Lord Philip Hunt

Lord Philip Hunt, Shadow Deputy Leader of House of Lords, and former Trust Chair 

So here we are again at one of Roy Lilley’s Health Chats.  As you can see from below, I managed to get Lord Hunt to accept one of my books, and to pose with it!

Lord Hunt, Roy Liley & a cook Book

Philip Hunt and Roy Lilley admire my book!

Why was he being there at The Kings Fund?  Apart from the above, he is also Shadow Health Spokesman.  That’s good enough for me…

I had half hoped that Roy Lilley’s avuncular yet barbed style might have morphed into a Paxmanesque routine. How many times would he ask “So, what is Labour’s Health Policy?”

Was I disappointed? Only slightly. Three times was enough.. but it is amazing how you don’t need to be barbed to get some deep insights, and the occasional, “Did I hear that right?” moments.  As always – a health warning here – these are my own views and opinions of the event, and if you were there, you may interpret differently.

NHS Managers.net - and Lord Hunt

Calm before the questions!

He’s been around a bit. Baron Kingsheath (a bit of OK Birmingham), was on a sit-in with Jack Straw as Students Union President back in 1968. It seemed important at the time. Then on to an Iron ore mine in Australia (but as a dish washer in the surface canteen). Been there at a lot of the changes (and there have been a lot) in the NHS.

What always impresses me with the folk who get there – really at the top of their profession, pulling the levers and making things happen, is their sensitivity and ordinariness. But then you get the twinkling intellect – the memory for names, places and what happened – and the absolute passion.  Philip added a dry sense of humour and self deprecation to this mix.

It was the names and anecdotes that hit home for me.  Frank Dobson (so good that Blair sidelined him into standing for London Mayor) – was so different as Health Secretary.  He praised people (heaven forfend…).  He made the service make waiting times come down to a position where it wasn’t worth having private medical cover.  Astonishing. Now they are increasing exponentially.  I wonder if the government has any contact with private health care providers?  Sorry, becoming a bit cynical…

Some other powerful quotes: “…Enforced marketisation”.  I loved that.  And any organisation that has had Activity Based Accounting, or ever cross charged to another part of their organisation will know all it does is cost bureaucratic money.

“Why is the NHS supine in the face of the ludicrous things it is asked to do?”   What a great question.  I suppose there is no leader, no head, no General to turn to, to complain.  Maybe the Trusts and the GPs and the Junior Doctors (such a dismissive nomenclature), should start saying NO?  Maybe just to ask for forgiveness if they screw up, rather than forelock tugging begging for permission to do what they know is right?  “There are a litany of new demands placed on them which are very removed from reality”.  Amen.  Start handing stress back to the rightful owner, you local leaders…and let the central guys sweat.  Or just work with The Vanguards, and cut all the others out.  Maybe only pay for your CQC inspection if you firstly concur, and secondly that their suggestions for improvement actually work.  (What do you mean they don’t make suggestions?  Why pay then?  You wouldn’t pay an external consultant unless their report gave you suggestions?) (That bit was just me ranting, like Roy does occasionally (!) about the CQC and others…)

Lord Hunt was slightly more circumspectly political when the Junior Doctors strike ballot surfaced. No real advice to the other Hunt, but I think there was a glimmer of sparkle in his eyes which I read as ‘serves you right for being so negative and condescending’.  I may be wrong….

Devo-Manc was discussed as a good idea, but will the money really follow? (and if everything is devolved, and we stay in Europe – will we really need 650 in The Commons, and the 850+ of their Lordships?).  Contentiously, the prospect of Social Care being means tested did surface too.  I got the feeling Philip thought it inevitable – and it is happening by stealth anyway.  The Dilnot suggestion for limiting the amount you spent on your Social Care was in the Conservative manifesto, but conveniently dropped once they got in against their own odds…

I have a simpler suggestion.  Means Test all social care, and let the local authorities do that.  But if your mum is in a Nursing Home – as they used to be called – then that should still be NHS funded.  How do we decide it is nursing care?  Simple.  If the ward or home has to be locked, because your mum may walk out and harm herself, then that is Nursing, and should be NHS funded.

Lord Hunt quietly talked of the madness of allowing GPs to look after £80Bn of funds when they look after the governance of it themselves.  No public involved.  No real accountability.  He just quietly dropped that in, as is his style.  If you weren’t there you missed the musings and war stories of a fine man.  I just wish he wasn’t Shadow.

NHS Food and Customer Care – Guest Blog, Jay Dodson

(This is a guest blog from my Old Bull & Bush compadre, Jay Dodson, and his recent stay in a local hospital.  And as he says, if everyone was out one meal earlier, then we could save millions.  It isn’t rocket science.  I also concur completely in his assertion that backside covering is too much of the focus in the NHS,  and other healthcare providers.  It prevents good care – what gets measured gets done.  And if you measure the wrong things…people make it fit to what is measured… (waiting time in A&E causes ambulances not to be used efficiently – patient in an ambulance doesn’t start their 4 hour wait until they cross the threshold. So they stack up outside in ambulances  Absolute imbecility)

In a recent posting of soft skills for hard times, Phil was discussing an evening learning from the experiences of Sarah Wollaston who chairs the Health Committee in the House of Commons. She had posed the question “have any of you spent a night in a cell?”

After a recent two night spell as a guest of the (I)NHS – the (Inter)National Health Service, I would like to pose the question “have any of you spent a night in a hospital bed?”

Jay doing team stuff...

Jay doing team stuff…

OK – so this was only my second experience as an inmate, and the first was nearly 40 years ago! The staffing at the hospital I visited was truly international – multi racial, and multi-cultural through necessity, rather than a diversity policy I’m sure – but I have to say that with one notable exception the customer service and care levels were superb throughout – committed and caring people with natural high quality inter personal skills. Unfortunately the one exception was the first person I met, as I checked into the reception area at 7 am with a nervous but cheery “good morning” – to be greeted with “take a seat and fill in your menu request for later”! What I had been expecting was a calming and confidence enhancing, welcome and summary of what was likely to happen before going for my operation!

After a spell under general anaesthetic, where an excellent surgeon appears to have done a great piece of work and a short spell in a recovery ward, I was fortunate to be transferred to a newly refurbished ward – E bay on Redlands Ward – where as far as I know, nobody was bidding for my newly repaired body. My experiences over the next 36 hours really do make me wonder if the NHS has yet managed to get their priorities right.

My ward was full of mature people, who were recovering from elective surgery – and I’m sure their shared priority was to be fit enough to return home as quickly as possible. The caring good humour of all the staff I met was a great start, although I believe that it’s a great shame that the most highly qualified nursing staff spend far more time on patient administration and “arse covering” than they do on patient care. My deepest disappointment was the food. Overcooked and flavourless food served cold just cannot be the right way to promote recovery. Just imagine a scenario where even in a short stay environment, every patient’s stay could be shortened by one meal – because they had been fed on well balanced, well-cooked nutritious attractive and tasty food – no extra budget required per head, because they go home sooner. Not to mention the knock on benefits of more bed space available, shorter waiting lists, and happier healthier patients.

Now transfer that scenario to longer stay wards, where good food could shorten stays by even more significant time frames. I would love to be involved in an experiment to produce good food in small satellite kitchens serving a small number of wards, and contrast the health results with the failing model of contract caterers providing such an essential promoter of recovery on an entirely inadequate budget. Is this another TV show idea Phil?

Oh and as a final thought, shouldn’t a ward of nearly 30 people have access to more than one bed pan?! The lack of multiple bed pans (which are after all just cheap bits of plastic), stole so much time of highly trained nursing staff one night that could have been far better utilised with enhanced patient care.

To desk, or not to desk?

I did promise to write about desks after my last missive on the NHS.  The application of my off the wall idea may indeed have wider implication and utility, but the pressure cooker environment that is the NHS (constant imposed change that feels intent on killing the service by a thousand cuts being foremost in my mind) provides us with a sensible and captive model.

Here it is.  No board member or their direct reports should have a desk or an office.


What problems would that solve?  (Thanks to Glasstap and Trainers Library for the above)

A consistent theme running through Francis report (1 & 2) and Geoffrey Robinson’s TV series “How to save the NHS”, and my own experience would suggest that a closed door policy exists; that senior managers are remote from front line staff; that there is little input into decision making from staff members.

All solved at a stroke.  The board would have to be out and about.  I’ve mentioned Management by Walking About before – and now we have a simple mechanism to make this happen.  MBWA is just a guru wish without a mechanism to force it to happen.  No office or desk?  You don’t have a choice.

I know managers need to do some work behind closed doors.  There should still be boardrooms and meeting rooms, and the senior team would be able to hot desk there, amongst their team.  And the meetings would still happen there.  And any discipline or private meetings (typing up your resignation letter because you were culpable of presiding over a shambolic service, for example) would happen in small meeting rooms.

Simple.  Successful senior managers spend more than 50% of their time in informal meetings with members of their teams, at all levels of the organisation.  Staff would be shocked and probably amazed at first – they may have to ask “Who are you” when you first arrive on a ward, but that will pass.  But it could work.  Cut the umbilicus between the board and their desks, and we are on our way to fixing the NHS – and maybe other organisations too.

Mid-Staffs – Francis Report

I subscribe to an NHS managers e mail newsletter / blog.  Roy Lilley is most often the writer – and anyone with an interest in the NHS and its management can subscribe (go to www.nhsmanagers.net)   As someone who works with many different people within the NHS and who are suppliers to it, I find it very useful, interesting and deeply upsetting sometimes.

The Francis report is forensic and detailed (nearly 4000 pages with 290 recommendations).  I quote from today’s e mail – written by Professor Brian Edwards:

“Much of what Francis says makes sense but one wishes he had stuck to the big issues rather than chase down every detail, with a lawyer’s instinct.

It is I am afraid a full week’s read for everybody. Expect dozens of Department of Health working parties and expert groups”

And therein lies the problem.

When so many suggestions are made, everyone can point at someone else, and hide behind a working party or two.  At least some big ideas are there.  No more wholesale changes to the NHS – it stops people doing their jobs.  Good!

The very first recommendation is that patients must come first with care delivered by caring, committed and compassionate staff working within a common culture. 

Are you amazed that this needed to be stated?  When did we think filling in a form to say why you hadn’t done what you were supposed to do was better than doing what you want to do as a caring and committed human being?  It could be you in that bed!

So we have more potential for managers hiding away, and not taking responsibility.  Or measuring the wrong things.  Or sacking whistle blowers.  I have three simple recommendations.

  1.  Incentivise whistle blowing – but sack malicious accusers
  2.  Have a medical majority on all Boards
  3. All board appointments should be for three-year terms and all staff should vote for who should be board members

“In the shadow of the Leader” is a very useful concept to apply to most organisational problems – and positives.  The whole sorry episode looks like a failure of management who showed a complete lack of leadership.  End of.  Heads should roll – and lets stop pointing at the workers first!