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.

~WILY Week 4 addendum…sorry!

Two things happened last week – met a  load of new contacts at a media type of networking meeting – Thanks Steve Blacknell for making all the Waffle Club stuff happen!  Nice people, great fun. (link to his biog on IMdB ).  And, as eclectic an array of folk as you will find anywhere…which was part of the fun.

The other big item last week was my single tweet about the NHS – regarding a meeting I summarised in a blog below – The Future of Primary Care.  What was particularly splendid was the number of hits the blog received – well over 600.  Thanks to Roy Lilley for giving me the shout out in his e newsletter. (if you want to read the blog – scroll down…

Thanks all.

NHS Whistle Blowers 2

It is now almost a week since The Speaking Out Summit, chaired by Roy Lilley. (nhsmanagers.net) Here are my (very) edited highlights of the day.

Roy Lilley quoted himself: “I don’t know why managers don’t crawl on their hands and knees, from one end of a hospital to another and grovel, to be told what the front line knows.”  The tone was set.  The aim? “Get the right people in the room (administrators, whistle blowers, lawyers, senior bosses, managers), and see if we can thrash out something practical doable and useful to help people to speak out”.  Easier to write than do, of course, but there was energy in the room.

Roy's Rallying call

Roy’s Rallying call

Dr. Phil Hammond felt he was very inspired by whistle blowers. “Difficulty is the excuse history never accepts”.  (I told you the day was full of thought provocation!)  If we think of whistle blowing (which is still too pejorative  a phrase, and is tainted with ‘snitch’ mentality), but turn it around to feel it is about constructive dialogue for clinical accountability – think of it positively – then we may be on the right journey?  You got the feeling that as lawyers may be complicit in covering up the stench of raking over the masses of dirty linen, the level of inaction on what can only be described as avoidable deaths may well still be occurring?

Phil Hammond calls us to action

Phil Hammond calls us to action

Dean Royles from NHS Employers gave the management view and presented us depressing stats:  54% of complaining staff feel they are never listened to.  If you raise concerns and it is acted on, courageous whistle blowers know that they are likely to lose their jobs. As soon as lawyers get involved, then there is allegation-tennis, claim and counter, and money being wasted.  This was the first mention in the day of mediation being a logical start for all, and keep the lawyers out.  It has worked in Construction – another seriously litigious sector.

It was great to hear from our first ‘celebrity whistle blower’.  Dr David Drew, former Paediatrician.  ‘Former’ – that is the reality of whistle blowing.  Trumped up and spurious allegations to blacken the reputation of the complainant.  And we all lose the services of a good medical practitioner.  It just feels so sad.

Our second celebrity WB, Gary Walker, was a CEO of a trust.  Boards were running hard to hit targets.  I got the feeling that target chasing can yield needless deaths?  Isn’t that sobering?

I loved Prof Christopher Newdick, from University of Reading.  The disasters that have occurred (and he took us through many) centred around core problems: a lack of leadership, a lack of accountability, and a lack of infection control causing a Clostridium Diffcile outbreak in one hospital.  In Stafford, 120 to 150 clinicians ‘knew’ what was happening.  Chris again brought up the target driven mentality leads to the wrong things being done, such that concerns about patient safety, morbidity and mortality were lower down the list of objectives than they should ever be.

700 days is the average tenure of an NHS CEO.  Bucking the trend is Sir Robert Naylor with 14 years at UCLH.  Showing and sharing the vision, leadership, empowerment and sharing of the objectives – like a proper organisation should be run – were the cornerstones of clinical excellence.  He would be the CEO crawling on hands and knees to find out more from the front line…

I’ve mentioned James Titcombe and the avoidable death of his son in my last blog.  It does make all the rest of the day pale for me.  We just have to do more to make speaking out work quickly and effectively.

And that’s where we ended up.  A final brain storm of what to do next.  Roy and the team are currently working on Best Practice Guidelines.  I want the emphasis to change to rewarding speaking out. Let’s think of Speaking Out as the equivalent of Suggestion For Improvement boxes that some organisations still have.  And if the suggestion – any suggestion (investigating poor clinical practice, saving a wasteful methodology, adding a new operating procedure, removing a poor system, pointing out outlying HSMR and why), and lumping them all in together as positive, then we have the change in mentality that is necessary.  And so we can then offer incentives if the suggestion leads to savings.  It just might help the change in behaviour we so desperately need.



Kindness creates confidence

I’ve mentioned Roy Lilley before – hard witting hard-working Health Policy analyst and conference person.  If you have any opinions or feelings for our NHS – you should take a peek.  His latest blog (access via http://www.nhsmanagers.net/newsletter/ ) was about “The Little Things”.  His main story was linking the little things that make a difference in Supermarket choice to the little things that mean a lot if you have to access NHS services.  His mum’s friend had been in hospital recently.  Roy was cringing , waiting for the news of bad behaviour, lack of cleanliness or just bad treatment choice.  He shouldn’t have feared.  They were all so kind.  Everyone was so kind‘, she said.

Now I don’t know about you, but this made Roy proud, even as ‘just a bystander’, as he self deprecatingly described himself.

Little things do mean a lot, don’t they?  It’s that moment when someone says, whilst you are waiting for your Cream Tea order to be taken “I’ll be with you next – sorry about the wait…”  Or conversely, if you have been on hols in Devon last week, and your experience of the same situation was “(…if I don’t look at the customers and race past because I don’t know what I’m doing as I haven’t been trained and no-one seems to be boss around here and I just need to look busy…”) – then that little incident means a lot too.

Little things mean a lot.  Same situation, completely different feeling for me.

De-icer - a little thing that meant a lot to me in February, just left for anyone to use at a company car park

De-icer – a little thing that meant a lot to me in February, just left for anyone to use at a company car park

How often does this sort of thing happen in your daily life?  Yes, the big boys (still mainly boys, sadly) are sitting in their meeting pontificating on strategy and vision.  And the Customer Service team are spending hours on sorting out complaints.  Yes, both are important things to do.  But the way to success is often much simpler and day to day, and it’s too easy to neglect that in our big picture views.  It is about feelings.  It is about being polite and involved and being there and smiling and saying thank-you and fixing stuff and saying sorry and being happy to help and support each other.  That’s all.

And it is so easy to forget it in our busy-ness

Letting go

Another superb blog today from Roy Lilley at NHS Managers. net.  Here’s the bitly link:


“Bitly” is a brilliant free tool that can shorten any link for you – really useful for bloggers and especially useful for tweeters – saving loads of your 140 character limit…

The title of the piece was ‘letting go’.  It is all about trust, delegation, involvement, empowerment and delegating responsibility and accountability.  Yes, if your are chief exec, the buck should indeed stop at your desk (more later) (about desks). And  there do seem to have been too many times recently when the captain has abandoned the ship before all the passengers have been catered for.  But you should let go to get more done.

In case you are not convinced to go read yet, here’s perhaps my favourite section:

Don’t over organise; let-go and give people the space to self-organise and create natural, informal groups, gatherings, huddles and teams.  Leaders will emerge, consensus will surface and people will sparkle.  Give them room to innovate.  Understand it creates more failures than it does successes.  Asking people to innovate without being free to fail is like giving your other half a programme for a West End Show and calling it a night out. 

Isn’t that just stunningly simple?  As with all common sense, it isn’t that common in practice.  It takes guts, and a complete change of focus inside the managers head.


Keep them involved – and informed (from Trainers Library)

If you read my last blog, Funeral for a Friend, we had a movingly sad celebration of a great woman yesterday.  We were in county Durham and had plenty of hours to talk on the coach to and from.  One of my friends has been on courses with me and we chatted.  “I didn’t think I’d be able to let go of that task at all.  I love payroll”. (note from me: it takes all sorts, and thank goodness someone does!). “But our new person is more than capable of doing it – and in fact is embracing the recent PAYE changes easier than I could because it is all new for her. I’ve got 4 days of my month back now”.  I asked how this had been able to happen:

“Because I changed me”.

That is my only concern with any sort of obvious but rare approach.  Roy is right – this is absolutely the way forward.  There will be managers who think “that’s for other people not as successful as me” – and they will be wrong, long term.  There will be others who think “that’s all very well, but I’m paid to manage!”.  And they will expire overworked and unloved.  Then there will be the leaders, who think, “I should be doing this, and more”.  Their teams will thrive.  And so will they.