Fab NHS Do-Ath-On

NHS Change Day started in 2013 and  was the biggest day of collective action for improvement in the history of the NHS – Fact. A countrywide event in England, NHS Change Day was a grassroots initiative devised and driven by a small group of emerging clinicians and improvement leaders.

That’s the introduction from the report to last year’s NHS Change Day from the Academy of Fabulous Stuff web-site. (See it here). (And you can flow aroud the wonderful ideas streams there too…)

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Cajoled, Corralled and kicked off!

As was said during that day – it’s no good having ideas unless they are actioned.  That’s were the Change Day Do-Ath-On came in. Roy Lilley, Jon Wilks and The Blonde from The Academy of Fab NHS Stuff led a group of about 175 committed ideas folk to the RCN in London on 11th January.

I work as a leadership trainer.  It is said there are three types of organisation:

Those who make things happen….

Those who watch what happens…

And those who wondered what happened!

OK – the majority of us are in the middle.  But, we can jump into the elite leading group if we put more (often simple) practical stuff into action.  And share it, so others can steal it and mold it to their own needs, and with pride!

Here my views of the proceedings as a participant – and when the action report comes out – end of January – I will send you the links too…

The portals of the RCN HQ in London may never have heard such a confection of marvelous practical ideas. Fab NHS Change day was back in October. And a huge number of pledges were made for big and small ideas then that were shareable, scaleable and do-able.

The problem is? They were pledges, not actually doing stuff.  OK some of them were add-ons to fab ideas that were already  live.  But many were pledged by some of us who got caught up in the excitement and the infective nature of other’s enthusiasm. Nothing wrong with that. This do-ath-on day was designed to entice all of us into making our pledge a reality.  It was safer than that though (no finger pointing or accusations!). We had 5 hairy and complex problem areas to work on as streams. If we could come up with action plans that were do-able not just by preaching to the converted delegates in the room, but by others who couldn’t be there through using the action plans created, that would also give confidence to other pledgers to push on with their ideas.

Here’s the Big 5:

  1. Home First: How can we attempt to make sure that patients get back to their own place as quickly as possible?
  2. Visible Leadership: creating collaborative Leadership – perhaps just by walking around?
  3. Patient Experience: Going even further than “Hello my name is…”, seeing the whole from a patients eye view and making that experience the best it can be
  4. Living with Dementia: Taking out the disabling nature of some of those descriptions e.g notes saying ‘Dementia Patient” change it to Person with Dementia).
  5. Sepsis: 60% do not know what it is or what to do. How can we improve outcomes for something that kills more people than cancer and Traffic accidents combined, per year.

We already had some heady quotations from the champions of each section:

Stealing is good

Patients see me as an angel abut also as a death sentence

The very first requirement of a hospital is to do the sick no harm

We Scanned first in our favoured section. This expansive tuning in it got us all to focus on where we were. And that helped to focus on what we wanted as outcomes and end points. Which meant we could then come up with do-able actions

That was the focus. What was do-able by those who were immersed at the workshop. What should be do-able for those not able to be there – an action plan that was actionable from just written instructions. And like Christmas and a dog being not just for, Fab NHS Change Day is for ever, not just the day.

The summaries from the 5 showed a lot of actual actions – verbs were in evidence! OK some of them will need working up from just wishes, but it really was an energetic start. There were also some common themes – an awful lot was said about the language we use. Phrases like “discharge to assess” may say what it is, but patients don’t like the sound of it.  What about support to go home? Just feels more like-able?

The papers have been collated.  The action plans for each area will be formulated.  They will be out there by the end of January.

And then all you have to do is find them, on the Fab NHS web site.  And just do them.

It was a positive and realistic day. There is real energy for positive small action change. And that’s were monumental life changing starts.

We need to not just talk about the action, or disappear up our own analysis, or feel like we have done it because we have written the plan. We now need to do stuff.

‘Twas ever thus.

Can I ask for some help too?  My pledge was “Time for Buurtzorg in the UK:  Is it time to change the way we do social and community care. I want to investigate the Buurtzorg (Holland) model of looking after more people in their homes. I have no idea how far the concept has progressed in the UK, but if it needs a positive push, and an action centred conference of committed individuals, I pledge to be that enzyme”.  

If you have any ideas or contacts – e mail me on phil@onestepaheadtraining.co.uk

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…and wished safe journey home by Andrew Foster Chief Exec in Wigan…

 

 

Simon Stevens CEO NHS England and Penderyn Whisky

Two stars of the show? Maybe, maybe not.  I had my favourite in mind before the meeting, but I was willing to be convinced that Penderyn was not the star!!

Award winning, and absolutely resolutely proudly and excitingly Welsh.  Yes, it’s good enough to fuel Roy Lilley’s e newsletters….but not his NHS Health Chats…he saves it until after the event…

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Pensive and thoughtful – not just the audience!

Usual health warning…my views alone here, so biased and opinionated. If you want to check yourself, watch the recording on the You Tube link. Here…

How often do you get the killer question in the bar? I was sitting next a BBC journalist who had interviewed Roy Lilley that afternoon. He had invited her to witness the NHS world via a Health chat at The Kings Fund. “A lot of that went over my head” she said, ” But why can’t one size fit all? Why should the care and delivery and outcomes be different in different parts of the country?”. I blustered and flustered. She asked the same of Roy in the same bar. He blustered the same as me.

Maybe it is simple? Maybe it should be central edict? The pendulum swings. As it always does in management and leadership? And in reforms.

I just find the scope of Simon Stevens job just too mind boggling. He feels like the ultimate polymath who is a hyper generalist – and has to have specialism too. Can one organisation do that? Can one leader?

Or is it just rearranging the deck chairs on The Titanic?

A lot of the trends look good? 0.8%improvement in cancer survival rates sounds small. Until you factor in 300 000 new diagnoses per year. 2 400 families will have their loved one at home for Christmas this year who would not have had them last year.

And what about the differences – late presentation (a big determinant of survival) worst among blue collar males? My view – perhaps we have to live with that? Keep up the health education pressure, but not everyone will listen and act?

Will we always end up robbing Peter to pay Paul?  Simon has to intervene to attempt to save the Mental Health budget being dipped into. But then something else will give?

What a job!

The 5YFV – five years forward view now has 200 weeks left – a growing and ageing population to care for, and austerity budgets with deficits (possibly political?) the norm, and hoping that 2% of the savings will come from reducing demand! And A&Es will not fall over this winter and what about social care?  (If you need a reminder – this is the ‘easy read’ option from NHS England – here)

OK…a long and badly constructed sentence, but I am just trying to give you a feel for the complexity. It feels bonkers.

Will the 44 STPs really be the answer? Well, it should be a great focus? Or will as Roy suggested, the consultation process kill any major change ideas. Local hospitals always want to be saved by local people….even if they can be proved to be offering a better service after a local closure. (Simon had local news from one of the questioners hospitals on his smart phone as the question was asked – smart indeed!).

There does feel like a lot of positive change. 1 million fewer smokers than 10 years ago. Down to 7 million. Tax or health ed? Or none on TV and none in pubs? Or a bit of each? Can NHS England influence that? Sure it can.  One thing I have noted all year is the passion from the top of the NHS mirrors the passion of the best from all levels.  Let locals fix the local agenda, and the centre set the policy and direction? Can it be that simple, getting back to my original questioner? The myriad of questions from the great and good in the audience certainly prove the passion is there. And it may never be as simple as ‘there’s just not enough money’ . Perhaps the 5YFV does set the right agenda and the STPs and the Vanguards and the highly copied ideas from FAB NHS.net and continued centrally derived strategic direction will get us there.

But we maybe have to think totally differently.  Let’s maybe steal other ideas from other parts of Europe (I am very enticed by Buurtzorg social home care from Netherlands, for example), (RCN updated briefing here) and get past some of our sacred cows, we might get more for this amount of GDP. It is pretty good, but maybe we now need to future scope stuff. We might need to consider interoperability of IT and data transparency systems.  The next efficiency level could be in the realms of real time information systems that are truly enterprise or nationwide? Why not?

Why does the NHS management development scheme become oversubscribed with the best graduates, when there is so much crap going on? Maybe it entices people who want to fix the messes, because it is a huge opportunity to make change, realistic and long term, happen? As Simon said, we don’t want to be short term smart and long term stupid…

It feels like that is why Simon Stevens does his job. If he can just get past the treacle stream of vested interests, his passion and intellect and deep networked knowledge could see us through to an NHS still existing in 2022, and maybe even thriving.

Enjoy the Penderyn all who came and took a sample! And toast a rosy future for our NHS. We are all in this together. It’s not just up to Simon and his team…

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Roy’s favourite whisky – Welsh and award winning! (Miniatures lined up by Hannah!) (Click on photo to see their web site)

 

Fab NHS Awards 2016

Hi everyone! I am blown away with powerful positivism after spending the afternoon at an award ceremony at O2 in Greenwich. The concept of sharing great ideas that are proven and already used anywhere in the NHS and deserve wider circulation and utility was the brainchild of Roy Lilley, Terri Porrett and Jon Wilks. And as a vehicle for positive change, it has already proven invaluable.

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I had a snack before leaving the venue. Guys on the next table saw my badges and lapel stickers. “Awards? Was it just the usual Corporate rubbish?”.  OK, it could’ve been, I said. But with magicians and bubbles and the NHS Choir…it wasn’t your average back slapper!

You had to feel the love. Most of the guest performers, the grand fromages from NHS, the award winners and nominees were quite visibly, emotionally involved. Some to the point of what my sister beautifully terms “happy hankie”.  Including the blogger…(it was the standing ovation for the NHS choir singing their 2015 Christmas number 1 that got me).

Dr. Phil Hammond, Private Eye medico, and West Country GP brought a Clanger. Acronym alert – Connect, Learn, Action, Notice stuff, Give, Eat well,  Relax, and Sleep. I love Clangers!  And had us all shouting out (in appalling West Country accents) “Our NHS”.  OK – this audience is on side already…but don’t underestimate the love, politicians….

Before I give you links to the award winners, through the Fab NHS web site, I just need to mention all if the performers and their simply fabulous metaphor links to what the NHS is and does…

Positive news doesn’t sell newspapers. You might not hear about this in the Daily Wail, or the Excess…but you can read it here. As Simon Stephens said “You 290 winners and your 1.3 million colleagues in the NHS are winning everyday”. Touching the lives of 650000 people directly, the NHS touches everyone…

So who performed – beautifully? Dancers, with Nye Bevan’s speech at the inception of the service. Sometimes it must feel like the troupe is all in time and in tune? A woman doing the splits on a tightrope…don’t want to stretch that too far (!), but the finances make it feel like the safety net needs fewer holes? A posh guy making impossible things happen with bubbles. “Bubbles have to make the most of every precious moment…like you all do”. Surely a perfect metaphor for some of the wondrous stuff that happens, hourly? And Nurse Pseud, the astonishing (you had to be there…) Hula Hoop queen. Sorry, she managed 10 at one point. And was naughty  and quirky and loud and very proud of being an NHS baby. And was moved by saying thank you. And finally a magician – please make your own metaphor link….it’s too obvious…

The roadies and crew were so like the NHS folk. Committed, quietly getting on with it, unobtrusively committed to excellence.  The sponsors are deeply embedded, excited to be so, and want it to grow and grow.

Twitter nearly broke. 857 729 people had interacted with tweets about #fabawards16. Wow.

And maybe a tweet summed up the objective of both the celebration and indeed, the vision of Academy of Fab NHS Stuff:

Enjoyed following on twitter. Some amazing people doing some incredible things

And finally (as the Two Ronnie’s would have said), I had the serendipitous joy of sitting next to one of the award winners. Lisa Webster  now with Wirral Community NHS Foundation Trust , (recently moved from Pennine Care NHS Trust) win the Mary Poppins Award. “Be Happy”, was the share. She was shocked. And so blown away. As was everyone who won. And all those who were nominated. Cliche it may be – but all are winners of course, because they were the chosen 4 out of 50 nominees for each category…and in the end, it’s is the NHS that wins, through this hugely positive sharing platform.

It works. It really works. Go check it out:

Here’s the categories – Fab Awards Categories

Here’s the nominees and winners – Nominations

Here’s the photos from the event – Photos

And couldn’t without the positive pushing and vision of Roy. Terri and Jon. And the sponsors. And the sharers.

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Fabulous.

Read about Developing a Home First Mindset; LEAD it In Leicester; Caring for Carers, Be Happy, Designing & Implementing an ‘Acute Hospitals @ Home’ Service #FutureHospitalsProgramme, Fab Change Day champions, and more on the Fab NHS site…and share something with everyone. Your little idea may be bigger than you think…

https://fabnhsstuff.net/

(All the links to the nominees are on this home page)

The Sponsors – and it couldn’t happen without them:

Cerner

Deloitte

IBM

IMS Maxims

Institute of Healthcare Management

Interserve

Quintiles

 

Dr Sir Sam Everington

If you’re not sure you have heard of Sam, or cant quite place him – click here and here (first is Kings Fund, second Wikipedia).  Those who attended, in person or via Periscope will have learnt more at last weeks Health chat with Roy Lilley.

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Sir Sam Everington

Less like a Sir, less like a doc, more like a visionary?  Roy Lilley certainly does get some crackers to his health chats.  Read on to find out more of what I think I found on that evening. (Available to watch again on You Tube link in case you didn’t catch it on Periscope).

I thought I might get the feel for a person who had moved from law to GP and find him a little highfalutin’ and pompous. Not likely for someone half Norwegian (and brought up by his madly hospitable, open house mum). He does wear that sort of jumper, normally only seen in Scandi Noir cop shows.. For work too…no ties on him! Trainee woodcarver to ships welder, through Called to the Bar, to GP. All before 23 or 4… Saw a fellow student killed by a crane when a welder. Formative moment. Resolved to become a GP.

Why general practitioner, asked Roy?. He knew that’s what he wanted in Medicine.  it’s a people need. “You need emotional Intelligence, not straight A* s to be a good GP.”.

The Practice he still works at 2 days a week (you got the feeling he needed it as a bed rock of his existence) is well visited by the great and the good.  Heavens, Roy has been there! Bromley by Bow, in Tower Hamlets. Deprived area. Hugely varied communities. And a beacon of excellent care.  The practice sounds as central to community life as a holistic social, health and cohesive service should be. Taking the place of pub, church football and maybe even family? Or just making that mix work better? Is Sam’s thrust just that? Maybe his powerfully political pushing and absolute moral conviction is the enzyme that allows others to have their head too? I know he doesn’t do it all, and says he can walk out of the practice and it will still flourish..but I think he just makes the space for the positive ideas to flow.  And the positive people to come to the fore.

Like Social Prescribing. I didn’t know what that was, really (description here). It starts with the the opposite of normal thinking.  Not “what’s the matter with somebody” but “what matters to somebody”. Like a lot of things – simple to say and to “get”. But harder to do?. Of course. But you have to start at the “what matters” question. Like their practice building. Church audience falling? What do our ageing parishioners want? They want social care.  Let’s bring the GP in here. Another practice defined many of their health issues were related to crime in the local estate. So bring two police officers permanently based into the building. Guess what? Crime reduced 80% and healthcare outcomes improved exponentially.

It is big joined up thinking.  It is all about mind set.  But don’t say it to Sam.  He doesn’t think what he does is the important bit.

Tough? It is. The passion makes it happen.  And others will now follow. Thank you.

Next? Making the High Street healthy….

Good luck, Sam. We get it.  You lead, and we will follow…truly an inspirational chat, and chap.

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Sam and Jumper Fans!

Matthew Syed. Black Box Thinker

Oh dear. Too many quotes, too quickly at this particular Roy Lilley NHS Managers.net Health Chat event.  Matthew – I apologise already if I misquote you – especially as you are a journalist. (Journo’s never misquote, I am told).  So scary.  Usual health warning – as ever, this will be my views of the evening. If you were there, or watching the event live, on the Periscope feed, or the whole thing on You Tube link, then I apologise.  (You Tube link herePeriscope is easy to add to mobile devices and computers – and now you don’t need a Twitter account to get it)

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…and so, it begins

I didn’t really expect so many sound bite quotes from a table tennis ace, of Pakistani and Welsh decent, who left school very early to pursue the love of sport, then taught himself “A” levels, went to Oxford and got a job as a writer for The Times by phoning Directory Inquiries and phoning the sports editor directly.  Not a lot surprises me except that sort of powerful self-belief, when it actively works.  Matthew doesn’t seem to know no as a concept.  Or “You can’t”.

He continues to be enlivened by sport. “Sport is a very broad canvas.  It is the tapestry of life.  And it has beauty.”  There you have it.  This is a man who not only showed impeccable emotional intelligence during the session, noticing when his metaphors had gone too off tangent for much of the audience, and redesigning them so we got it, but also showed and shared an awful lot of passion.  His own and other peoples.

(He had to rush off, as a working journalist, to write a piece on the passing of Carlos Alberto, who scored one of the best goals at any world cup, in 1970, for Brazil.  And he did so impeccably.) (I would normally say “death” not “passing”.  But if you watch the goal on lone from the 1970 World Cup, you will see why I chose the word…)

Roy and he agreed about Positive Deviance, and about sharing, and about learning from things that go wrong.  Matthew was quite outspoken about the reticence to be open in Healthcare – I felt he felt it worse than most professional environments?  Get the culture right, and you create success.  Roy begged to differ.  “You can’t change culture”.  I got the impression that they agreed that some things could be changed – there may be Marginal gains (like Sir Dave Brailsford and the British Cycling team) or big, disruptive change.  It doesn’t matter what we call it, guys, but if the atmosphere changes and the positively noisy angry individuals keep at it, we will get both marginal and major disruptive change.  I don’t care if you call it cultural change, micro or macro change, learning from failure, sharing, openness to change or whatever….just do it and stop trying to define it.  Not is a word that does’t help us move on.

How do we create high performance change?  “You can’t improve your golf in the dark”  Great metaphor.  Let’s switch the lights on!  That means valuing whistle blowers?  I think so.  We need to get beyond self justification protectionism and Group Think. (Please find out more about Group Think – wiki link here.  Janis will make you think differently…).  Continuous Improvement culture, openness and collaboration and the underpinnings of positive change.  And sharing.  We know we are not already perfect.  So that means trying to do things better.  Always..

You need data too.  And root cause analysis.  Central line infection caused 45 000 deaths per annum in USA.  Analysis showed that not sterilising the catheter site was the root cause.  Change in procedure – and the infection rate became zero.  It sounds like many people may have died unnecessarily whilst professional testudo was in place?  “These infections are due to a complication of the procedure itself”.  No, it wan’t it would seem.  I wonder how many things are going on today that this sort of knee jerk circling of the wagons, group think and not listening to voices of concern, is preventing better patient care and outcomes?

So, a few more quotes:

“You cannot create high performance through high blame”

“The organisations with the strongest learning culture have the best balance sheets”.

“Healthcare has real difficulties with senior people not admitting their mistakes and becoming defensive”

“We need to create openness to track unintended consequences”

Yes, if we change the model, if the noisy ones can stay noisy (and keep their jobs), if we are not threatened by our mistakes but use them to improve, we may get the behaviour change to keep happening.

One last thought from me?  What if we banned gagging orders from compromise agreements between Trusts and whistle blowers who have been pushed out?  Or at least, the Press Release must say “There is a no comment order attached to this case”.  Then the Press could speculate.  And I bet the Trusts would be more open, because the speculation is likely to be wilder than the truth…

 

Ed Smith NHS Improvement

NHS Heath Chat at The Kings Fund – always thought provoking, and Ed Smith gave as good as he got from Roy Lilley.

(Usual health warning – this blog is my view of the evening.  You may indeed have a different one.  You can check if you weren’t there by viewing the chat here – The Blonde seems to have done a sterling job despite some technical difficulties!)

Ed Smith CBE, FCA, CPFA, Hon DUniv, Hon LLDs

Ed Smith is Chairman of NHS Improvement.  Can one organisation be led well enough to actual live up to it’s title – which sounds like a mission statement in and of itself?  We sat and wondered…read on and find my view.

I call it ‘Not Monitor”. Roy’s insults did begin even before the official 6 pm start at the Kings Fund…but for once, the interlocutor / victim / silly for being there person, responded in kind.  Alternately ignoring or riposting – a fine tennis match!  (I still wonder why people do it…volunteering for this interrogation, gentle as it is?)

Born in Calcutta (as was), and had long history not in the NHS.  Visited hospital where he was born, and phoned his mum back in England from there.  Unusual to see something slightly different from one of these NHS Chats.  I usually witness people who are totally NHS born and bred, and so fully entrenched and committed to the cause, it becomes almost a given to be that driven.  What I saw on top of that with Ed Smith was someone whose passion also had emotion.  He is probably one of these people who become tearful watching certain films and TV.  I understand.  And I really don’t think there is enough passion and enough emotional involvement or the spending of emotional currency in organisations.  (I will return to this at the end.  Marketers call that a tease campaign…)

30 years in PWC after 4 with Coopers.  Straight into “Shouldn’t the NHS be able to sort itself out?”  Well, yes.  Sometimes needs expert help and advice – but some of the baseline is wrong.  Ed talked of the lack of a learning culture, no peer review and little peer engagement.  I thought there was some – but guess it is only at the rear view mirror level, not looking forward. The retrospectoscope always gives you 20:20 vision.  Planning for the future takes guts.  Taking action for the future takes balls.

He has brought a lot of his other experience emotional intelligence and passion from other roles.  WWF for Nature?  “We must learn we are tenant on this planet – not its owners”.  Perhaps the same could be said of the NHS?

I got lost in acronyms.  STPs?  Sustainability and Transformation Programmes.  Apparently, a web site explains (see here…) but it seems to come down to the people bits of the providing excellent care, s ever.  “We need a more collaborative approach.  More coaching and mentoring.  We need Lean and Process improvement.”  The mantra continued – positively.”  There needs to be more Clumsy Solutions (loved that – just do it and keep refining?)There is a common mind set?  Everyone wants better outcomes for patients – and remember, we can all be patients… but the prevailing atmosphere is of a set of people (the 1.2 million who work in the NHS) who seem more disillusioned, dispirited, disaffected and disillusioned than ever.  It is 1 minute to midnight to turn the NHS around, warned Ed.  So, how?

Managers and leaders must oxygenate their organisation.  Allow people to breathe their job. Get back to People, Process and Purpose.  Celebrate what we do, what we achieve every day.  Of course I agree.  It will never make the news.  Only bad stuff sells.  But at least we can do this for each other?  Get to the Fab NHS site for ideas, and to share.

I get the feeling that some of the amazing folk in senior positions in today’s NHS are coming together – coalescence of positive group thinking and for process and purpose.  If they can get that right between them, the NHS teams will get the rest right.  As Roy said yet again tonight, management’s job is to show people what good is, and get out of the way while they get on and make it even better.  And I was with Ed when he talked about the need for a 5, 10 and 15 year plan.  2030 is only 14 years away (and how scary is that??!).  2020 will happen, almost whatever we do now.  He argues cogently that we need to define the purpose for 2030, or it won’t happen at all.

Fascinatingly forthright, open and honest.  And the insult tennis was a score draw between them.  And you know what?

Roy and Ed want the same thing.  It is also what everyone in the audience wanted too.  Better patient care delivered by people who are loved and respected for what they do.  Let’s just do it?

 

Sir Andrew Dillon – NICE!

Sir Andrew Dillon & Roy Lilley

I’m sorry.  It is a bit childish, isn’t it. National Institute for Health and Care Excellence is no laughing matter. Originally, just the proper NICE acronym – in 1999 – “The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care”.  Laudable.  Then the remit changed in 2005 – after merging with the Health Development Agency, “we began developing public health guidance to help prevent ill health and promote healthier lifestyles. Our name changed to the National Institute for Health and Clinical Excellence”.  Proper Health Service, rather than a sickness service (which has always been my gripe with NHS as a name – more fixing the sick than stopping them getting sick first).

Yes, another health chat, with Roy Lilley being chatter in chief.  These are my reflections having watched on Periscope (easy to download onto your pad or phone) last week (I’m moving, hence a bit tardy!)

Another great way of seeing the whole thing is via the Academy of Fab NHS Stuff You Tube Channel – click anywhere on this coloured bit to take you to it.

Do you sometimes wonder why anyone ever gets to want to be interviewed – by anyone?  If your organisation is in crisis, the first thing any Crisis Management Organisation suggests is never appear live, or you will be hung out to dry.  Well, the insults started early.  I was already thinking “Why put yourself through this?”

“You were described once as having less personality than a paper clip”.  Well fielded by the Knight of the Realm…”Yes. Paper clips are useful.  That was how you rebooted your phone, remember? I took it as a extraordinary compliment…”.  The softening up is always so nice from Roy – and you learn a lot about how the person formed to fit the high ranking role they are now in.  Always so pleasing to see that many of the people Roy interviews are actually long term NHS stalwarts, and many jumped into the organisation at teenage or new graduate input.  Andrew Dillon was no exception.

His trail was blazed with moving from unit to unit to hospital – and they all seemed to close after he left…except The Royal London.  I’m sure it was just coincidence – but Manchester and environs may have heaved a sigh of relief as he took the M6/M1 route to London.

There was lots of political interference and ‘leaning on’ from Big Pharma.  An early spat involved a Flu treatment from GSK – Relenza, I think?  The Rapid Assessment system (cost benefit analysis linked to clinical utility – or maybe more complicated than that?) resulted in a ‘no’ from NICE and the head of Glaxo demanding to see the PM (Tony Bliar, star of recent 1.5 million word historical document), I assume to ask for some part of Andrew Dillon’s anatomy?  (Head?).  It certainly seemed to get them known.  There was a lot of flummery and anger about pulling investment and people out of the UK (this sounds awfully familiar), but that didn’t seem to happen.

Reforms create pluses and minuses – winners and losers.  The Griffiths Report (1983 – wow…feels like yesterday – and the link is to an HSJ 30 years on review).  One thing that both Roy and Sir Andrew agreed on was regretting the demise of The Firm within hospital specialisms. Teams always seem to have the prospect of fulfilling the promise of better results – better care, lower morbidity and mortality.  (Prof. Michael West’s work when at Lancaster, for the Kings Fund – super set of slides here – “A positive organisational climate is associated with low and declining levels of patient mortality”  Good to know?)

Maybe that’s what it boils down to then.  NICE remit and objectives felt a little bit ethereal and ephemeral to me – I still couldn’t fully describe what it was all for. I got a bit lost in the enormity of the scope of the remit. So I asked Roy Lilley. “It puts a rationale behind the use of resources”. I like it!  Maybe, like most of the super talks I have been to or watched remotely in the past year of the Health Chats with Roy, they have proven to me that, yes the NHS is a behemothic highly complex beast.  But some of the fixes are simple in essence.  Like getting back to The Firm as the central structure with ward rounds and teaching and learning and team work and support and job satisfaction and better outcomes and more effective use of resources and and and…

We just need to stop messing about, and start taking action, not just talking about it.