This Weeks News And Comments Roundup From Roy Lilley

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Disappointing…

I don’t know who runs the House of Commons but they need a kick up the backside.

I was at Portcullis House the other evening, for the launch of a paper on IT and paperless-ness and all that other stuff.  

I arrived in good time, just over half an hour in hand, only to be faced with a queue that might have made a football match look respectable.  A line of people, around the block, waiting to get through security.

Thirty five minutes later, still in the queue.  Good job it was a May evening, we survived being just frozen, without the hyperthermia associated with proper winter.

A horrible experience, particularly for several elderly people made to wait.  According to the cheery doorman; ‘This is nothing, you want to see the queues some days…’

One by one, we were admitted to our-Parliament, to divest of everything a-la airlines, through one X-Ray machine and one screening archway, past two men with guns.

It seems to have come as a complete surprise to the HoC authorities that people might want to visit?  Parliament is waving two fingers at the great unwashed who turn up.  Parliament, mooning at electors.  Don’t give a stuff how ill equipped, ill prepared, ill planned their arrangements are.

Which ever dumb bloke it is running the show (its bound to be a bloke, no woman would plan this), get rid of him and sort it out.  It is an insult to the people paying for it.

MPs probably don’t know about this… they have a separate entrance.

When I finally managed to get in (late) my purpose; the launch of; Powerful Patients, Paperless Systems, author, Alan Mark MP.  I was interested because, as far as I can see only the Centre for Policy Studies is doing any thinking.  Other, so-called think-tanks, preoccupied with. ‘there isn’t enough money in the NHS’.  

The CPS came up with the the Lifetime ISA, transferable pensions, the Enterprise Allowance and one or two other policies that are routine.

Yup, its a Tory think-tank and a large part of the report’s introduction is given over to praise for the NHS, mention of the Maymite’s commitment to a long term funding and how The Tinkerman is committed to  technology.  

The Forth Industrial Revolution and stuff about empowering patients.  Making us more efficient, or is it effective?  Dunno.

The report argues for a disaggregated approach, ‘we must avoid a top down approach’ to the IT revolution… and has a gratuitous side-swipe at Connecting For Health, a Labour idea.

It’s wrong, of course.  The lack of a central strategic approach, 150-odd Trusts doing their thing, 200 CCGs, 8,500 GP practices, STPs and 70 local authorities has led us to the electronic Tower of Babel we have now.

Apparently we are to save the NHS with a ‘flourishing ecosystem of Apps’. Gimmestrenght… 

The aim of a paperless NHS, due this year, is pushed back another ten years.  They’ve got that right.  There’s more chance of a paperless lavatory than a paperless NHS.

The report calls for 10 key recommendations (Page 4), no time frame and no costings… no idea how it will happen, plus a bureaucratic ‘report to Parliament’ every year.  Don’t bother going, you’ll still be in the queue this time next year.

There’s loadsa rhetoric and examples of stuff going on outside health.  When the examples run out, the author reverts to kicking Labour.  He seems to forget the Tories have been running the NHS since 2010 and in the lifetime of technology, it’s a life time.

medCrowd gets a mention, the replacement for WhatsApp… one ray of hope in an otherwise very poor document, full of must do, should be, needs to do and no… how to.  Nothing new.  It’s a tarted up wish list.

It makes the mistake they all make.  You can’t have an IT strategy, or a workforce strategy, or any other strategy without a business plan and the NHS doesn’t have a business plan.

Thirty five pages, not worth queuing 35 minutes for.  Disappointing.

Your troubles will go away…

How safe is the NHS?  I’ve no idea.  How do you measure it, compare it, benchmark it?

For most of us the NHS is a life saver, for a few, who have suffered from its mistakes, carelessness and stupidity… it’s a life changer.

Today, about a million people will be in the care of the NHS, someone is bound to come unstuck.  You can’t do a million anything and get a million right first time.

In the US medical errors rank third as cause of death.  Here, UK, EU… it looks to me like it’s guesswork.  We don’t know what we don’t know. 

Errors are rarely the fault of an individual, they are almost always a system fault and even the best hospitals and practices (whatever ‘best’ means) will drop the ball.

Safety?  We don’t have much to go on.  An out of date CQC report will tell us on a particular day, from what they saw, it was OK.  That’s like taking your car in for an MOT and on the way home a wheel falls off; ‘It was OK when we checked it’…. useless.

Hospitals are supposed to be rated on infection control, blood clots, response to national safety alerts and ‘Would you recommend this place to yer granny’.  Not all hosptials have all the data.

I can’t say I think NHSI take it seriously, they’ve had an interim covering the Director of Safety for nearly a year; just got around to hiring a permanent person, from Wales, who thinks ‘England’s lost its national pride’.  Good luck in the job, mate. 

The latest wheeze is incident investigations.  There is a consultation, on-going, on a revised Serious Incident Framework and an eye-drying, clunky, interminable survey.

Why is what we’ve got, not working?  Why can’t we answer the question, are we safe?  I’ll tell you what I think…

Serious incidents are used as a performance measures instead of a learning measure.  Investigations are bolted-on to the day job, when clearly it’s a job in itself.  No one has time to do a proper root-cause-analysis. No national analysis of trends.  

The same stuff keeps happening time and time again and that must tell you something.

The solutions on offer include… 

  • Not investigating everything; picking the right things to investigate?  Bet the farm the easy stuff gets done.  Good luck with that.
  • Every provider to have a trained team of investigators; as we don’t have enough trained teams on the wards… good luck with that.
  • Allow plenty of time for investigation or have a 60 day cut-off; drift, or do.  If it’s not prompt the same stuff will happen in the meantime.  So good luck with that!
  • A national template for reports; there is one now, so good luck with that. 

It’s all pretty useless.

Learning from mishaps, if we are serious and it is important, has to be immediate, zero-tolerance of delays and what’s discovered cascaded as soon as we know it.  

A sense of urgency brings with it an emphasis that it is important, has a point, concernment, significance.

The overlooked issue?  The people.  We need people to say; ‘Whoa, I’ve got that wrong!’  

The only way to achieve that is to de-pompous the GMC and NMC, strip them back to maintaining a register and stop hounding clinicians with all the masonic, legal palaver of hearings that are, ultimately, duplicated by the courts.  

Make Trusts responsible for the conduct of their employees and de-criminalise errors and mistakes.

Clinicians are rarely criminals but they are always human beings and we make mistakes, get confused, get tired, get screwed up by poor systems, bad designs and pressure.

If people think owning up to a mistake could end their career, they’ll hide it and hope.  That is hopeless and serves no purpose.  We have to put a purpose into honesty.  The purpose is to keep us safe and that is all that matters.

To manage means managing the unmanageable, to forgive means forgiving the unforgivable.  To ask people to be honest requires honesty and honestly… 

… the wards aren’t safe, there are not enough staff and rota gaps are not filled.

Start with the basics…  

Value the people on the front line of care, fund it property, make it fun to work there, make sharing the good and the bad routine… and your troubles will go away. 

Integrity…

It seems Ms Rudd’s got herself into a jam. I find it hard to be sympathetic given the the unwarranted and unhelpful attitude she had for the NHS, (not her brief) when it was struggling, along with a dozens of global organisations, with the upshot of the WannaCry attack.

She might be doing a bit of wanna-cry of her own now.  Certainly, as a spectator, this sad affair makes me want to weep….

I thought I’d had my say on the Windrush fiasco.  Silent citizens have been persecuted, lost their jobs, driving licences, the right to travel… pretty well everything you and I would take for granted, as a citizen in the care of our crumbling government.

The plastic apologies, the scramble to protect the Prime Minister from the consequences of her decisions and policies is sick making.  I don’t know what else to say and it’s not often I say that.

Clumsy, cruel, crack-handed government.

All I can think to say is; ‘Not in my name’.

Setting aside the human shield quality Rudd brought to the equation, protecting the cruel excesses of her predecessor, she’s either a fool, slapdash or has a misplaced sense of loyalty.  Time will tell.

We have to assume she told the truth about overlooking briefings and not knowing the details of every nook and cranny of her department.

The first lesson, obvious; the department’s too big.  As migration becomes the myopic focus of our post Brexit world, a Secretary of State for Migration and another one, Secretary of State for Our Homeland, might be no bad thing. 

The more interesting question for leaders of large organisations; when do you quit?

As the boss, you are responsible… but are you always culpable?

The ins and outs, the behaviour of individuals, the nuance and impact of every policy and decision.  When do you stay and when do you go?

The job of the leader is to settle strategy and deliver it, set the organisation’s architecture and make sure the right people are in place.  

It’s easy to become hypnotised, lose a sense of self awareness.  When the people around you tell you what you want to hear, the workaday of large organisations create blind spots.  What is really happening out there?

The predicament is compounded if people around the leader know they can only stay around, if they say the right thing… so, they say the right thing.  

Leaders require no repertoire of magic, just the ability to ask the question ‘why’.  Why do we do it like this.  Why is this happening.  

In any organisation, no matter how big, if three people tell you the same thing, it’s very likely true.

That’s why there is no greater truism; people don’t leave jobs, they leave bosses.

When colleagues have to make themselves look stupid supporting the boss; when a line of integrity is crossed; when the stress of the job is taking a physical toll; when you become the story and the work of the organisation fades into your shadow… that’s when to leave… Ms Rudd. 

Leadership is about responsibility, not power.  When things go wrong leaders may have the power to put it right.  It’s not  a reason to stay.  There are fresh eyes and ears to do that.

The responsible thing; think about the work of the organisation and the people doing it.  The responsible thing; think about the customers, the patients and the people we serve.

Leaders are responsible for the organisation but they are not culpable for everything it does.   Leaders are accountable for their organisation but they are not always to blame.  Leaders carry the can but they may not be at fault.  

Leaders are symbols of their organisation.  They are either a beacon of bright light to guide a safe passage or they cast a long shadow.

Leaders are answerable.   Answerable to the organisation, to the people that the organisation serves but most of all, they are answerable to themselves.  

What does that mean to us; managers, team leaders, chief executives and the board…

In the tumult of the day, the pressures of the moment, we are all answerable to the small still voice within, it has a name; it’s called integrity.

A tale of two Trusts…

I wonder how many times I have started our daily conversation with, ‘I’m on a train…’

Well, I am… on a train.  On a train with the biz-folk, head down tapping their keyboards.  The heady perfume of a nearby couple, holding hands, scrubbed up, ready for a night out in London.  

A bloke, who really shouldn’t, stuffing his face with fruit cake, washing it down with Red Bull.

And… a mysterious slim, fashionable woman, expensive headphones, orange leads, plugged into ears that are already heavy with huge, gold-hooped earnings… engrossed, I’d guess, in Netflix on the screen.  Occasionally, she breaks off and whispers into her iPhone.

I’m heading home after a fabulous day with the enthusiasts that are Musgrove Park Hospital.

They are on an improvement journey… who isn’t.  They are rolling up their sleeves and getting into innovation… who isn’t.  They are doing service redesign… who isn’t.

The difference… they mean it.  It looks to me, if they were a tube of toothpaste, they’d have ‘improvement’ written in the stripes.

They are, doing the 7-outs; 

  • find out, 
  • figure it out, 
  • plan it out 
  • sort it out,
  • try it out, 
  • roll it out,
  • check it out.  

Musgrove have fangly-dangly PowerPoint slides and a PDSA cycle.  If it was a smell it would have a whiff of Lifeboy about it.  

However, on the ground, talking to people, it’s reassuringly Dove.  There is huge buy-in.  They’ve saved money, bed stays and have recruited the invaluable assistance of Bob… bums off beds!  

Austerity, I thought, was an orphan but it may have a distant cousin, innovation. 

Their techniques are very good and I expect we will be featuring them on the Academy, sometime soon.  You can check it out for yourself.  This is a Trust that is trying really, really hard and good luck!

The contrast spoke in my headphones, I’m listening to the news…. another Trust trying really hard.  

Trying, in the teeth of world press attention, trying to run a service for some of our most vulnerable and most anxious.  They are on the news again.  Alder Hey and the sad story of Alfie.

The unwanted attention of the right wing media in the US, who use the story to condemn state run healthcare.  

The unwanted attention of our own media, largely unsympathetic.  

The unwanted attention of the crowds who turn up outside the hospital and chant.  

The unwanted attention of the Courts and their panoply.  

The unwanted attention on the staff, the target of threats and writs.

A series of unwanted events culminating in the Pope sending a Vatican plane to whisk Alfie to Italy and who knows, lifesaving treatment?  Maybe, if miracles happen, who better to summon one.

Alfie has been described as a prisoner of the state.  It’s wrong but it’s right.  In a sense he is.  Somehow we have got ourselves into a situation where the NHS can offer no more than an end and no one is allowed to offer a beginning.

I have no inside track on the events at Alder Hay, every one is tight lipped.  In happier times I have known the Trust to be innovative, caring, leading edge and not afraid to ask for help.

If they thought there was a way, they would have found it.  The problem for Alder Hay, they looked like they are not looking. The message they sent, ‘if we can’t fix Alfie, no one can’.

A situation compounded by the courts, who, consulted for their wisdom, give us no more than process.  

The NHS can do no more, the parents want more.  Alfie, oblivious to anything but his fight for life, was in the Court’s dubious protection.  Obliged to protect him from pain, suffering and it would appear a final throw of the dice.

There is always more to these stories than meets the eye.  Is there an institutional arrogance at Alder Hay?  Are the parents obdurate? Have the Courts lost their humanity?

Musgrove will succeed by finding better ways, listening to the people who deliver care.  

For Alder Hey to succeed we must find a better way to listen to them when they say they can do no more.   For families to succeed we have to listen when they say they want a right to their choice.  Each side must be allowed to follow their conscience.

And justice?  It draws its authority, not from Parliament, neither the courts but from us, the people.

It is us who consent to them being our protectors.  They didn’t protect Alder Hey, they didn’t protect the family and they didn’t protect Alfie.

If society is to continue to protect the courts, by granting our consent… they must find a new way because Alfie may not be our family but he is our people and that makes him our family and that means it could happen to any of us.

In one day, the best of times and the worst of times; a tale of two Trusts.

In the small hours of Saturday morning Alfie grew his wings and is gone.  Who served him best…

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