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.

Sir James Kingsland, GP. In conversation with Roy Lilley.


Smiling, happy people – James Kingsland GP, OBE & Roy Lilley

Another day, another health-chat?  Well, maybe not – this really grabbed me at the beginning…

And you know I really do like quotes!

“A doctor with a stethoscope and a Cheque book achieves more than a doctor with a stethoscope”.


This is my summary, opinionated as the participants, of the chat between Roy Lilley of NHS mangers .com fame, and Dr James Kingsland, OBE, erstwhile GP, innovator, practical realist and has been there and got the T shirt…

Serendipity and overtly specialised secondary care made him join a GP Training Scheme. Specialists vs. Generalists. Or, as James put it Generalists vs. partialists! Thanks from us all to the ENT Consultant who referred one of their patients to a Dermatologist and James realised he could deal with it, and didn’t need the cost and upheaval of transferring care. Thank you, whoever you are…

Trained at Liverpool. Still a partner in Wallasey (posher bit, on Wirral peninsula, over the water from Liverpool. Scousers call the inhabitants “woolly backs”, due to them having sheep in fields near them…).  He became senior partner at 30 due to two retirements and then an untimely death…

We had the angry tour through the endless, meddlesome reforms (including the sensible swipe at Lansley madness). There was much discussion about perverse incentives built into the systems. About some good nuggets of utility on some of the sweeping changes.  Fund holding could work if you used it right. This was the start of what has evolved into Primary Care Home (Roy…”yes yeah – we’ll get onto that later…”). We did.

I chatted to James afterwards. He took great pride in being the only GP who Mr Lilley has never manage to insult. This acted like a perverse incentive of course, and Roy’s gloves were off.

Here’s the start, just 3 minutes in if you are going to watch the you tube player repeat of the event…(click here for that)

“How many GPS do you have then?” “4 partners, 2 Associates and 2 or 3 in training at any one time”. “So you’ve got 10, 12 thousand patients?” “No, 6000,” “well, no wonder you can offer such access – you’re over doctored! That’s outrageous”.  “Why is immediate access outrageous?”.

I warmed to him.

The model works. It pays, whether it is over- doctored or not.

(Here’s an article explaining it – from James: it is on his LinkedIn page – you may need to be a member: Understanding The Primary Care Home just click on the blue bit…)

Is the NHS being so bottle-necked because of lack of Social Care? It’s possible, but also possible that a system that saves 4% of its budget through business efficiencies, year on year on year must be doing something that needs to be copied?

It is the change fatigue that James’s way of working and thinking is attempting to stop. Keep the organisational memory, so that we can keep the good and add to it. So simple. But you have to be confident that the willing are following you.  It’s the people who make it happen.

Societal change does have to be catered for, of course. And I still contend that there is no one size fits all solution.  That goes for individuals too. Our own healthcare needs keep changing from immediate need for an acute episode, where we will be happy with any healthcare professional. To a longer term condition that requires a little more TLC and continuity – when we want our main professional partner to keep a watch on progress.

Is there a difference between accountable care organsations and Primary Care Home? Is Primary Care Home just really the Buurtzorg idea (click here…I think Burrtzorg should be rolled out over the current UK…see RCN view here), but amplified beyond fully featured nursing care (including prescribing and referral) to include all health care professionals?

I like the empirical approach. If it works then do it and get the evidence during practice, not as a trial. Polish, don’t start small and hope scaling will work.

Is it simple? Maybe it is.  The model as described is what most patients thinks is what happens in their surgery anyway? The triage system at reception (first contact…either physical or electronic or phone), means the patient is directed to the right sort of health care professional, first time, every time. Now Roy expressed shock that untrained staff were given such responsibility. I say, get over yourself, Roy! It is working. It needs new skills inputs and protocols and algorithms. But if it works, why knock it? The partners will still be the ones who go to the GMC or jail, if it all goes wrong, so they must feel confident.

You need horizontal integration of the various professions – which can include some secondary care personnel. You do need a coalition of the willing, the committed, the trusting, the excited.  And a bit of size for muscle.  30 to 50 000 patients. Back office savings, then. And of course, a bigger Cheque book goes with size.  I say horizontal rather than vertical because it is a flat interlocking model of different professional healthcare people picking up leading the individual patient needs at the exactly correct moment.  What’s not to love?

Sometimes you just have to believe.  Start empirically and with organisational memory to build on, not chuck away. Then check and refine in practice.

Then you have a winner…and I think James Kingsland is certainly one of them.








Jonathan Ashworth MP, In Conversation – with Roy Lilley

Jonathan Ashworth, MP, Shadow Minister of Health.

Jonathan Ashworth MP

NHS Managers meeting at The Kings Fund in London. Jon was in conversation with Roy Lilley  (NHS This is my opinionated summary – so if you disagree, check out the You Tube recording, and e mail me! I wasn’t able to get there, but watched on line.  It was a fascinating chat…

Roy Lilley had to allow a breaking news story in – this happens occasionally.  Jonathan had arrived from grilling of Jeremy Hunt in House of Commons regarding 500 000 letters and reports from patient test results that had been discovered in a warehouse. As far as all were aware, no patient safety issues had resulted from the non delivery of reports and letters…as far as they were aware. Interesting legal phrase, I think. Anyway I sometimes wonder if the privatisation of some of the support services only gains a cheaper result, not a better service, in many cases.

Then straight in with the usual Lilley kicking. “Your a good looking bright young man – why waste that on politics?” Good top spin serve, down the centre line…hit straight back to the questioner. “You are a cynical old goat…”.  Audience on side…

This member of the audience was even more onside with the next 20 odd minutes of personal stuff. “You had a difficult upbringing…”. I don’t remember if Roy actually said anything whilst Jonathan told us about his alcoholic father, who wasn’t violent, but who died of his condition ?is that what we say? Addiction? Illness? What? Died two months after not returning from Thailand for Jonathan’s wedding, because he might have been an embarrassment at the event. It was gut wrenching. Watch it if you can, and see if you can stay cynical, and not cry.

(see the You Tube here:  whole event on line)

It is not why he went into politics. Always was addicted from pre-student times, through student politics at Durham, then into researcher for Labour Party and successful by election winner in Leicester. Never done a real job, as Mr Lilley opined…but he was there with his heart, wanting to help change the agenda of government and to get things done. Like helping to support children of alcoholics. Like actively intervening with Sugar Tax and maybe minimum alcohol unit pricing.  His aim is to change policies.  And will feel his time well served if he can do so.

Main experience was gained in the Whips office (we had a Corbyn aside regarding not toeing the line) then Cabinet Office team, Treasury with Gordon Brown, concentrating on economic policy, before landing in Health. As Roy told us he had seen 16 Secretaries of State for health, and perhaps he would be the 17th (maybe not in 2020 was the rejoinder after that…)

He was scathing of the PM who, he suggested, has no interest in the NHS.   That was interesting. Then we got into a bit of blather about Stabilising the NHS, needing more money, STPs helping to aid the transformation, not just frittering the money away on reducing short term problems like waiting lists (so seeing no long term changes).

Most of this was pretty text book stuff to me, and felt rather at odds with the very open start.  Then, we gained a golden nugget of an idea.

“We need to stabilise the relationship between the clashing cultures of local authorities looking after social care, and health being in the Trusts domain.” A potential solution was proffered. How about nationally agreed eligibility criteria for Social Care? Then, overseen by the OBR or similar, the clashing culture wouldn’t clash. 23% of people who used to get local authority support don’t any more after years of austerity measures, Roy informed us. 900 000 people, possibly.

Much of Social care is rationed and or means tested. I personally think we should be putting the Buurtzorg model of looking after people at home as much as we can could help us discharge people more easily from hospital as Ellis as keeping more of them out of there in the first place.  In Holland (where it began) hospital occupancy is about 80%. What are we? About 90 to 93% depending on where you are. Click through and check it out. Thoroughly honest and honourable rising star, I thought. The Portable Eligibility Criteria idea may need a bit of wordsmithing, but hey, you’ve got to start somewhere. We will be seeing more of this man, I feel sure.

5 things you need to do as a CEO

Image result for David Astley OBE

David Astley, OBE

“to survive (and thrive) as a CEO”. That was the sub-title…from an evening with  David Astley, OBE, Non Executive Director at Cambridgeshire and Peterborough STP.  And more…see his LinkedIn profile here

Interesting to note a Liverpool accent in the speaker. Instant kinship for me, as an exiled Scouser. Turns out he went to the same school as me too.  Alsop Comprehensive in Walton in Liverpool. Isn’t networking fascinating?

I’m going to try to sum up David’s talk – and as ever, it will be embellished with my opinions and views, for which I don’t apologise!

What was most enlightening was the simplicity of the ideas and thoughts from his experience. I suppose that what’s experience is for. To give you the confidence to keep things simple.

I think a lot of the themes were designed for those who want to be a Chief Exec in the NHS, so I have to say, the specifics may be well, specific. But the 5 major thought thrusts are very transferable, as I hope you will see.

  1. Is it the career for you? OK, in healthcare, the specific motivation maybe to help to provide safe, effective patient care. Any chief exec needs to expose themselves – you need to be visible. Especially when the going gets tough. It’s even more important to be in there with your teams and staff when the 5 h one T hits the fan. As a public servant though, you are part of the fabric of the community. It is slightly different than being in a business to business organisation.
  2. If this is to be your ‘final’ job, don’t peak too soon. Time your run for the top well.  I counter that with the fact that there is no such thing as ‘the best time’.  And how long will you stay in position?  Some Chief Execs have been very long term in post – 20 years plus. But the average stay is now 20 months. And 20 percent of posts remain unfilled. Not good. David sold it as such a fulfilling job, but for some reason the pressure or lack of support for Chief execs, or the continuing bad press makes it hard to find the right people and to keep them. Maybe this difficulty will be part of the solutions offered by the nationwide Sustainability and Transformation Plans (STPs). I suspect the NHS part of the STPs will learn a lot from the clever back office sharing, partnership and collaborative working, and (heaven forfend) sharing of CEOs that the local government side, who are now budget holders for Social Care have had to do in the last 8 years… Another point David made is that once you have been a Chief Exec, it is hard to go back into the ranks.  Looking at David though, he has carried on in exciting Non Executive Director posts, and heavy involvement in his local STP group. Sounds like a positive bit of giving back to me…
  3. What do you want to be known for? As a CEO in the NHS, you need to remember that you are in a patient care role. All chief execs should remember what their organisation is for. You need to understand yourself – be self insightful. (In my experience, people who move up into management and leadership roles tend to have that ability to both know their good points, their gaps and be analytical enough to create the fixative action plan to sort it and improve.)  Learning from others is another key to focusing on what you want to be remembered for. You need to be honest, and to be you. Staff will notice instantly if you are not authentic. Best to just be you at your best. Don’t try to be anyone else – just be you. Everyone else is taken, remember. David insists that the time of the Heroic Leader is over. Is it time for the Servant Leader? Your job is as simple as being the helper – just make sure you clear the rocks from the runway. Get the right people doing the right things and get out of the way…trust and a bit of humility will go a long way.
  4. Be Flexible.  David didn’t say a lot more than that about this. Perhaps doesn’t need much embellishment!
  5. When the going gets tough…One of my first bosses said that anyone can be a good news manager. The only reason you get paid more to fix the bad news. As an NHS Chief exec, you can imagine the sort of calls you may get ” The Daily Mail is running the story about our trolley waits…they want an interview…”. You need to show a lot of bravery, resilience and understanding especially when you are thinking if you have a job to return to in the morning. You can be very swiftly exposed…and it is how you fix it is how you grow, and keep your refuting growing!

Other great one liners:

  • remember to say thank you. The little things (hand written notes, saying thanks, public praising). Little things have a big effect.
  • When the bell tolls perhaps before you want it too, hope to get out with smiles, claps and thanks…remember you can be the wrong person in role at the wrong time…be honest and brave and move on.
  • In NHS Trusts one of the most important relationships is between the Chief exec and The Chair. It seems to work best when it isn’t too cosy, but that they respect each other.

The Institute of Healthcare  Management – The IHM seems to be heading in the right direction and having this sort of presentation, where someone who has been and still is at the sharp end shows it isn’t rocket science, is powerfully life affirming and confidence building.

You are not alone…

(If you want to join, or find out more – click through here)


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…)


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


…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…


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 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…


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