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.

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.

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…

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

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 www.babylonhealth.com

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!

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.

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?

Ok. I could have titled this “International Healthcare Comparisons”, which is the title of this NHS Health chat for goodness sake. But no. You maybe would be less likely to click through. That’s where we got though…

Let’s start at the end. I’ll explain who later. But you should listen to these people. They do have experience…and know many tens of other countries health care systems…

3 Stools…

So, asked Roy Lilley, to both Mark Britnell and Sir David Nicholson, where would you prefer to die?

“Here”

“Yes, here”.

End of blog.

3 Stools filled! Sir David Nicholson, Mark Britnell and Roy Lilley

But, there is more. Much more than I could note. Having two experts who both love to expound meant, as a non journalist I couldn’t keep up! If you feel the same, click this link to watch the whole 9 yards. Jeepers, it is worth your time…

click here to view the excitement…

This was a break in tradition. I’ve seen Roy Lilley run many a panel discussion. And many a one to one interview, where we got the willing participants back story to understand how they had ended up in their senior position. This was totally different. No back story, because they had been eviscerated before. We just wanted their expertise. And boy, did we get it.

“Are International comparisons useless?”. Thanks Roy. Gets them onside that does….so he dug his hole deeper:

“Not worth doing? Not comparing like for like?”

There was more digging. But Sir David Nicholson, and Mark Britnell respectfully disagreed. Agreed that comparisons are difficult because no one gathers the data in anywhere near the same way. There are problems, yes. No one wants to be compared. Unless they of course want to use the info, often naturally enough, only the parts that serve their cause. (So stats don’t lie so much as we try to lie with statistics.  Be careful who you lie with, I suggest)

There is so much to argue over. Do we measure systems or outcomes? End points or production inputs? Productivity or efficiency? Doctoral theses originate in this sort of one liner…

There were some hugely positive spins, a bit like the last words above. David works a lot in Africa and Asia. Their systems and workers and population were inspired by the NHS. (Daily Mail and Fox News – please note). The audacity of the premise of instantly everyone in the population was involved in being under a NHS, and that,  “The rich support the poor” (quite the opposite of our Lottery), was felt to be both groundbreaking – and aspirational.

There were lots of comparisons floated. The NHS was described by Mark as universally respected but not always envied. I would have liked to know more. I did ask at the end if he feared for the future of the NHS in England…as he often quoted England, not UK. His answer was enlightening, in saying absolutely not, and agreeing with that it did have a future, thank goodness!

Some of the highlight comments then came thick and very fast, so much so that you may have to watch in case I misquote.

1. League tables are difficult comparators, and everyone can pick and mix to suit
2. A smaller arms around number in a population makes life easier from data collection and data sharing. About 5 million suits well for arms around (guess what – same as most Scandinavia and Nordic countries…who make the best use of population data (apart from Israel and Singapore)
3. UK could have an integrated care model. Split the country into 10 sections to make 6 million in each? Oooo, maybe that will be happening?
4. Money input and investment has been flatlining. More Doctors Nurses and more money does lead to better results
5. The problem with austerity underfunding is the effect is cumulative. So we have less to invest in breakthrough management and strategic change. Less AI, less robotics less bots fewer changes to sharing our own data (even though it is ours),

So what about the potential for the future? If we (rightly in my view) assume that there is not a lot more we can squeeze from an over pressed workforce who are now too tired to scratch…what do we do?

Here’s what I formulated from their ideas:

1. If we want to curtail the $124bn pa spent on healthcare consultancy projects, we need to invest in making the managers better (and as turkeys don’t vote for Christmas, I guess we cannot expect the consultancy forms to suggest this…may I suggest the NHS dos it themselves using smaller training organisations alongside their own colleges and colleagues?)
2. We need to get past unyielding national targets, and get the front end staff to devise their own measures, and have them both aspire and live and die by them. Don’t impose from above
3. Foster greater competitive tension internally. Not market driven, as it demonstrably doesn’t work, but pride in the work, Fab NHS ambassador winners, role models. Get away from trench fodder mentality.
4. Austerity has at least fostered innovation. But we need to both be led well, and to let the front line continue to fix stuff.  And forget top down target setting and hitting – it just wastes everyone’s innovative zeal.
5. Maybe pay management bonuses on staff retention rates, and never on output targets?
6. Protect whistleblowers; reduce political interference; invest in technology and AI and IT – but only on the 6 million cohort level
7. If you haven’t got a digital strategy, you haven’t got a strategy. Oooh, thanks Mark!

One of the panel said “just lets be kinder to each other. Look for what we do best, not worst. Remember investing in health makes a country wealthy.”

Why don’t we get that, still?

Great evening. Thanks Roy and Sir David and Mark.

Fab.

The Integrated Care Expo was organised and run by The Institute of Healthcare Management.  Ably partnered by 2020 Health, and sponsored by Novartis. It sounds like the organisers were already living the integration dream! It was a very full session, with thought leading punchy presentations from real hands on practitioners, and then the speakers left it to us to pull some actions from their erudition. Phew. All to be put together as a report to add to the governments Green Paper on the future of social care. And it was fab.

Why? Well, there was more than a slight dose of the complex reality that we are dealing with. Money, silo mentality, means tested care and free at the point of care…it went on.

There are myriad vested interests, and a level of overlap between all of the areas we were presented with (from Primary Care to private provision to home care to mental health to workforce support to targets) just served to prove how impossible it is to consider one without the other. The level of overlap meant our workshops all came up with overlapping proposals. I do hope Ricahrd Vize, the highly respected Guardian columnist will be able to pull the disparate strands together. Nothing he hasn’t seen before, I don’t think.

What felt good was being in a room with like-minded people who really want to make things happen. We have all had an input into a government discussion paper. And there were loads of great ideas, including scrapping all of the inspection bodies. And a windfall tax on the social media companies to be ring fenced to spend on youth mental health (as they are probably part of the problem?)

Thank you IHM, and partners and sponsors. I felt listened to.  Amongst friends. And had a voice inputting into future policy.  More specific than voting! What’s not to love?

Thanks to Roy Lilley and Team from the IHM for chairing, cajoling and forcing us to think hard…

Some of the speakers at the Expo…

“Dame Ruth Carnall has over 30 years’ experience in health care, including 20 years as a chief executive in acute hospitals, mental health, community services and health authorities. She spent seven years in charge of the NHS in London as Chief Executive of NHS London and now works providing strategic advice to leaders in health care.”

That’s what you will find if you google her, and read her bio on The King’s Fund Web Site.  As ever in the studied intimacy that is an in-depth 90 minutes chatting with Roy Lilley, he does unearth much more.

Roy Lilley’s first health chat guest was indeed the brave and innovative Ruth Carnall.  5 years later, she returned.  There had been many other guests in-between.  And I am sure there will be many a returner now that Ruth has paved the way – again.

I wasn’t able to be at The Kings Fund for the meeting, but caught up via NHS Managers You Tube channel which you can do yourself by clicking here.  It is worth the time.  The comments as live at the time on Twitter were summarised as “Common sense and a deep determination, from a normal human being telling it how it is – bold but modest”.  Go look, and join the 7000 who have done so already.

Let’s get back to the late 1970’s. There were very few female directors in any businesses at the time, and even fewer in her chosen specialism – finance – and even fewer in the Health Service. It does appear to have improved over the last 40 years, but maybe not at a startling pace.  First day back from Maternity leave, she discovered the Chief Exec had been removed, and she was to be acting Chief Exec from that day. Brought son to work, because they had a workplace nursery at the hospital.  Lots of discussion about why this wasn’t common practice still.  As Ruth said, it made money.  And with a predominantly female workforce in the health service, wouldn’t it make a lot of practical sense?  40 000 nursing vacancies should give us a feel that something simple but radical could help? Roy had one when he was a Chief Exec…it seems a non brainer to me?

Ruth started in London, trainee in finance department at Mary’s , then onto St Thomas’s. Even in 1979, when the accounts were still handwritten and ledger driven, Tommy’s already had Speciality Coding with clinician involvement.  It was paper driven, very labour intensive, but worked.  The culture shock was moving out to Hastings, which wasn’t quite at that level of sophistication.  Resigned from there because they wouldn’t allow a Chief Exec to be involved in a job share. Applied for a job in SE Thames which was a 2/3 day split job share.  Big positives are you get two for the price of one, with the best of two different approaches. Avoided London whilst kids were young, because of the commuting and longer hours expectation of networking and the like.  Roy did discuss this balancing act of work life and family and work with Ruth.  It was interesting that this often happens with a female in the chair at a health chat, and I have never witnessed that with a male interviewee.  Do I just need to get over it?  Like Ruth did with her opposition to a nanny when she had two small children, for fear of delegating the mothering part of her life? She realised it was her who had to get over it.  A leadership decision if ever there was one…we will come back to resilience tips later.

London beckoned after East Kent when the nanny offered to leave as the children could cope now they were over 12.  The big stuff in changing the way London acute health care worked happened now. Working with Lord Darzi, the evidence based changes centred on centralising genuinely acute care.  The Stroke initiative in London personifies the approach.  As Roy said, the thinking is based around starting with the patient and working backwards. Had a stroke? You used to be taken to one of 33 centres, who were generalists.  Now, there are 8 Hyper Acute Stroke Centres. Geographically optimised to minimise ambulance hold ups. Para medics trained to diagnose and take the patient straight to the specialist centres.  And outcomes are hugely improved.  The mapping caused the first hurdle as one of the best performing potential units was Tommy’s, and the leading Stroke consultant there was naturally not convinced.  Dr Tony Rudd though changed from that to becoming an advocate through evidence based argument.

That’s one example, and it is the special case (to me) that is London. It has been rolled out in some other metropolitan areas, like Manchester, Birmingham and other cities. But centralisation wouldn’t work in some parts of Devon.  Ruth gave the example of Barnstaple, where perhaps having a stroke centre would make specialisation excellence sense, but it wouldn’t geographically, because having a 65 minute ambulance journey would lead to worse outcomes.  Evidence based, horses for courses.

Andrew Lansley was brought up in this health chat, yet again. A lot of these initiatives were harder to do as Lansley thought all would be improved with having a market mentality. (I am sure the likes of North East coast railway and Carilion may make us decide differently in future?). Ruth and the team managed to get it through (but it is teeth grindingly difficult in the face of politics and the hoops to jump through to get anything past the anti change audits and form filling).  Memorable phrase from Roy: “We are at last scraping the final bits of Lansley reforms off our boots”.

Another fascinating section was Ruth’s top 10 tips for improving Resilience.  She wrote it originally 30 years before.  It was mentioned on Roy’s e newsletter, and had 2000 downloads.  Ruth found that a little depressing.  Why does it still resonate so much now? When will we move on? There is still prejudice in the workplace.  It is still hard to get the balance between job and kids sorted.  There is more pressure than ever.  What with Social and other media, and the loneliness at the top and  the lack of support.  20 % of chief execs in hospitals are currently interim appointments.  The most successful places have a long-term incumbent.

Another area? Merging Health and Social Care.  Roy has changed his mind, and thinks they have to remain separate, because one is free at the point of delivery, and one is means tested.  Ruth agreed with that, but thinks a merger has to happen, and we just need to think differently about the means testing. A debate for the future…

She was sensibly proud of the Stroke initiative.  And Leadership Development for Junior Doctors (some classroom, but main learning from being assigned to a mentor Chief Exec, and learning by osmosis).  This worked both ways, as you as a Chief Exec heard from the front line how your decisions affected outcomes, affected individual patients.

There was more…click here to go watch if you have the time.  I loved it. It really is a worthwile lesson in doing, not just talking about it.

Professor Jane Cummings is the Chief Nursing Officer for England and Executive Director at NHS England.  OK – that’s the NHS England web site piece – but what did she say to Roy Lilley in the NHS Health Chat at The Kings Fund?  read on for my personal take…

Ready to roll!

It’s always interesting to attend one of these Roy Lilley Health Chats. You do meet a lot of interesting folk, chatting before and after. I honed in on one of the post chat questioners, who asked the final killer question “55% of nurses don’t work in the NHS even though nearly all were trained by the NHS. They feel disenfranchised and don’t know who their leader is, even though, in England, it is you.”  What are you going to do about that, was the gist of the rest of the question. So I asked the questioner more. Who are they?

I’d assumed private, nursing homes, social care, and fringe stuff like tattoo parlours, school nurses and sports and stuff. But it also includes nurses in General Practice – because they are private businesses  and are employed by the practice itself.

Can you already see how complex this is?  Would you have thought that?

Jane wanted to be a nurse early on, when practicing bandaging on her long suffering brother. Lost the urge, but then regained as a teenager seeing what happened in such a positive way when her mum was in and out of hospital when Jane was a teenager.  A&E Sister at 24. Clinical Nurse Specialist at 27. This is where she honed the Art and Science of nursing – and started to manage people and process. Roy was asking about why move from the vocation to being a manager. I think she had proved how that question was irrelevant. And she also still did, and does a shift on occasions. Management by Walking About? Or Motivating Others By Doing It? MOBDI – my new acronym!  Getting your hands dirty is always going to both play well, and give you so much useful pulse level information. I love that.

After transitioning into General Management Jane then moved into the Department of Health. After her own personal trauma of losing her husband to Lymphoblastic Leukaemia, whilst working on the 4 hour max wait target, she wanted to get back into NHS work proper. Chief Nursing Officer for the North of England. Then this current place. She did indeed seem destined for it!

Having worked on trying to hit a target (98% of patients will be seen within 4 hours of arriving at A&E) Jane agreed with Roy that sometimes, “you can hit the target but miss the point”.

And after that, we traded numbers!

More nurses and midwives, to make sure that more doctors could actually do what they were employed for. But, still a huge shortfall 36000 to 40000. That is offset by 31 to 32000 bank and agency staff – some of whom may be local staff supplementing their austerity capped wage?

Retention was a big problem and not just in older staff. This occurs just as much in first year post graduation. So there are schemes designed to help such as mentoring preceptorships and more. There are many beacons of excellence – Sheffield was mentioned. (And many others…)

Flexibility seemed to be the key here. Some nurses loved the 12 hour shifts. Some really didn’t want that. Sheffield seemed to accommodate so well they had a waiting list of applicants! I have always believed in stealing ideas with pride. Forget not invented here….just nick it and use it. That’s what the FabNHS website is for…as well as looking locally. (Click to visit)

Technology will help. Jane herself had Skype and data upload interactions with her own doctors and nurses (sorry…can you imagine the Chief Nursing Officer making an appointment to see you? Oh heck!). And there will and should be much more of that.

Our protagonists did agree the non-rocket science answers, based around Compassionate Caring, were indeed simple to state.

• workforce planning, with flexibility built in tune with staff needs
• Being a good employer
• Have great ideas like Retire and Return schemes
• As well as mentoring for newly qualified
• As well as apprenticeships for those nurses who prefer practical to straight academic I assume? (Already being successful, I am informed)
• Patients are not the most important thing here. Staff are. Get the staff right, feeling good, doing the right thing, and the patients are cared for stupendously.

If we get the duty of care right for our workforce, we will serve our patients best.

Amen to that – thanks Jane and Roy.

All we have to do now is just do it…

Baroness Harding

Dido Harding was different from almost all of the Roy Lilley guests I have witnessed over the last 4 years or so. If you have read any of my up sums of the events, you will see a theme of home grown talent, completely immersed in an often quite varied but mainly NHS job trajectory. Dido Harding had been at NHSI for a few months!  So, her back story is even more pertinent perhaps? And why has she jumped into the maelstrom that is the NHS…all her friends and colleagues suggested that she shouldn’t do it.

All smiles, sponsors and all, before (and after!)

From a military family, born in Germany, brought up on a pig farm in Dorset. Granddad was a Desert Rat. Actually, a Field Marshall).  Here’s the first quote, this from Granddad, who she loved deeply (emotion and touchy feels stuff will figure highly in this report).
“You can’t be brave unless you are afraid”.
Granddad taught her that it’s ok to be afraid.
Catholic Convent in Dorset, followed by McKinsey (one of the big 6 consultancy firms then). They do suffer from a bad reputation, but Dido talked up the objective view from outside, the bought in skills that you may not have in your teams, and that ability to take a helicopter view of the leadership and culture in the organisation. She agreed with Roy that the consultants are as good as their clients. The problem is, I suppose, that if you knew exactly how to brief them specifically about the current set of problems that you are faced with, then you probably wouldn’t need them in the first place! In 25 years in business, she has used external consultants 10 times.  She was sponsored through her MBA at Harvard by McKinsey and also gained a scholarship. Quid pro quo meant returning to McKinsey afterwards. She felt too young at 22. Not enough real world experience. The MBA at the very least gave her grounding in pattern recognition. Which should stand her in good stead in her new NHS role.

A recurring theme surfaced in her career path. “I wanted to put my head on the chopping block”. The path went from Thomas Cook (squeezed by competitors because they only had travel agencies, and not planes and hotels), but “learnt the value of price”. Then at Tesco’s reporting to Sir Trevor Leahy, Chief Exec. No.2 to Sainsbury at the time, and a bit of a scared number two. Changed during her period there. Ruthless efficiency. Sometime at Woolworth as Commercial director – and realising she couldn’t answer the fundamental question as to “why was it there?”. Then potential being head hunted and moving to Sainsbury after being at Tesco? Her ex colleagues didn’t speak to her for some time! Sainsbury was nice, Tesco ruthlessly efficient. “You can be both”. Well said! She thought Tesco had its stumble because of the way it treated people.

MP husband, a 1 year old and pregnant, and suffering the usual balancing act that falls mainly into women’s laps. “I learnt a lot from the women around me on the staff who had children but had it much harder – either single parent, or very tight budgets and more”.  She is a soft skills stalwart and active practitioner.

“To be an effective leader, you have to be who you really are. You cannot do it if you are trying to be someone else”.

And didn’t that come to fruition when she had the the horrible experience of being Chief Exec of Talk Talk when they had the first major data breach in the UK. Web site ran slowly; Emergency call. Enacted the contingency plan; realised it was a real attack; sales team devastated because they couldn’t add orders! Then, anonymous e mail with attachment of customer data. I can’t imagine how that level of violation, followed by black mail threat, really felt. Loads of expertise, from GCHQ to BAe systems. “The breach could be a very few people, or 30 million e mail addresses”. Jeepers! Because they didn’t know what had been taken, they – mainly Dido Harding herself, I suspect – decided to tell the customers and to mainly be aware of people phoning and pretending to be Talk Talk. So, she did the people stuff again, first and foremost. Including looking after her own staff. They made mistakes, for sure. But protecting customers by warning them, and keeping staff in the loop through personal blogs (which she did 3 to 4 times a day instead of 1 per week), and then offering a free upgrade to all customers after the dust settled, which all served to save the business. After the crisis, the National Cyber Security centre was set up – “my little gift to the UK”. (The other was her team being involved in creating screw topped wine bottles. History will record which was felt the greatest achievement…). Talk Talk was better for the horrendous experience. They stopped being complacent, and turned to being a challenger for change.

Now? Well NHS Improvement and NHS England cannot become one organisation, legally. (However much Roy and others press for its logic). But they are having some joint cross Board appointments. They are learning to trust each other to get on with their part. To share things, so they only do something once. And to challenge the system. As well as making sure the Secretary of State doesn’t micro manage her.

One rejoinder to Roy Lilley, which I particularly enjoyed, was about looking forward not backwards. This raised a bit of a cheer.

She owns a horse, who is now 30, and cost £7000. But still Cool Dawn won the Cheltenham Gold Cup back in the day. She was an amateur jockey for 20 years too.

So, currently not hugely experienced in NHS, but diversely experienced as you have read. I think her lack of NHS tainting will actively be an asset. Coupled with a fearless practical intellect, and an overarching belief that getting the people parts right has to be first and foremost and the main driver of the way she leads, then NHSI, and the health service and social care as a whole, is in for an exciting time. Her level of humanity and engagement just shone through. Fabulous!

(If you wish to watch the Health Chat click here…)

Yes, of course it’s water…Roy and Shirley settle in

I needed to look Shirley up after hearing her speak and before writing about her. Her NHS Health Chat at The Kings Fund in London, was so wide ranging that at the end I was confused about what she actually does…

Shirley Cramer, Public’s Health guru. Well, that’s how she came over! Luckily, her main job is Chief Exec of The Royal Society for Public Health, the oldest Public Health organisation in the world (161 years old).  And she gets involved in a lot of other things too – see later.
As ever, my views prevail here as the writer, but you can watch the podcasts (4 segments, easy to digest), to see if you agree with my take or not…click on the links below:

Section 1           Section 2           Section 3            Section 4

or the whole thing:  CLICK HERE

It is often the chatees (interviewee is the right word, but doesn’t fit Roy’s avuncular evisceration technique) – the chatees back story that informs why they have ended up in that chair right now. Shirley’s was more varied than normal.
17 year old girls from the unfashionable coast of West Cumbria don’t do their last year of school in Colombia in USA? Billeted with a family and schooled in a very different environment and style of schooling – she did a 7 page essay when everyone else did a paragraph or two, about a book – is a bit of a full on 24/7 learning experience. She just remembers it as a big adventure, but feeling homesick for first 3 months…

Went to uni after A levels. Applied Social Studies – 4 year course and come out as fully qualified Social Worker. 22 year old, in the Emergency team, even sectioning people in ambulances…

Married, husbands job goes to USA, so couldn’t work herself, as no permit. Masters in 13 months at private univ. Left in 86, and went voluntary, learnt about fund raising. East Side, NYC. Tough, I imagine…

Back in UK – involved in Muscular Dystrophy – already managing…

Back to New York City. (Tired yet?). Voluntary sector again. Learning Disability. Set up a Washington office. And was told to be bi-partisan, as she was issues based. Managed to befriend both sides, which stood them in good stead. Clinton 1 administration at the time. Worked. Televised Summit – “No child shall be left behind”.

A book fell out of this – still available – “Learning Disabilities – Lifelong Issues”. Click to see..

So why all this history? Everything that Roy Lilley and Shirley talked about afterwards was completely built on the foundations of that history. I’m not sure I have listened to anyone who has convinced me completely that they have learnt from every scrap of their experience. That’s what felt powerful tonight…

The Royal Society for Public Health is the oldest of its type in the world -as I said before. Abroad, it is talked of reverentially. Roy batted that back with the he rejoinder that Public Health had failed.

We did have a lot of talk about the reports they publish. Interesting, they are both fact based at the start, but also add in public opinion of those facts to find out if change is plausible and possible?

The discussion ranged wide – as wide as The Public’s Health remit is. Smoking? Tony Blair given plaudits for it. Sugar tax? £430 m – already taken, and has been allocated to schools specifically for fitness and outdoor kit. It’s probably only £20 000 per school, but it’s money they wouldn’t have and they can’t spend it on anything but sports stuff. Will it prevent childhood obesity? Maybe a step in the right direction?

There are pockets of excellence to copy. Portugal making possession of drugs for personal use legal. Crime and death rates have dropped. Scandinavia has the infrastructure (and smaller populations, I contend) to manage poverty well. There is also a positive attitude to ‘herd immunity’ everyone gets their kids immunised, to protect next door. We do it for our own.

There have been som excellent nudges in the right direction (report on high streets and poor areas having the worst range of shops).
I liked Shirley’s “evidence alone is never enough”. Her attitude also adds in public opinion. It gives the facts nudge worthiness…

I think though I tend to side with Roy.  Once we have the pointers from pressure groups such as RSPH, then Brits need legislation (Crash helmets; Smoking; Speed limits).  If you visit Scandinavia, you will note that (e.g.) the Danes don’t venture forth to cross a road until the little green man says so.  Brits ignore that, and get tutted at.  We are essentially a little bit rebellious, and don’t like to be told what to do.  But if it’s law, we do tend to do it right.  But we need to be pointed in the right direction first, and bodies like RSPH can do that very effectively.

Despite being in the widest job brief I can imagine, she also gets involved in other charities and groups. It seems she may not know the detail or the specifics, but that doesn’t matter – she has great people around her. And she is very good at leading and motivating a team. A vision person, I think.

Her one wish? Politicians to become more engaged and brave.

If that happens, maybe we could slowly move from a sickness based service to a Public’s Health service, with the NHS there for the fewer sick?

It’s a thought…