon

NHS Health Chat. Roy Lilley in conversation with a disruptive intellectual futuristic optimistic entrepreneur.

Ali and Roy

Ali Parsa and Roy Lilley – all smiles…

I wasn’t able to be there in person, but managed to view the recording on Catch Up via the NHS managers .net site (click here to patch through) Roy’s e newsletter. It is worth taking the time out. This is my take. And you could feel the excitement and energy in the room – I do wish I’d been there, but it’s not a bad second string to watch the recording ‘as live’.

I’d like to start at the end. What is Babylon? Take a look here

It offers GP consultations on your phone, in many parts of the world, and in London currently. Oh, and Rwanda – one of the poorest countries in the world. Artificial Intelligence based, the algorithm actively learns. If it makes a mistake, it’s the last time it does so. It will refer the same way a GP does, to NHS, private, or just advising. The A.I algorithm scored 81% on the GP entrance exam. The consultation (face to face, on your phone, after the initial A.I. questioning), means the consulting GP has a lot of information at their finger tips to make the consultation more efficient and effective straight away. And 1 in 10 patients does require a physical examination after the consultation, and the system makes that happen too.

Problems? Well, as Ali said, if you are getting an excellent service already from your own GP you wouldn’t sign up for the Babylon service. But many commuters, for example, might leave for the train before their surgery opens, and arrive home after it has closed. And you might wait 2 weeks for an appointment. 1 to 2 hours was the normal waiting time, and it is available 24/7.

Other problems? Just guessing there might be some vested interests from CCGs, to CQC to BMA to Royal College of GPs – as well as a lot of GPs thinking – OMG…we could lose a lot to this!

Ali audience

Rapt audience

And this all feels very natural to me. It is disruptive technology. But the reality is we are 5 million doctors short worldwide. General Practice can still be the gatekeepers.  I cannot see why these two physical and technological ways of accessing help cannot work seamlessly together? Ali offered the service to a London GP who attended the chat, for £1 per patient per year. I think this meant to work alongside the normal GP service, but the devil will be in that detail?

He also said how the UK would be a small part of Babylon Health Global. So if we stop it or ignore it or don’t work out a way of it all working together, we may find we create Bell Communications, as the originator of the telephone, Alexander Graham Bell had to when the UK resisted his invention for 7 years, but then he gave up and sold it in America instead.  And remember we pushed Freddie Laker out of cheap airline flights business, with the vested interests squeezing him into bankruptcy. We wouldn’t have FlyBe and the rest without that pioneering spirit.

So, I was enticed and could see the potential, and also could see the arguments against – and why resistance is likely in the UK. Is it very different from GP@hand? (Click again, for their website). I don’t know, but would love to know more! But that has the babylon name attached to it – so is it the same service??  I feel I have more questions than answers…but I think it may be a competitor service??

Fascinating backstory: Iranian refugee. Arrived in England with no English at 16, having walked to freedom in Germany,and then on to UK. Taught himself English, then did GCSE and A levels in record time to get into Cambridge. Engineering degree and PhD (a proper Doc…) in Flow (you’ll have to watch, as I didn’t understand this part..) At 16 managed on handouts and scholarships though University and started his first company whilst doing his PhD research. Total entrepreneur (just listen to the story, and also the warmth of the applause at many stages from the audience – some of whom represented some powerful vested interests, I’m sure). He became an investment banker after his first business was sold, because they seemed to take a healthy slice of the sale. He found that work great for money, but not for him. Very long hours, and he didn’t love what he did. “I was freed by my daughter. 2 weeks paternity leave – and I didn’t return.”

Took an e learning company, had the technology platform, and content from BBC, and a box shifting company, but no engineers.  Offered to buy a company, the owner got greedy and asked for 50% more so he said no, but next day caught workers on the way in to the office with a new contract offering them 25% more. Asked them to turn up that evening at a local pub and signed many of them up, including the CEO….yes, an entrepreneur…a bit ruthless in pursuit of the goal. But always honest direct and open. You would always know where you stood.

And then we got on to Hinchingbroke. The third Cambridge hospital, when probably the local health economy needed two? His first venture into health was a private hospital, and it won awards for hospitality! It was designed by Richard Rogers and Foster. Research has shown people recover more quickly in pleasant surroundings, but when a local hospital spends money on carpets or fantastic public art, they are usually turned over by the local press quite spectacularly. Anyway, “bit of a disaster, that Hinchingbroke fiasco….they gave the keys back half way through and lost, what -about £5 million”. Now, said Ali. “It was doing phenomenally well whilst I was there”. He left Circle during the tenure. They used to have loads of staff involvement (engagement is what it’s called now…). Like Town Hall meetings. The staff were involved in the plan to turn £10 million overspend on £100 million budget into at least breaking even. Of course, there needed to be staff reductions, as 70% of NHS costs are staffing. And they managed the volunteers out happily. Then staff helped with the business planning.  Just 4 questions:

  1. Where do we need to be in 2 years?
  2. What do we need to do to become amazing?
  3. What are the barriers to the first two questions?
  4. How should we overcome them?

Sounds simple? 1100 involved people replied! Out of 1400 staff. Wow.

2 years after Ali left, it sounds like the place reverted to type? No Town Hall meetings, for example. Suddenly, £2m debt. Circle paid £5m to hand back the contract.

It is also possible the other local hospitals, the other vested interests and more decided to squeeze the upstart in case it became a success? I’m not sure – conspiracy is easy to promulgate.

The audience were incredibly warm to Ali. Watch the whole thing here, and see if you agree with me? There was much laughter and a lot of applause during the session, not just at the end.

I think Ali Parsa wants Babylon to work in partnership with General Practice in the UK. I fear that there are far too many players who don’t want the idea to work, yet. That’s a bigger fight than convincing a certain cohort of patients that it might work for them.

Ali demo

Demo of the latest Babylon system

I just hope we don’t have another Alexander Graham Bell or Freddie Laker case study in the making here.  “The doctor will see you now”,  is certainly possible if they can start in a virtual sense, just to make life far more efficient. 1 in 10 or 2 in 10 might need to be seen to be safe – but hey, waiting a fortnight for an appointment might be endangering some patients, mightn’t it?