Alwen Williams Chief Exec Barts NHS Trust

Alwen Williams

Alwen Williams, CEO, Barts Trust.

The last NHS chat with young Roy Lilley of 2017. And what a fine send off the year had.

Alwen is patently well suited to her role, and has most definitely inspired me. She was calmness personified under the usual Lilley onslaught of contentious questioning. I especially enjoyed her almost complete blanking of “so what does a Chief executive actually do?”. Ignore impertinent questions! Not a bad start…

37 years in NHS. Barts trust will be her last job, she said. Lived in East London all her life; honoured to be involved in making the most important local employer better.  Been through all the “reforms” from Griffiths, to Lansley, to Austerity. After languages at uni, decided it wasn’t for her.  Looked for management training scheme, and found the NHS one suited. Been in operational management for a lot of her time in the NHS.  Her first contentious statement. Which I totally agreed with, (as did Roy…Christmas love-in?), was when she said most of the reforms only created change at the margin.  So all that messing about, like getting rid of RHAs, competitive tendering, FPC becoming FHSAs morphing into PCTs then CCGs , with a soupçon of fund holding…only had effects at the margins.  And I bet 5% of the budget went on management consultants fees to try to explain to everyone what was going on! It doesn’t really work…

In NE London and The City, she was there when 7 PCTs were amalgamated, and she was the overarching boss. Sorry, accountable officer. It was a bit easier to be strategic, when at least the NHS boundaries were co-terminus with the local authorities…

“Having an Internal Market is not the panacea for service improvement”. Alwen quietly kept hitting us between the eyes like that. I guess her teams know this already.  Not a quiet assassin. Just a highly committed people person.

Roy asked her more about what she did and how she did it.  Deep seated core values just flooded out. Here’s a flavour:

  • They have 200 leaders in their trust. These can be Chief Execs or Porters. All equally important.
  • The leaders need to define the needs of the organisation, then make that happen.
  • There has to be continuity of purpose, and everyone needs to know it, live it and share it
  • “I make sure I have great people around me” It is simple isn’t it?  Simple to say, but hard to keep doing…
  • You need to pay attention to what staff are saying, and act on it
  • If you espouse Safe and Compassionate as your core reason for being, you have to recognise it, do it, support it, laud it, praise it and kick out those who can’t or won’t do it! (I added the past bit. always is too polite to say that!)
  • You have to nurture and develop people. Not command and control. No Ivory Tower.
  • Everyone is respected. There is no hierarchy espoused. Everyone is as important as each other.
  • Leaders set the direction

In the end, it was all about engaging the staff.  Operational imperatives emphasised this, for me. Like the following:

  • Make joint appointments so that the prestige St Barts post also had sessions in difficult to recruit parts in their area.
  • Whistle blowing – encouraged and protected ( and I assume vindictive claims equally stamped on?)
  • Have a great Occupational Development team, to make sure the big conversations happen.
  • Move away from Agency cover to home grown Bank cover. (Please, steal this idea, everyone…)
  • Huddles – for specific communication purposes. Like, Safety: or Cyber Attack coordination (which she says she never wants to live through again…which is very understandable.)
  • Take your services to the people…don’t make them travel miles to you if they are ill, infirm or very worried.

16000 staff and  2.2 million people covered in the area. It feels big.  It feels very accountable.

It feels in good hands. Calm and effective.

Gives you a bit of confidence, and a lot of pride, yet again, in the standard of leadership we witness within the NHS. I’m smiling whilst writing.  There’s no need to grieve for our NHS yet.

If you missed the chat, you can view it by clicking here

Ed Smith, NHSI

Just stepped down as Chair of NHSI – after a positive marriage guidance role betwixt Monitor and NHS Trust Development Authority.  And ex captain of the Titanic (no relation – but hey, we always get someone who asks about re-arranging deck chairs when Ed is on stage…he has the decency to smile still…).

Health Chat 51 (I only know it’s the 51st because the last one was the 50th.)

Did we get anywhere near finding the answers to Health Care in the UK? Well maybe not? We expected more from this health chat more than others? Just because he has left his role? Well, a lot of people had arrived in the hope…I think

I just loved some of the themes. I do find it difficult to keep up with Ed’s train of consciousness. So maybe I haven’t noted everything!  But I hope you get the overview. Biased by Phil, of course. If you want to see the whole, to make your own view, see here.

The great thing about all the people Ed encountered in his time was simply summarised. “Desperately committed”. And they were exhausted, in the main. And had never been thanked. Just so many great people. Daft. It didn’t help that we have had to endure the Lansley legacy. Reforms that were specifically not only left out of the 2010 Tory manifesto, but we were told there would be no change whatsoever in the NHS, as too much re-organisation had been frosted on it already.  You can always tell when a politician is lying, because you can see their lips move…

How would Ed fix the NHS?  Three phases, he started with. He and Roy Lilley kept going off at tangents (Roy said and interrupted more than Humphrys, so I got a bit lost. I think, like all of us, he got a little excited…and his respect shone through).

Immediate need? Emergency level of funding. If there is a Flu epidemic (it’s overdue, and is already happening in Australia) we are up that creek without a paddle. And the biggest problem? If 10 % of staff are laid low, when we have unfilled vacancies everywhere (which is why everyone is knackered and deserve even more thanks. Just remember, these are the guys who run towards the shit hitting the fan.). So the emergency money has to fund temps. Tough. But please, get someone to negotiate this well? And if someone takes the rise, stop them being used anywhere in the NHS. Or let’s simplify stuff? If most agency nurses (for example) are NHS staff, pay them sensible overtime. It’s a lot cheaper and safer from a continuity point of view…

Second? We do need to invest money, Keynsian style, to bring down waiting lists.  OK, you do need fiscal responsibility. I do think a lot of the Brown Blair money was wasted. Setting the target as spending up to the GDP average of the EC doesn’t mean you get value for money.  We need to get back to basics, I think. Ward level budgets, real time spend on dashboards on every ward (like they do in every manufacturing company I work with, who are successful). And a sister in charge of that budget,moraines and incentivised. (Sorry. Last 5 lines were my views…back to Ed and Roy…)

There’s a maintenance backlog as well as a workforce challenge.  The estate will not be fit for purpose if we don’t fix stuff and just let it decay.

Thirdly? A need for investment in transformation. Luckily, although ere is legislation to back the Lansley reforms, the people on the ground ignore it, and just get on with doing things properly. This will need 3 to 4 billion per year over 3 to 4 years.

There is no one magic bullet…no one size fits all. There are different needs in different communities.  There are different patients with different levels of confidence in their own input into their healthcare in all parts of the kingdom.  We really need to change the mentality.

How? Ask the citizens? That’s Ed’s view (- although there was some concern that Brexit result shows what happens if you ask…). But if we start with free to use at the point of care? My view is there will still need to be rationing, and we still have to think health improvement as well as sickness fixing.  We still have to make digital work for us, and keep it simple. Maybe we all have to hold our digital record, if we want to, on a phone or a memory stick or on a personal cloud?

Primary Care is just another provider, Ed said.  But we maybe need to change the way we think about how we fund the patient interaction across the whole of health and social care? Pay for inputs by the General Practice, not an annual fee per patient. (Sorry guys – I think we either have GPs as fully small business or we have all of them salaried. This in-between level just confuses funding.)

What is the plan? He talked about when he started at NHSI, that their main aim was jet to keep the lights on.  Have we moved on? It doesn’t feel like.  Workforce planning would be OK for unskilled jobs? But most of our NHS and Social Care gaps have a 5 year lead time to fill them.  That was one of Ed’s regrets, not adds sing that earlier.  Along with not convincing politicians of the need for collaboration. On the plus side? Very proud of working with the Grim Reaper (Jim Mackey).  And to be trusted by the people he worked with.

He talked with passion about about being involved in a good, positive regulator. And of a blended ‘bricks and clicks’ style of healthcare provision, tailored to each citizens need – which will vary by citizen of course, depending on each situation they are in.  He often described what he was saying as ” romanticised “. It maybe was.  I call it passion.

He did show that passion at the end, expressing his view that Roy should Keep Going. He loved him, for representing the citizen in those e letters we all read.  And I agree.

We may have lost him from the NHS at the moment.  Ed Smiths legacy though is that he hasn’t really left. His ripples keep expanding.



Health Chat 50

“So, what is a Health Economist doing in a place like is?”.  Being chatted to by Roy Lilley of course, at The Kings Fund in London, at one of the NHS This was a landmark occasion – the 50th Health Chat. I was there for the first, and the majority in-between. And always, always have been uplifted and learnt something.

Roy & Anita Charlesowrth

Anita Charlesworth with Roy Lilley

The willing interviewee was Anita Charlesworth, Director of Research and Economics at the Health Foundation.  She is also Honorary Professor in the College of Social Sciences at the Health Service Management Centre at The University of Birmingham

Interesting Roy alluded to the first ever interviewee, Dame Ruth Carnall. He linked the fact that the 50th interviewee was another woman in a senior NHS role.  As Anita pointed out, the fact remains we are still less at than 3% of senior positions held by females.

She did hanker after going back to berate her Careers Advice teacher.  There are more possibilities  than becoming a nurse or a teacher (with nothing against those prospects, but she is right, there is more that is possible).  It just that no one told you that back then…

Gosh, it was a free ranging discussion.  We started with how and why Health Economics was her calling.  As ever, serendipity and an influential inspirational boss were the enzymes. It was the Masters in Health Economics at York that got her started.) (all the degrees, even chemistry and physics, used to be BAs at York.  I play am still rather upset that all economics degrees are BAs and MAs.  Why can’t it be a science?)

But what do Health Economists do?  Anita’s Masters dissertation gives you some idea of the questions they try to answer.  “Should every woman be screened for Breast Cancer?”  The attempt is to have science and numbers answer those sorts of question, not passion or opinion.  I suppose that sums up the raison d’etre, really?

Let’s get some of the quotes:

“We often focus on what you can measure”  (Sadly, what gets measured gets done – even if it is only measured because it is easy to do so…)

“Show me the evidence”

“If you were good, anywhere in the senior civil service, Treasury stole you”

I got the feeling that no one is leading the NHS.  No one is looking at the whole piece – old style DHSS.  Health and Social Care together.  Surely my cynical alarm can’t think the government might have sectioned off social care and community services to save money and screw up local authority budgets (so they get blamed rather than the government)? And maybe, hyper-cynically, to make the NHS wither on the vine?

I did want answers from Anita.  I wanted my cynicism to be assuaged.  I got a list of priorities, that were evidence based.

What were her priority concerns? (I liked them).

  1. New government 2015 decisions were worse than 2010 coalition.
  2. Austerity is proven not to be a good way to fix funding shortfalls
  3. We might need Keynes mentality, not Cameron / Osborne austerity continuation
  4. Investing in people’s health is worthwhile – Public Health, not Sickness is cheaper, but needs investment
  5. Tax funded health service, free at the point of use, is sustainable
  6. The model is fundamentally right
  7. Anita worried about the next few years – especially the potential for staff leaving who just throw in the towel, because they are undervalued and not engaged
  8. We might need to invest first before we gain….sorry, we need to do this, not might.
  9. It’s not worth doing investment in one specific area which might give a positive sound-bite…like more consultants…if they have no nurses to support their work. No one thinks of the whole piece

There are amazing and effective new models of care out there, and need to be out there:

  1. Sam Everington from Tower Hamlets (a previous interviewee, and very enlightening), where 93% of first contacts in NHS happen in GP land, for only 11% of the budget. It is a bargain.  And works. (Click here for more)
  2. Primary Care Home works well in areas it is being trialed (see NHS England summary here)
  3. Buurtzorg could easily be adapted to our UK funding model, and nurses would love it, and so would patients and their families. Let’s not forget that.  And suddenly, we don’t have as much delay in transfer of care.    And powerfully. (See founder Jos de Blok presentation to Kings Fund

OK everyone – you may have noticed at health chat 50 I have been more self-opinionated than normal.  But the whole NHS and Social Care arena feels like it is under attack, and that attack is not going away.  And that is not for the want of all the totally committed people who keep it rocking and rolling.  The staff.  The poor overworked and under resourced stalwarts, who get abused from all sides, and hopefully never read The Daily Mail.  Let the good people and their managers and leaders get on with it – they can keep it going.  Let’s just get the politicians out of the way. Except to sign the cheques.  And maybe agree and set some boundaries.

(Thanks to Roy Lilley – and here’s to number 100!)

(If you want to see the whole interview – it is available here )

Do Life Sciences & Pharma have a future in the UK?

A debate at Quintiles IMS,London, chaired by Roy Lilley.

And just look at the panel…

Roy Lilley (NHS Writer, broadcaster, commentator and conference speaker), chaired and cajoled

Meindert Boyson represented NICE

Chris Carrigan, patient involvement via My Data

Ben Howlett – Director of Public Policy Projects, and ex MP

Prof Keith McNeill, NHS Chief Information Officer, Ops and Info at NHS England

Mike Thompson, Chief Exec ABPI (Pharma Industry Group)

Tim Sheppard, General Manager QuintilesIMS – our hosts for the evening – thank you!

And the audience was a good cross section of patient group advocates, senior NHS folk, and high level representatives of global Pharma.

Pharmaceuticals is a big business – and personally, I do hope it continues to be successful, as I have pension interests tied up in that! £60bn turnover. £30bn exported (probably only defence is larger?). Anyway, pretty darn big.  We did really only have space for the question in the title, but with nuances around Brexit, John Bells report and a few asides to show Roy hasn’t lost his shin kicking skills. As Tim from Quintiles IMS said in his closing remarks, the shin kicking at least had been distributed equally…)

There was a lot of positivity from the panel – with Mr. Lilley providing the negative balance!

What do we think about the NHS? Here’s a feel for the opinions:

Patients love it, but good news doesn’t sell well, so we hear mainly bad.  Our Aussie prof (Keith) suggested we are excellent at beating ourselves up, and we should be proud of the level of care provided, and celebrate rather than denigrate. Tim, from the sponsors, felt it is creaking, and change, rather than evolution, might be necessary. Our ex MP reminded us that two million people more are seen in 2016 than in 2010.

What about Brexit – is it really the road to hell in a handcart? This question took us into John Bells report on the future of life science in the UK, and into Pharmaceutical Research and more. Roy was concerned this 75 page report specifically excluded pricing.  He did have more concerns – and I did too – read Roy’s critique on his e newsletter here, and look at the full John Bell report here.  It was this second question which took us all the way to wine and canapés ! OK there were many supplemental tangents and some inputs from the audience, but it does show how much people have invested in thinking about the effects it will have.  It was fascinating.  Let’s have a game of positive and negative tennis, shall we?

  1. The NHS helps to make the staying in UK decision easier. 60 million captive cohort to work with.
  2. The negative is our difficulty in sharing the data. We had one story of 30 contracts having to be drawn up to allow this to happen in one small research project.
  3. On the other hand, one of the audience talked of their local project needing only one sheet signed contract to gain consent
  4. NICE sounds like it has become very positive and cuddly, despite the chairmanship acerbic comments. 80% positive outcomes the institute that likes to say yes! They could also be recommending spending more on treatments that are more effective.  It isn’t just about saving money
  5. Not ugh MPs or people on the Clapham Omnibus really know what Life Sciences is all about, which doesn’t help the public debate
  6. Patients want to share their data, in Chris’s experience. Yes, many want safeguards, but data boundary issues are all solvable
  7. We are bad at spreading good practice.
  8. High skilled workers will continue to be allowed to immigrate
  9. But we need the lesser skilled too.

It does sound like a lot of positive things may be happening.  I was particularly heartened by the local initiatives stories. As an example, the Pharma Challenge from Christies in Manchester.  This grew out of a Vanguard group, doing what was said on the tin, and this forum manage to make things happen, and saved a lot of money. Everyone was involved motivated and they made it happen.

Unlocking the vast data store we have does not seem beyond the wit of man.  It needs to be shared and used well to inform patient outcome improvements. It has been done. It can be done more.  Care.Data 2 or the MY data patient led project need to happen quickly.  It feels like we need also to improve the speed at which Pharma research can start. It only takes 90 days in USA, and up to a year in UK. That could drive people away?

It does feel like a lot of things will focus minds with Brexit actively driving innovation through fear of the negative consequences?

Professor John Bells summary of the future of life sciences in the UK concluded, “This strategy provides a unique opportunity for the country and I hope it can be delivered effectively in the coming years”.

I think there are reasons for remaining optimistic.  The panel talked a good game.  The many local golden nuggets of good practice, already happening, gave me the most positive feeling.  We just need to keep innovating, which is what Britain and the whole Life Sciences sector has historically been good at.

Especially when under the cosh.


Winchcombe Fire and Rescue Service

Photo of Winchcombe Fire Station

Iain Robertson, Manager and Station Watch Commander, Winchcombe Fire and Rescue, managed to fit in a chat to our new Winchcombe U3A monthly meeting in August – in his very busy schedule!

So, I thought, this is one of the people who look after us.  The people who run towards when most of us will aim to run away from some of the terrible things we see in the news.

The Winchcombe Area U3A members were ready to learn more from Iain , Incident Commander in Winchcombe.

(As ever, there were loads of particular sayings and acronyms that all professions have. If you attended, you may notice that I have mis-noted some.  Iain, if so, I apologise…)

“We risk our lives to save save-able lives and save-able property”.

OK – our attention was most certainly grabbed.  We wanted to know more.  Why add “rescue” to the title? Part time firefighters? So, just volunteers, and amateur?  I wasn’t brave enough to ask these as questions, you understand, but I think similar thoughts might have passed through the minds of other audience members.

It used to be The Fire Brigade.  Remit is now much wider. Fire calls have dropped 63% in 5 years.  Road traffic accidents continue to increase.  Flooding rescues and fixing still continue to escalate.

Nowadays, the Retained Duty system Firefighters tend to be more rounded in their skill sets.  They have to do the firefighting, of course, but there are presentation skill needs, social work style inputs at safe and well visits to the vulnerable and socially isolated, defibrillator use, and more.  There seems to be much more emphasis on prevention and protection as in fixing an incident.

The trainees have exactly the same training as full time fire fighters.  3 to 4 years. Then exams.  Practical stuff after that, like use of breathing equipment, how fires develop, and a full day long assessment.  And they have a day job too.

I was most taken by Iain also talking about the effects on family life.  They have to be 5 minutes from the station, sober, and ready to leave whatever they are doing as soon as their bleep goes off.  It’s the effect on family life that seems too intense for many, I would think.  120 hours a week on call?  Wow.  Just so surprising.

Other facts that fascinated:

  1. 1800 litres of water are weighing down that truck. It will be used in 2 minutes. 2 MINUTES! Other sources from geysers to known rivers and ponds are built into local contingency planning.
  2. The firefighters have to have periodic fitness tests and pass a minimum level of strength test.
  3. The most common cause of damage and death in a fire are fire gasses, not burns
  4. The truck is ready to roll in 3 minutes from a call out
  5. It needs a minimum of 4 crew, and one has to be qualified (so Iain can be last all the time!)

Advice to us all?  It is no trouble to be called out.  “The second you think you needs us….call”.  And as a family, have a fire plan.  And it’s better if you can, to just get out.

The safe and well visits, plans for the vulnerable, prevention and protection all seem to be bearing fruit.  I suspect it is just far more logical, but with much less adrenalin! They have partnerships with GP surgery, day care centres and food banks.  There is a sensitive amount of social awareness here, and it feels like it is working well.

I’m glad they do the running towards, on our behalf.  And although currently all 11 are male, 3 of recent applicants were female.  Winchcombe Welcomes walkers, and fire women!

(Iain had to rush off after questions to do a safe and well visit. After much applause).


Claire Murdoch, with Roy Lilley

I have mentioned before what I feel links all the speakers I have ever seen at Roy Lilley’s Health Chats: it is the passion the interviewees have.  It is more than vocation, which must be where it begins, I assume. Most of those I have heard interviewed have been in and around the NHS most of their working lives. The passion is not just part of their make up, or a line on a CV.  It is the umbrella over their whole, the glue, the oil, the Raison d’etre.

Claire Murdoch

Claire Murdoch exuded it in everything she said and had done and is doing.  Even to the point of giving the Lilley a good going over! (He is only as interrupting as John Humphrys like as he is, if he likes and respects the interviewee. I think I would worry if he suddenly became nice…)

Roy, Claire and sponser Michael

Roy Claire and Sponsor Michael (Fab socks!)

I think though, I missed out on one bit. Are we over medicalising mental health? Is the model of care clinical or what? I think it dripped out later but not as a straight answer? Check out the NHS Health Chat You Tube recording here to see if you agree, and also if you agree with my opinions here.

Mental Health certainly has changed from the Asylum days (although asylum is quite a positive, cosy and protective word, just lost in negative connotations.). And in 30 years time we know that people will look at what we do now, and think ‘they did WHAT?”, like we do to our predecessors.

I got some new stock phrases that I may have to steal. “Rich and textured view”. “Peer support workers”. “Lived experience”. Like those? There were more…(I knew peer support workers, honestly.  The others felt new to me, and felt apposite.)

First question was about the impossibility of recruiting 10 000 staff by the end of the 5 year forward view. (5YFV).  Spread over 44 STPs that is only 300 each…which does sound more possible? And retaining just 1% more than today gives 6000 extra workforce anyway…

And one way to achieve that? Claire hit back at Roy’s assertion that Mental Health is hard.  “We have got to get away from that thinking – always describing the arena as awful and tough. That’s not my experience. And not the experience of the people I work with.” Talk up the job, and ignore The Daily Mail? Maybe easier to say than do?

Next excellent forehand return was to the rejoinder “so what stopped you being patient facing and going into management?” The reply – “I am still,patient facing, and always will be”.  Lilley trailing 30 love already…

It felt like her rise through to the top had been serendipitous rather than driven.  I loved the reason she applied for the Chief Exec role at her Trust. “I didn’t want anyone else to do it”. Fab!  Ruth Carnell was on the panel, and said to her that there would be a time in her first twelve months when she would hit a wall and wouldn’t know what to do.  Claire was congratulating herself on getting past her 12 month point.  But it did happen, after 14 months.  She phoned Ruth, 9 pm on a Friday (as she had offered), and it worked for her.  A peer support worker is needed by us all! (Why do crises always happen at 9 pm on a Friday, with the phone boring with vitriolic reporters? The only solution is to go home at 8!)

Listening to Claire you do get the feeling that this is the time for Mental Health to make the most of its positive standing in the 5YFV. And the extra funding  (which has happened, and continues to happen, and is actually a positive return on investment. There has been an explosion in demand, but the reason for that is simple.  We are talking more, being more open to discuss and so intervene…

There were a lot of initiatives, copiable and shared.

  • Navigo at Hull. Bought a Garden Centre.  So people being treated could have a job as part of that treatment.  This goes alongside having a good place to live, and someone to love….
  • Lincoln Young Mums club – Peer support Network par excellence.
  • Talking therapies for the elderly – one of the most effective talking therapy results.  You forget that loneliness kills…
  • Early intervention – prevention are at least preventing escalation, is becoming the norm.

There is currently a greater appetite for Mental Health than there has ever been.  There is a very talented workforce. And a great team at NHS England.  There is less stigma.  More organisations are putting it positively and centrally in their training and support services…even the NHS it would seem!

The twitterarti fed back how much they enjoyed Claire’s masterclass in handling the Lilley. One assertion she didn’t like was met with a 15 second silence – just excellent, I thought!

She thanked her parents for making sure she was a glass half full person. And this meant she wanted to celebrate the fact that our MH provision is world class. If the people you work with are courageous, sympathetic and amazing, as Claire suggested, then it is hardly surprising that this is so.

Yes, pathways of care will have to continue to be worked on to remain properly inter grated across all parts of the service.  And people with dementia will number 1 million in 2025, and how will we manage that?

If MH has come of age, then I have to feel we will cope well.  And it does feel in very good hands.


Lilley:Swindells Health Chat.

Lilley Swindells

Can you feel the love?

If you weren’t there, last Wednesday, you missed a treat. The Kings Fund in London hosted a very moaning and summer cold full of it Roy Lilley, and a combative Matthew Swindells.  Roy was doing the man-flu thing (“I’ll say goodbye Phil. I may not make it to when we next meet…”). And Matthew being hit between the eyes many times, but fighting hard, explaining suavely, articulately and succinctly.

The virus was making Roy even more – how can I put it – skewering than normal.  “I’ve never heard such a bullshit title in my life….what the hell do you actually do?” OK, like all great interviews, dressed as a chat, don’t let that avuncularity confuse you!  It is rather good at actually pulling out what makes these folk tick, and what it is in their back story that got them there.

I was interested to hear anyway.  You may disagree with my conclusions, and the health check here is to admit they are solely mine, and you may have interpreted differently (watch here on the NHS managers You Tube site, if you want to check!). It is a helluva title! “National Director: Operations and Information”. The answer?  “I manage Big Systems”.

Started in Supplies. Had myriad jobs Patricia Hewitt’s team when she was Health Secretary. Brought in the Smoking Ban. Did it in summer, to lessen the prospects of social unrest!  “Can’t smoke inside and it’s raining….I think we should riot…”

Matthew seemed to move through a number of jobs before he ended up, after a stint in management consultancy, as IT Director. So not buying computers, but directing the infrastructure changes needed.  It did feel like a great grounding for his current long titled role…

Finally, I must say, I am continuously rewarded with a warm glow from every Health Chat I witness.  Matthew was typical.  Forthright, solidly committed, well connected, full of ideas, articulate and rather fine at arguing his corner.

As ever, the quotes and questions should give you a good flavour for what makes him tick. Starting with some Twitter highlights:

#LilleySwindellsHC we r ramping up training but we have never trained enough & relied on 30% trained abroad – now we need 2 train 50% more

#LilleySwindellsHC aim for 90% bed occupancy to enable flow u need to have 3 empty beds on the ward – less than 3 beds u have to take action

#LilleySwindellsHC stop working in silos,work as health economies so focus on delivering the budget & outcomes but find better ways 2 do it

What do you do asks @RoyLilley Matthew says he is a man who manages complex stuff #LilleySwindellsHC – he started as a supplies manager in NHS

Workforce is the single biggest challenge for the #NHS says @mswindells talking to @RoyLilley in #LilleySwindellsHC

‘Buurtzorg’ allows nurses to act as a ‘health coach’ for their patients, advising them on how to stay healthy

#LilleySwindellsHC do we need NHSE & NHSI asks Roy? 2 areas NHSE & NHSI work together for Urgent & Emergency Care 1 voice & have joint appnt

This is as hard as it gets but we don’t have £ for reform as it’s all put to clinical activity #LilleySwindellsHC-discussion targets in A&E

Neat; very human-centric. @picardonhealth points Canada to the Netherland’s “Buurtzorg” or “neighbourhood care.” – (Click here to find out more)

Matthew says NHS is great at innovation but still pitiful at sharing and spreading #FabStuff #LilleySwindellsHC

The role of management; to create the time and space for good people to do great things.

#LilleySwindellsHC – talking about the need for more central guidance for STP’s

Are we at the point when people desert #NHS primary care in favour of a @babylonhealth type service? asks @RoyLilley #LilleySwindellsHC


Do you get a feel for an amazingly deep and thought provoking 90 minutes? (If you want to see the whole thing, click through to the You Tube on  Here’s my highlights, and opinions:

Is it just about money? Should we be aiming to have our health spend reverse its trend, and move up to the European average of GDP investment? ( And I do think of it as investment, not spend or cost). Would it be frittered away in inefficiency and over spending? Would the outside contractors scent the smell of easy profit, and slurp deeply at the magic money trough? At the time of largesse, the best chief execs did fix their operating processes.  They did have a positive business style mentality.

We covered A &E problems – and how Flow could help, and has and can and should. Making A&E everyone’s problem, means everyone is involved in fixing it.  How simple is that?

Local solutions are both welcome and totally to be encouraged and embraced. Both our protagonists agree that we are good at that.  What we are “totally crap at, is getting people to share – just tell us what you’ve done, how you’ve done it and we will copy and fit it to our local situation”.  Spreading the good ideas has been pitiful. (Go to FabNHS to see some things you could copy! Roy Lilley and team practice what they preach). We do have to go beyond talking possibilities, to taking action.  If your action list doesn’t have  a verb in each sentence, then it is a wish list, remember.

Let’s have a few more quotes. Some of these are from Matthew, some Roy. And some from other tweeters. And I couldn’t keep up, so I have no idea which are which.  Give credit to them all!

  1. Do we need more central direction? Are STPs equivalent to leadership organisations? My view? At least the centre should set the vision – big picture, not detail. Trust the locals to know what will work for them.  And get out of the way…
  2. Changing structures does not change behaviours. Ain’t that the truth!
  3. Good management makes it possible to have great medicine. Love this!
  4. Management costs are 1% of NHS costs. This is tiny compared to most ordinary businesses. But try telling the Daily Mail that. Even though their own costs are proabably nearer the 7% average
  5. A&E hold ups? Maybe need to stick to having 3 beds free on every ward so we can get people through more quickly? If you are 95% bed state, then you have no wiggle room. How do this? Reduce the stay in hospital by 10%. Share best practice. Maybe have a Socail worker embedded in discharge team? Maybe have Buurtzorg nurses or neighbourhood nurses making Social care  provision and helping people stay at home and get back home quickly? I think we need to scrap our district nurse system, personally, and do something completely differently.  These nurses need to be empowered to do lots more than they do now. Not sure what, and need your help to make it happen.
  6. We need to ramp up training. NHS has always not trained enough! We need to guarantee the stay ability of our European workers.
  7. We need to make it as attractive as possible to stay in your NHS job. Workforce numbers are our current most pressing problem.  Keeping people is the first and easiest way to help fix this.
  8. Operational Connectivity is uniquely easiest to fix locally. Forget about a central fix.  Just do it , and tell others how you did it.
  9. Do we need NHSI & NHSE? ….discuss…. ( there are 3 vowels to go…)

OK – I repeat some items because they did keep rearing their ugly heads, and I wanted to get my views in too.  But their is still deep concern.

My main fear remains – is this particular huge and hairy problem – making sure the NHS remains as free as can be for all, equally, rather than being denuded to become a poor service for poor people – is it really possible to square all the circles?

I am unsure.  I do know a lot of hugely committed people are doing so every day – and they are being well led by many, and well managed by the majority, day by tiring day.

The Sponsors

Protagonists and Sponsors – IMS Maxims (& Salix Consulting)

Chris Hopson NHS Providers

Chris is Chief Exec of NHS Providers.  This is their Influencing Strategy outline from their web site (see here for web link):

“NHS Providers’ policy development and influencing work is focused on promoting and protecting our members’ interests against a backdrop of a rapidly changing health and social care system, and an extremely challenging financial context.”

Their members include the vast majority of NHS Providers. It is the membership organisation and trade association for NHS acute, ambulance, community and mental health services that treat patients and service users in the NHS.

A health warning first. Roy Lilley’s Health chat at the Kings Fund with Chris Hopson had a health edge. Roy had managed to mangle an ankle by tripping out of a black cab in London. He crumpled in a heap. The taxi driver (“gawd bless ‘im”), said “how are you?    (not good) “Would you like me to take you to a hospital?” (yes). But I don’t think Roy expected him to charge £15 for the lift! ( maybe we are not blessing him as much now…..)

This means Roy was in pain. And tie less for the first time I can remember (watch the whole event here, if you want to – see if you agree with my biases:  see NHS You Tube channel.)  I expected him to be even harsher in the cat and mouse game of this cosy chat.. It was as eviscerating as normal. And as ever, if you know Roy, he gives people a harder time if he likes and respects them, I think.

But I have to say, the way they were chatting was quite depressing. This was a week before the amazing election result / the predictable election result ( did you like that?). We talked money, staff, STPs, CQC, CCGs, and the fact that it was all going to hell in a hand cart.  There were lighter views. But, I remained depressed at the prospects for the NHS throughout the event.  And honestly? I don’t think we should be that fearful.  I will return, but just for once, I think I may have to give you far more of my ideas and views, if that’s OK, on top of the overview of the event.

We were in the midst of Election Purdah….which doesn’t really apply to the NHS itself, as Roy politely pointed out.  We have become more and more fearful of these sort of suggested rules, I worry for democratic debate.

Let’s look at the highlights:

  1. STPs : are they damaged below the waterline already? There was a suggestion from Chris and Roy that the level of public connection and involvement was not at the right level to make it stick.  My view? Get it on Facebook, and Twitter and have public presentations from the people involved, and present it on periscope or google live, and just get the ball out there, not in the long grass.
  2. Chris also talked about the fact that the NHS people themselves are doing a grand job. Roy interjected with Mid Staffs debacle having an long spectre hanging over everyone and everyone’s thinking still. Roy and Chris begged to differ over Foundation Trusts and runaway deficits in our NHS budgets. There feels like there may have been a lot of pressure to cook the books, prior to calling an election (surely not?). It does feel like there may have been ‘arms up backs’ to make things look OK. The first FTs seem to have been featherbeded with extra funding to make sure they worked.  And that sort of actuarial massaging is still occurring. My view? It’s healthcare, not a market.  And there really is no such thing as a free market.  From banking to the media, from oil to internet based organisations, the big control the little.  So let’s get the market out of healthcare in the UK.  But let’s add in business strategic thinking, otherwise we will never get spend under control. And everyone has to be involved and empowered. Except the politicians.  Set the budget yes, but get out of the way and let the people who do it, do it.
  3. Safe staffing. Chris talked about the 8:1 ratio, and argued, rationally, that this may not be sensible in every ward, every acute mental health trust, or wherever.  He suggested that we should let the local experts sort it.  That is the people on the wards, and all who are hands on with the patients.  I agree.  Matron led organisations need to be the norm! Sadly, we may not have enough nurses for the matrons to make sure they have enough people to cover patient needs adequately and safely. Chris said national framework staffing levels should be a guideline.  Why is it legally set in California, said Roy….I’m unsure, personally…
  4. Health education England have written that we may have a shortfall of 60 000 nurses. We still have over subscription for nurse training places, even though there are no Nurse Bursaries any more? (It is now 3 applicants per place, not 6.) Depressing bit came when both participants talked about the prospect of many European workers leaving for home.  I think this may change once Brexit gets less nebulous and we all know where we stand.  Why should it be really different than before we were in the EC?  I personally am very pro Europe, but anti EC…and I don’t think anyone knows what will happen.  Uncertainty though really doesn’t help long term planning.
  5. Election Purdah raised its head again.  Roy tried to get Chris to come down in favour of one side or the other.  He played the ball straight back.  He said the only way to be sensitively influencing all sides equally was to be even handed. So Jeremy Hunt, Jon Ashworth and Norman Lamb were all involved.  As all could be involved post election…
  6. We often talked about pockets of the NHS at the forefront of positive thinking and actions (Salford, Northampton, Northumbria, Frimley, Devon, and many more). Maybe we do just need to let the guys do it themselves? Just let them go, and do it?

Politicians don’t want us to use real evidence based reality to inform.  I would love PFI to be removed from all of Chris’s membership organisations day to day reality.  I bet this 2% of the whole budget occupies 50 % of management time in some Trusts?

There were many other interesting stats chucked into the conversation – have a look here…but if you want my two favourites, here they are.

Once we are 70, we start having the potential of increasing our demand on the health service.  We need to make sure the education on exercise and eating is inculcated from junior school.  We are living longer, but maybe less well?

70% of our lifetime healthcare costs come in the last 6 months of our lives.  Are we over medicalising death? Perhaps we need to start having the good death mentality, and let nature take its course – and save both dignity and money at the same time.

I think I still feel depressed at the negativity and extreme worry portrayed by both participants.  But madly, as a very annoying optimist, I want to let our amazing NHS teams be just that.  Teams.  Powerfully excited.  They need to be supported, thanked, enjoyed, celebrated and kept alive.  I think maybe Roy and Chris both feel that can happen, but will it be allowed to happen?

Politicians? Just leave them alone to get on with it.  I trust them rather more than I trust you.  And the NHS may well be ‘running hot’, but it is still running despite partisan politicking tinkering at the edges.

Thanks Chris and Roy.  You worried me. But made me think.

Professor Henry Mintzberg

Henry Mintzberg, OC OQ FRSC (born September 2, 1939) is an internationally renowned academic and author on business and management. He is currently the Cleghorn Professor of Management Studies at the Desautels Faculty of Management of McGill University in Montreal, Quebec, Canada, where he has been teaching since 1968


Evening, Prof….

Ok – that’s the WikiPedia background.  Now onto meeting and listening to the man himself:

They say you should never meet your heroes, for fear of disappointment. I met Henry Mintzberg, erstwhile management thinker and writer during my OU MBA course, in print, and was always fascinated by his thinking. I was lucky enough to meet him in person at two meetings at The Kings Fund in London.  The first was under the auspices of The Institute of Healthcare Management – an intimate affair with lots of question space. The second meeting was an NHS Health Chat, with Roy Lilley interviewing Henry. (Film of the meeting available here)

I wasn’t disappointed.

Much of the Profs work has started out very simply. “All I did was get down on the ground and saw what was going on. Then just wrote that up.  My findings were always just the patently obvious, but no-one was doing that”.

Healthcare has always been part of his research interest.  His latest book “Managing the Myths of Health Care” is as provocative as the title suggests. Anything that says after just a few preliminary pages, that Health Care is not failing, but succeeding, expensively, and we don’t want to pay for it. So the administrations, public and private alike, intervene to cut costs., and therein lies the failure”.

His thinking is always nuanced, not in extreme ideological positions.  There is great debate on Globalisation in the worldwide political sphere as we speak.  It is black and white, good or bad, as far as most report their views.  Henry?  “I’m for and against it”. I needed to listen more closely ( and as with all my summary blogs of talks, I may miss things that you would hear differently. And I will allow my opinions to the fore. So, this is not a report, it is a view…).

The myths were discussed a lot in this chat. Especially the ‘not failing’ view, but just succeeding expensively. The chat then veered into how organised or not organised health care is.  With the rejoinder that it is very easy to reorganise for short term patch up of problems.  Anyone can do that.  The book then goes onto how do we reframe the whole.

John Stephens and Henry Mintzberg

Henry with Simon Stevens, NHS England

His stories and observations drive his thinking and opinions.  More than for most of us. And he is still learning. Outsiders can give some ideas, but insiders need to drive change.  Budget constraints provide focus, sometimes.  Those in middle management can feel constrained and demoralised (ain’t that the truth!). Quotes abounded too.  “If you have responsibility, you don’t need accountability”.  He made the case for looking for causes (whether problems in an institution, or a health care issue), rather than cure.  In the main, I agree.  We still have a National Sickness Service in the UK.  Health promotion is in the mix, of course, but always feels like the poor relative.

Fascinating tangent on measurement: in his hometown of Montreal he asked his local hospital chief why they measured so much?

“What else do you do when you don’t know what’s going on?”.

We’ve all heard paralysis by analysis…and Henry’s line was a chapter title “Analysis:analyse thyself”. My line is “You can disappear up your own analysis”. And, another favourite, “you don’t fatten a pig by weighing it”.

What is efficiency? As soon as you use a word like that, it isn’t neutral.  We measure what is measurable.  I think we measure what is easy to measure, distorting what is not measurable.  It may mean we cheapen what is really important.

Good enough, or World Class? Best, in a competitive situation, may not be good enough. Too low a standard, as prof said! Good may be your best.  Every person to be their best? Is that how we get to being more than good enough?

And what vehicle to make that happen? Collaboration, versus self interest, may be easy to say.  He talked of Communityship, a refocus on society.

In the evening session, softly interrogated by Roy Lilley, we learnt a bit more about why Prof Mintzberg was so against ordinary MBA programmes.  (A show of hands proved a good 25% of his audience were MBA graduates). “Wrong people taught the wrong things at the wrong time.  You don’t learn to swim in a classroom”. Most of the grads there were mature students originally, so that takes care of wrong people wrong time.  But I agree with the supposition that function expertise can be learnt – marketing, strategic planning, finance – but not hands on people skills.  University of life for that, I feel. His triangle of Art, Science and Craft, standing for people and soft skills, analysis, and expertise, rang true for many. To improve the selection of managers, he suggested those they have managed before should input into the process.  Blindingly obvious, but rarely done?

Simplifying the message was a core theme repeated often by the Prof.  So I will do the same:

  1. Why do we obsess about data and analysis? We only measure what is easy to measure, not what is truly important.
  2. Stories and anecdotes are your company culture
  3. Remote control management fails, every time, over hands on, getting down on the floor
  4. Management is what we do. He is not a fan of leadership (Hurrah….I always fell out with the writings of Warren Bennett over this.  We all do both.  One isn’t better than the other).
  5. Everyone has something to input. Hierarchy can stifle that.

Finally he said that Healthcare is a calling, not a business.  If we can just do that, with everyone aiming to think how can I get better at my job today, and keep the crass business models out of Health, then we can let Communityship flourish.

Just a final thought.  US healthcare costs 11.5% of GDP.  U.K. is 6.3% – and is universal.  Just experienced the NHS at its best at a minor injuries unit in Tewkesbury, on a Sunday. Triaged and fixed in 45 minutes.

I know where I’d rather live.

Helen Stokes Lampard, Chair RCGP

Helen Stokes Lampard

“It was a fair fight for the position. Four candidates. I won.”  We expect Roy Lilley’s chats to be rather more combative than fireside, but that was a fairly typical response from Helen.

Not only chair of the Royal College of General Practitioners, but one day a week partner in General Practice in Lichfield, And in her spare time, Governor of the Birmingham Women’s NHS Trust.

Where did it start? A penchant for science, led by role model who was dad, in Swansea who taught science. Excited by Dentistry, through another role model who she stayed with one long vacation. She made the job sound very enticing. (Funny how a lot of role models and influencers are passionate about their work…). Salutary first underachieving at A levels was a useful life lesson, and St Georges beckoned after the second attempt. “Why not Welsh medical school?” “Family would have loved it, but as a teenager, I wanted to be far away!” House jobs through a swap, back in Wales.  Then a fun serendipitous turn of events….a penchant for research led to a PhD (so a proper Doctor!), which changed gynaecological screening in the UK. This led to joining an unusual (but shouldn’t be?) training scheme.  Half GP trainee, half academic research.  Then later in Birmingham, added in learning to teach soon.

I only give all the background because it does inform the view of the person, and how they have got there.  Although this is always my personal opinion, you can watch the whole interview free, clicking on here for the NHS YouTube channel.  But I really got Helen’s passion, drive, intelligence and vision. Motto of the RCGP was repeated a few times. “Scientific knowledge applied with compassion”. Anyone can trot out platitudes, but I got the feeling she not only meant it, she lived it.

As ever, we learnt as much about Mr Lilley’s foibles as the chatee…”Why women’s hospital…we don’t have men’s….”  “What about getting me an old geezer GP – I’m not seeing a woman!”.  Then a bit more banter level “You fell out with the builders at the new office, 30 Euston Square?” “And we won the dispute”. I was really enjoying the instant replies.  NHS was castigated as a non family friendly employer.  Crèche spaces as rare as rocking horse droppings.  This moved us nicely onto that nights publication of the RCGP manifesto – out long before the political parties have managed theirs for the election.

The theme and main thrust of the evening was around is General Practice about to wither away? A simplified 6 part plan to save the NHS loomed over the audience (embargoed until midnight that night, but we kept getting sight of it as Roy continued to be naughty!).

(You can see the Manifesto here)

The election should not just be about Brexit.  The entire population needs healthcare. And everyone has a story, opinion and bias about “our NHS”. Here’s my notes on the 6 steps to save the NHS.

  1. Fund primary care so the GP 5 year forward view can be delivered
  2. Support euro and overseas employees, healthcare and allied professions.
  3. Extend GP training to 4 years from 3. They are “expert medical generalists”, and the job is more complex than ever. Cheaper in long term.
  4. 5000 more GPS by 2020
  5. A new return to work initiative for nurses, mental health professionals and pharmacists to join the multi faceted teams needed for evolving general practices
  6. Sort out the spiraling costs of GP indemnity insurance – yes, if mistakes happen, sort it, but not ambulance chasing.

See the whole here, but I like the simplifying.

70% of NHS costs are people.  We cannot just make the savings asked for from efficiency of the 30%.

What else for the future?  More remote consultations? Maybe it has to be “good enough” for some situations? I do feel one size doesn’t fit all.  And we all have different needs for different conditions  ( notwithstanding maggots in the scrotum, which Roy quoted twice, from Mormon a west end musical…don’t ask…). Maybe Skype, or apps like Babylon, or Face Time, or just the mobile phone, or near patient testing can help some people sometimes? Best quote of the night ? Roy: “There’s no silver bullet here, but maybe there is silver buckshot”. Primary Care Home is being successful in some places.  Sustainability and Transformation Plans (STPs) occasionally left GPS out of the solution – until hospitals told some of the local planners not to be daft. We do need to grow the wider GP team.  We do need the holistic approach of Primary led, secondary fixers and social care support to become fully dovetailed and smoothly transitioned. There need to be more new ways of working, and GPs tend to be active early adopters.  It feels like Helens vision around recruiting, retaining and returning of all the allied healthcare professional teams will help drive it all forward rather than over a cliff.

Some other great ideas about social prescribing, the tripod of social care, primary and secondary care, GP in A & E, other folk appropriate to the patient need (paramedic in out of hours triage, for example).

It was an evening full of hard hitting practical do-able ideas that were not scary or mad or just talk.  It feels like we just need the powers of persuasion to make the talk stop and the action start.  Helen Stokes Lampard is highly persuasive innovative and very hard to ignore.

Whoever wins the election, please be aware she will come knocking…and won’t take no for an answer.