NHS Primary Care News And Comments Roundup

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Make a difference…

It looks like Number 18 has hardly covered himself in glory in his first few days as Secretary of State for Health+.

He started by hacking-off 200 people who had bought tickets, paid railway fares and in some cases hotel accommodation and air-tickets, by ignoring the convention, of accepting his predecessor’s diary commitments and ducking out of Wednesday’s HealthChat.

Then it emerged his constituency office is part funded by an old mate who now chairs a so-called ‘think tank’ that is waging all-out-war on the NHS.

On Thursday the The Times revealed No18 is a signed up member of the Babylon run, health-app that is demolishing primary care.

Next was a visit to UCH London and later accused them of undervaluing their staff.

Could you expect a new SoS to step into a conversation with me about the NHS.  I don’t see why not, there’s lots of tangential stuff to talk about, like his penchant for AI, Apps and stuff, very much part of the NHS future.

Are we surprised that a Tory MP has got links with a right-wing lobby group?  Not really but if you are really committed to an NHS free at the point… and all the other blah, blah it’s worth remembering… you are who you hang out with.

Is having a GP access App on yer phone a crime?  No, it makes a lot of sense but if you are the one who is going to have to reconcile the BMA, NHSE, funding, public attitudes and GPs going broke… it sends a message.  You are what you do.

No18 has a big job on his hands.  It’s called trust.

On the face of it, can we trust a gung-ho, thoughtless, right-wing technology bobble-hat with our NHS.  Or, are we being asked to Trust a young guy who is very like most other Tory MPs and sees the world through a different optic.

Trust is the foundation of management and leadership.  It is upon Trust everything else is built.  

Workforce survey after survey reports on the engagement, or otherwise of staff.  Last year the Gallup survey reported 70% of US staff are disengaged.  A similar survey here found the percentage to be 48%.

Wellbeing, job satisfaction and trust in management feature heavily.

Building trust is difficult.  Being careless with trust, assuming trust, ignores who we chose to put our faith in.  Because you arrive as the boss doesn’t mean people must trust you. 

Two things are important.

Communication; it’s at the heart of the problem.  Disingenuous communication is toxic.  People aren’t stupid.  They won’t trust someone who has one leg in a think-tank wanting to destroy the NHS and one leg in the DH saying how important the NHS is.

Which message do you believe.  Can you trust the messenger?

Behaviour;  there are two hundred people, looking at train trickets and hotel bills, who will remember No18 for all the wrong reasons.  They will have told 200, relatives, friends and colleagues and they will have told another 200, that No18 doesn’t give a stuff.

So, when No18 writes a ludicrous love letter to the NHS, I don’t know anyone who will take it seriously.

No18 will find the DH like no other department.  He has no power.  Lansley’s lunacy designed that out.  

He has a Mandate; the annual shopping list of wishes.  He also has Chief Executive at NHSE that is better know, completely trusted and more capable that most ministers of state across Whitehall.  All No18 might have is some influence.

You can’t use influence without trust.  No18 will also find he has no money.  So, when it comes to the tough decisions, the cuts, and all the rest that he will find an uplift of 3.4% makes unavoidable, he will need people to trust him.

Put to the test, which he will be… he’s going to find it tough.

The first three months in a job defines you.  Play it right and you will never be more powerful.  Handle it right and you will consolidate relationships that can last a lifetime.  Get it wrong and you’ll spend the next 5 years trying to scrape it off your boots.

Trust is fragile, easily broken and brittle.

Trust makes all the difference and it is the job of No18 to make a difference.

I hope I will…

With the arrival of Matt (… is he a Blood Donor) Hancock, I’m now on my 18th Secretary of State for Health.  They come… they go.

No Secretary of State for Health is ever popular.

The NHS should not be run by politicians.  How should it be run?  Heaven knows.  Whoever runs it, government, private sector, insurance companies, social enterprises… it will always be about the money, more money and all the squabbles around money. 

All the time the money is the public’s money, there will be a minister involved.

Having plenty of money makes the job a lot easier.  Andy Burnham, Labour’s Health Secretary, in the times of Gordon Brown’s plenty, will tell you.  Investment equals staff properly paid, waiting times down to almost zero and some very fine buildings that staff love working in and patients benefit from.

Ah, but… 

‘So much of the money was wasted.  What about PFI?’  

See, there will always be a row over the NHS!

What are we to make of Number 17, Jeremy Hunt’s, Teflon years?  

What was behind the quite words, aura of calm, understanding and simpatico?  Cycling, serenely to work on his bike as the NHS screamed around dealing with blue light emergencies, queuing outside A&E.

The answer; not a lot!  Boxed-in, unable to over-turn the Lansley lunacy and having to fight for every penny.

With no money he could only tinker.  Tinker with safety, efficiency, digital, innovation.  Meanwhile, swamped by demand, he watched targets slip through his fingers.  

Stood-by as good people lost their jobs, for not delivering the impossible.  Pushing for safe care but without the front-line staff to deliver it. 

Make a list of his top five, enduring initiatives… I’m struggling.

What I can tell you; unless you work at the front line of healthcare, you probably wont know about his weekend and night visits to Trusts.  A&E and wards where he changed the bed linen and mopped the floors.  You won’t know about the impact he has had, sitting down, having a cuppa, talking to people about the challenges of their daily routine.

Private visits, never publicised.  He also spent time with families damaged by the NHS.  The first time, I can remember, a SoS doing such a thing.

You’ll know the anger he provoked in the ranks of junior doctors, during their ill-fated strike.  Few know about the quiet meetings he had with junior doctors, trying to unlock the industrial action.

The abuse The Tinkerman accumulated on Twitter carried on, right to the end.

Jeremy Hunt is a career politician but for a record number of years, he campaigned to keep his job.  He could have moved.  He didn’t because, I think, he ‘got health’.  He became fascinated by its complexity, seduced by its emotion and convinced by its mission.

I am sorry to see him go.  Think what he could have done if he had had the money.

Jeremy Hunt is a skilful politician.  When politics becomes an occupation and not a mission we lose something.  I think he was on a mission. 

Privatisation?  ‘If the Tories had wanted to, they’d have done it years ago...’ is what he told me.  

Now, I move on to Number 18.  The former minister for VIP tickets is now the minister for queues and waiting lists.

Number 18 is married to Martha, an osteopath, has three youngsters… rode a winner at Newmarket, played cricket at the North Pole. 

Whenever a new boss arrives, with their vision and ideas, it’s a distraction but they will never be as powerful as they are in the first six months.

What will he do?

There might be a clue; Hancock’s constituency office is partly funded by Neil Record, chairman of the IEA think-tank, who don’t have much good to say about the NHS. 

Time will tell.  

A real kick, administered to the backside of NHSDigital, might be a good first move.  Number 18 understands digital, AI and its potential.  

Getting on, doing stuff, instead of reports into the blinding obvious might be another good start.

Tonight’s HealthChat is off, so I can’t ask him.  

But I hope I will…

Coming home…

I can’t stand it.  The arrogance, the deception, the cheating, the pettiness, the abuse, the excess, the waste, bad -temper, foul language, it’s horrible.  Everything we don’t want.  Everything we don’t want our kids exposed to or even less, involved with.

It’s football… 

I said I wouldn’t watch it… I have!  I’m a sucker, I know.  I’ve contracted World-Cup-itis.  

I remember, 1966, watching England win the Cup.  A tiny black and white TV.  The aerial moved to a precarious position on the sideboard, balanced on the fruit bowl.  

As the game drew closer to the final whistle, so we moved closer to the telly.  At the end of the game Dad let out a huge cheer and the aerial fell off the fruit bowl!

The screen turned into a blizzard of white.  It didn’t matter.  We’d won.  Little did I know how long I’d have to wait, perchance, to see it again.  

Little did I know it would be in full colour, widescreen and stereo!

In the intervening years my affection for football wained.  I regard myself as estranged.  The violence, racial abuse, costs.  But, yes… I’ve been watching! 

I’m always nervous about using sporting metaphors, for half of readers they will be a turn-off and the other half will say it’s the wrong sport.  However…

If you are interested in management and leadership, you will have to be interested in Gareth Southgate, the England manager.

Unlike so many of his predecessors and dare I say, many of his contemporaries, he strikes me as thoughtful, educated, smart, not covered in tattoos and very employable in just about every boardroom I’ve ever been in!

The Football Association produce a magazine.  This week there’s an interview with Southgate, who says; 

‘If players feel you respect them, they are more likely to follow you…’

I’ll pause, whilst you read that again.

There’s much more;

 “I like players to have responsibility; to think about what we are asking them to do, to have an opinion on the way we are asking them to play and the way we are asking them to train,”

“I think if the players have some ownership of what’s going on then that’s going to help them make better decisions on the field and also buy into the way that we are trying to progress.”

How about;

“I like the players to speak up in meetings… like them to have an opinion on the game, because in the 85th minute they have got to make a decision that might win or lose the game and we can’t make all those decisions from the sideline.” 

Cross out ‘player’ and insert colleague, nurse, doctor, manager.  

I particularly like this…

 “I think it is important to listen and I think it is important to get a feel of what motivates the individual.”

Perhaps there is more than something we can all learn from this young man?  

We live in a pressured world where results matter.  So does he.  Our answer to problems is regulation, guidance, legislation, pressure, targets and being shoved around by people who think they can inspect improvement into performance.

We know leaders are visible have a vision and share it, often.  

We know leaders create the time and place for good people to great things.  

We know we seldom do it…. 

… Southgate does. 

Southgate translates that into; players creating their own history, being given the freedom to express their talents.   

He talks about developing individuals to improve the team.  Individuals being given the opportunity to take responsibility. 

He has been an international player and understands what motived him.  He understands disappointment and knows about failure… and he is not frightened of it.

He is an intuitive, talent. 

Leadership and management have porous boundaries; attention to detail, inspiring trust, encouraging people to play a part larger than the job, a commitment beyond a contract, every one on the same page.

I don’t know about the football but it looks like management is coming home.


The bunting’s rolled up.  Enough Birthday Cake consumed to set back public health for another 70 years!  Now… Monday morning reality.

I don’t want to be a curmudgeon but it’s time to move on, draw the line.

Any excuse for a party, yup but beware of celebration syndrome.  Beware of believing; we got here and we don’t have to worry about getting there.

We’ve been smart enough to get through 70 years.  Are we smart enough to get through the next.

There is talk of a ten year plan… no, no, no.  Please… no… it’ll be a huge distraction that will only make conference organisers rich.

In ten years Obama came and went, the first iPhone was sold and destroyed the retail industry, YouTube screwed up copyright lawyers and Babylon set about dismantling primary care.  Who had a ten year plan for that?

Technology will wipe out any thoughts that you can plan for a decade and it is technology that will write the next chapters of NHS history.

Then, there is ‘the people‘… 

We’ve an ageing workforce who have had structured careers in an hierarchical environment that is quickly becoming archaic.  

Today’s Millennials aren’t interested in ten year plans, few will want to be in the same job for life… and anyway re-read the last paragraph.

Technology will turn doctors into interpreters, de-skill the work force and make us place a greater emphasis on human relations.  

Machines will do the tricky bits.  Machines will do the planning.  People should concentrate on what they are good at… people.

The future of the NHS will only be secure when we understand how to get good at people, build great teams and understand we can’t build a great culture until we change the climate.

No one wants to work in top-down, regulated, inspected, regimes invented in the ’60’s.  Told ‘told to do’ by people who can’t do it themselves.  

They want to come to work to feel good, not made to feel stupid.  

There is a worldwide shortage of care staff.  Short-term recruitment campaigns kick the workforce-can down the road.  We should be thinking redesign, flexible, multi-skilled.

Hire for attitude and aptitude… and here’s the real point; if you have a ten year plan, in that ten years, staff turn-over could be 28%.  

A quarter of staff coming and going.  Unless they are recruited with the right attitude, into the right climate every joiner has to figure out where they are ‘in the 10 year plan‘, not in the organisation.

Joining-in to be part of a three moth objective reduces learning curves and brings people in as part of a team.  They hit the ground running, knowing what they have to do today to make the organisation work.

Please… not a ten year plan.

The NHS is not universally the best, no nation is.  But, there’s good stuff out there.  We don’t have to reinvent it.

If there is a plan of any sort, it must be to become a world-class healthcare system by becoming world class, systematic, stealers of ideas.   

We are great at fixing up people with cancer… but we have to find them first and we are not good at that.

We could fix that in three months.  Steal Denmark’s idea.  People with non-specific symptoms, as a first step, get screened for cancer.  It’s a one step service.  We are dabbling with the idea here.  JGDI.

Data… go to Birmingham, see how they are doing paperless.  Copy their stuff, buy the same kit, install it everywhere and get on with the job.

Community interoperability… look what Virgin Care are doing.  Copy their stuff, buy the same kit, install it everywhere and get on with the job.

Single data-base records, go to Israel and re-read the above.

Patient control of their records, go to Australia and re-read the above.

Improve flow through A&E and early discharge, go to the Royal Liverpool and re-read the above.

Got a problem, try The Academy of Fabulous stuff, if the answer isn’t there, there will be someone who will help you… re-read the above.

Our only plan should be find out who is doing good stuff and copy it.

The party is over; for the next ten years we should aim to become world-class scavengers.

If you are interested in finding and sharing the good stuff, join in Fab-Change 70.  Details here.


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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.