This Weeks NHS News Roundup

primary_care_training_postage_stamp

Got it licked…

The world’s most valuable stamp sold for $9.5m.  It is the British Guiana, One-Cent Magenta.  Issued in limited numbers, in 1865 and is the only one known to exist.

That is an expensive stamp… cost a fortune.  Well, expensive or costly?  Let’s think about this.

There’s a difference between expensive, which means anything better than ordinary things, like expensive watch, expensive car, or expensive wines.  And, costly, meaning beyond the budget and something for which you might have to pay for, dearly, later!

The One Cent Magenta is expensive.  Strangely, it is ordinary stamps that are much more costly than you’d think…

I know a hospital that admits to spending around a million pounds a year on postage.  Now that is costly!  More than that, it is excessive, an arm-and-a-leg and profligate.  The good news is, they know and they are going to stamp it out… so to speak.

The majority of stamps are used for posting outpatient appointments; bookings, cancellations and fiddle-faddle.

They have a simple solution.  A neat piece of software that links to their patient administration system.  

Here’s how it works…

The prospective outpatient is sent a text with a live link. With one click they are taken to a portal that recognises them.  

After a smart security check, the patient is invited to book their appointment, which is immediately confirmed with a letter sent to the patient’s phone, tablet or computer.

It can also manage cancellations and more fiddle-faddle.  Oh, and sends a reminder.

That’s only the beginning.  

Once the patient is on the portal they are easy to network.  

They can see their health record, sort out medications, ask questions and the really smart bit; elect to have a virtual outpatient appointment and talk to a Doc on FaceTime or Skype.

You can do virtual clinics, Physio and pain reporting, all because they stopped buying stamps.

When we talk about the need to save money we think about Lord Bog Roll and the price of a bandage.  That’s just doing what we do, cheaper.  Cutting the expense of doing the same thing.  

If doing the something is costly… costly will always be costly even if you reduce the price. You might buy stamps at a discount, get cheaper paper and brown envelopes, but it’s still costly.

We need to stop doing costly things… Lord Carter should ban stamps.  Make it a crime to buy them.  

If you keep buying stamps you’ll keep dragging people into OP clinics.  

Costs in flow?

Bus tickets, hospital car services, car parking charges, time off work, recruiting an accompanying carer, sitting, waiting, assembling notes, lists, receptionists, clerks, nurses, HCAs, doctors, heat, light, lavatories and wear and tear, for something that might just as easily, be done, if it suits the patient… over the phone. 

And… occupying space that could be used for day-case surgery, wards, all sorts, that earn the hospital money and gets patients thought their journey quicker.

Start with the stamp and work backwards, why are we buying so many.  

Causal analysis?  

Well, I know there’s no agreed definition but if Cause X is the result of Y happening, we can link high stamp costs (X) to the out-patient appointment processes (Y).  

So, change the process.  Proper thoughtful management. 

Last year there were 100 million outpatient appointments, if each one required only one stamp that’s about £56million, plus the paper, the envelope, printing paraphernalia and the time.  

The reference cost for an outpatient appointment is about £100.  All up; £10,000,000,000.

Stamp out stamps and you put the NHS on a different footing. 

Stamps are for philatelists and there happens to be a very good Philatelic Society, in Milton Keynes.  

Funnily enough it’s where the local hospital, the very impressive Milton Keynes University Hospital FT, is stamping out stamps.

  • If you are running a hospital go and see what they are doing.  
  • If you are doing IT, go and see their stuff.  
  • If you have outpatient clinics… go, make an appointment with the future.  

If you are still buying stamps go and see how Joe and his team have got it licked. 

Have a good weekend.

Equal…

Cottrell Park golf courses.  There are two…

The Mackintosh Course; challenging but playable.  Close to 6,500 yards.  Retains original features from Roman times, set in parklands against the countryside of the Vale of Glamorgan.

The Button Gwinnett; named after one of the 56 who assembled in Philadelphia, 1776, to sign the American Declaration of Independence. Button lived at Cottrell Park in the 17th century.  It’s a shorter course.

Over this middle-class idyl, not the blue skies of the brochure… oh, no… a black cloud hangs.  There’s been a row.  According to the BBC;

‘Accusations that the golf club discriminated against women have been thrown out after a disciplinary hearing.

Lowri Roberts claimed Cottrell Park Golf Resort gave men prime tee times and said the “inequality” was unfair…

… the disciplinary panel said she was guilty of bringing the resort’s name into disrepute.  They banned her for a month.

Ms Roberts, (37, handicap 18) joined the club in 2014, so she could play alongside her husband.

However, she said she soon realised that men and women competed separately on Saturdays.

Ms Roberts, said: “I thought, ‘surely this can’t be allowed in this day and age’.”

The issue was raised in the House of Commons.

Ms Roberts said she was suspended from the club after speaking out in the media, about the issue.’

Dearie me, I thought golf had left the dinosaurs behind years ago?  

It’s all a bit of a shame really as a report from the R&A, golf’s governing body, is concerned that participation in the game is on the way down.  Dropped by 4.3% in the UK and nearly eight percent in the US.

They tell us women are 24% of participants but those numbers are falling and the gender gap is widening. Germany has the second most top-golf courses in Europe and 34% of players are women.  In England we rank 18th, with 13% women.

The equality Act 2010 forces clubs to make women pay the same fees as men.  There is a special dress code for women competitors.  

Make what you will of all that!

Equality.  It’s simple.  You just have to be blind.  Blind to race, colour and gender.

The Tinkerman’s latest is to stop turning a blind eye to the NHS’ gender pay gap.

Male doctors’ basic pay is £67,788… female doctors £57,569. The gap; £10,219 or 15%.  

Make a note; there are more women than men working in the healthcare sector.  There’s to be another shelf-warmer… an independent review and a report by Prof Jane Dacre, President of the RCP.

How is it that, with NHS terms and conditions so heavily prescribed, employment progression, pay banding and government authorised uplifts, we end up with such a yawning gap?

Apparently, the answer is that much of the pay and career progression is based on time served.  

When women take time out for maternity and carer responsibilities, they miss out.  Hence they don’t progress, lose out on medical excellence awards and men fill the career gaps.  There are but a few female top-medics.

I dare say this is true of all women working across the NHS; nurses, managers, allied health professionals… pretty well everyone.

Solutions are not easy.  

Ignoring time-out from the workplace may mean ignoring skills and experience deficits.  

Dealing with a 15% gender pay gap could add millions to the pay bill.  Millions Trusts don’t have and government will not want to fund.  

An easy answer; no man may earn more that the top earning woman in their sector?  Ouch… 

More productively?  

  • Have a good look at the data, find out what is really happening.  Don’t try and fiddle with the problem we think we understand.  Fix the problem we do understand.
  • Recruit more women into the NHS workplace.  
  • Require a greater transparency in reporting the gap.  Name and explain.  
  • Terms and conditions of employment where the default options include flexible, family friendly facillities such as creche, childcare and family leave.  
  • Help staff, taking time-out, to keep across developments with courses, webinars, contact points, social events and learning opportunities.  Make returning easier. 

Equality should not be a goal.  It should be a precondition.  The worst kind of inequality comes when you try and make unequal things equal.

A new deal…

Let’s start the week with the words of a disputed prophet, from a time when the Babylonians were up to no good…

‘You’ll use the old rubble of past lives to build anew, rebuild the foundations from out of your past. You’ll be known as those who can fix anything, restore old ruins, rebuild and renovate, make the community liveable again.’

It’s from Isaiah 58:12.  I’ll not bother you with a detailed explanation, you can find it here.  Suffice-it-to-say, there is mention of 70 years in the answer and given what’s happening to GPs, the Babylon reference is irresistible!  Nothing’s new under the sun!

NHSI and E are, dancing around their handbags, amalgamating, combining and don’t mention the ‘M’ word.  They are in the process of; 

‘…trying to rebuild anew, health services out of the rubble that is Lansley’s legacy and become known as those who can fix anything; restore old ruins, rebuild and renovate, make the services liveable again…’

… with no legal remit they’ll get as close as their lawyers tell them they can.  Quite right, too.

Obviously, there’s been more than a bit of negotiation – pushing the boundaries.  Flirting with the answer to the question; ‘When is a very close alliance, not a merger.’ 

I guess the answer is; ‘when you can do it without troubling Parliament…’ and anyway, who cares?

We can’t ignore, there are a few ‘issues’ with the new marriage; 

  • For my liking, there are too many people with planning and strategy in their titles; what are they going to do?  Strategy is sclerotic, at a time when we need nimble.  Events turn planning into pie-in-the-sky. 
  • Will the new regions really have the autonomy that the old Regions once had?  They should.
  • How will they sit with STPs?  Who cares, they’re finished… fumbled their chance. 
  • The Assembly is a great idea but will take some managing; expect everyone to turn up with their own luggage, skilled in special-case making.
  • And, there’s no COO, one FD and all the Directors, National and Regional will be reporting to two CEOs… form an orderly queue.  Expect everything to be lost in a matrix of incomprehensible management, mystery and mayhem.  The multiple boss dilemma.

Frankly, I’m not too bothered with the answers.  We are on the way back to something that looks like a Department that does Health, Regional Health Authorities and a vertically integrated, population based, capitated budget system, once called district health authorities.  

The problem is; there are four things that desperately need fixing and this heroic remodelling can’t do any of them.

Four things;

  • Funding.  It has to go back to back to 4% pa.  I could live with 3% plus 1% internally generated and retained.  Anything less, the service has to kick up stink. To avoid any uplift going to write down debt, we’ll need some QE for health. 

Make it plain, MPs are responsible for dangerous funding levels, not the NHS.

  • Dump contracting.  Remove the NHS from the purview of the Competition and Markets Authority.  Instead; Integration, innovation and incorporation – the three i’s of modern healthcare.  

Make it plain it is MPs who are responsible for cost, waste and the confusion that markets create.

  • Workforce; there is a global shortage of clinicians and carers.  We have to make England the go-to, you-are-welcome-come-and-build a career-here, destination. 

Make it plain, MPs are responsible for dangerous staffing levels and immigration policy, not the NHS.

  • IT and data; we struggled with poorly drafted legislation that made a mess of Care-dot-Data, not the NHS, not Tim Kelsey… who, incidentally, is having a stonking success in Australia, delivering their version.  Frankly, NHSDigital, Caldicot and the management of data is an incomprehensible mess.  All of it needs to be recalibrated for modern healthcare.  

A job for the MPs.  Not the NHS.

The NHS plays the hand it’s given.   In 2010 it was dealt the 2 of Clubs and 7 of Diamonds and has tried to stay in a game of  Texas Hold ’em ever since.

It’s a miracle it’s still in the game… it is time Parliament gave it a new deal.

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