This Weeks NHS Primary Care News Roundup

primary_care_training_overweight chart

Sleeves rolled up…

Do you want to know what’s going on?  It’s easy enough find out.  If you have a morning or two to spare and don’t have much of a life, here are 43 data sets you can trawl through.

  1. Statistics code of practice compliance
  2. 12 month statistics calendar
  3. Recent statistical publications
  4. Statistics contact us
  5. Collections timetable
  6. Revisions documents
  7. General guidance for NHS England collections for data providers and commissioners
  8. Guidance on non-submission of mandatory returns
  9. Accident & emergency attendances and emergency admissions
  10. Ambulance quality indicators
  11. Bed availability and occupancy
  12. Cancelled elective operations
  13. Cancer patient experience survey
  14. Cancer waiting times
  15. Children and young people with an eating disorder waiting times
  16. Combined performance summary
  17. Consultant-led referral to treatment (RTT) waiting times
  18. Critical care bed capacity and urgent operations cancelled
  19. Delayed transfers of care
  20. Dementia assessment and referral
  21. Dental commissioning
  22. Diagnostic imaging dataset
  23. Diagnostic test waiting times and activity
  24. Direct access audiology waiting times
  25. Early intervention in psychosis waiting times
  26. Extended access to general practice
  27. General practice (GP) patient survey
  28. General practice patient survey: dental results
  29. Hospital activity
  30. Mental health community teams activity
  31. Mixed sex accommodation breaches
  32. National patient and staff surveys
  33. NHS 111 minimum data set
  34. NHS Continuing Healthcare and NHS-funded Nursing Care
  35. NHS staff survey in England
  36. Overall patient experience scores
  37. Patient reported outcome measures (PROMs)
  38. Venous thromboembolism (VTE) risk assessment
  39. Winter daily situation reports
  40. Child immunisation
  41. Friends and family test
  42. Health visitor metrics
  43. Maternity and breastfeeding

… perhaps you’ve lost the will to live?  Spare a thought for me… I had to find this lot.

I’m hoping there will be more than a few readers who will know the name, Sir John Harvey-Jones.

A former sailor, sub-mariner, had command of a submarine at twenty four.  Later a spy, who became the chair of loss making ICI, a once huge conglomerate.  He broke it up, reshaped and turned into a profit maker.

He went on the have a career as a TV celebrity, business-fixer.  Nothing like the vulgarity of the Trumping Sugar ‘You’re fired…’ or the discourtesy of Dragon’s Den.  Jones visited companies, made sensible suggestions that were tough but worked.

A most unlikely TV celebrity success that millions watched in prime time.

My point in introducing him; he famously said, no company can focus on more than three things at once.

How right he was!

My list, that the NHS has to focus on, is not the end of it.  There are all the targets and regulatory codswallop.

Harvey-Jones observed;

‘Businesses create an increasing tangle of bureaucratic instructions which seek to legislate for an endless series of unlikely events which have occurred at some time in the organisation’s past . . .’

Yup, that’s the NHS.  The theme that ran through HJ’s work was common-sense.  He thought, Boards were for broad strategy and the rest could be left to the people doing the job.

Common-sense.

Instead we spend thousands and for all I know, millions, employ hundreds and for all I know thousands, to collect data, polish it and put it somewhere.

Do you know where to find Venous thromboembolism (VTE) risk assessment data, or mixed sex accommodation numbers?

I do… and I’m not telling.  If they think people are looking at this stuff it will encourage them to collect more.

Surely, the only purpose of collecting these data is to enable the DH, when asked why there are ambulances queuing around the block, to say;

“We have more ambulances than we have ever had…”

Do we need to collect this stuff?  I mean, really, really?  What would happen if we didn’t.  It’s only worth collecting data if we use it to leverage improvement or dig the foundations of something new.

If you collect data to establish trends, by the time a trend emerges it’s all happened.  It’s a much better idea to have some early warning ambassadors in the organisation.  They will sense if something’s not right.

Remember the old manager’s rule of thumb; if three people, independently tell you the same thing, it’s probably true.

I’d much rather have a realtime worry list than a sheaf of impenetrable data that needs a department to interpret it.

Harvey-Jones knew, common-sense is actually genius that comes to work with its selves rolled up.

Make it happen again…

One thing is for sure; unless we buck our ideas up about so-called ‘public health’ we will spend the rest of our time running up the down escalator.

Governments have done the obvious and easy things.  Clean water, adult literacy and childhood immunisation.  Beyond that, it’s up to us.

Anyone who doesn’t understand a large-latte-to-go and a chocolate muffin is anything but lethal, fattening and a bad idea, is beyond hope.

We are responsible for what goes into our mouths, no one else.  And, what goes into our kids.  End of…

This argument was finessed by Thomas McKeown, the only public health doctor who has had any impact on my thinking.  In 1969 he wrote, in terms;

‘… governments have done all they can, clean water, adult literacy and childhood immunisation.  The rest is up to the extent government is prepared to interfere in the lives of ordinary people…’

He was discussing the emergence of the ‘nanny state’.

So, we have legislation.  Crash helmets, seat belts, no smoking in the workplace.  Health and safety palaver and all the rest.  Legislation works.  It changes behaviour.

Now, we have the latest instalment.  Another report.  This one about obesity and making our kids thin by 2030.  It’s the usual wish list, consultation and time frames no one will ever check.  Most of the report centres on the State doing what my mum and thousands like her, did for me…

Turn ingredients into a meal.  Say ‘no’ and mean it and understand tough love is the best love in the world.

Apparently, the government is going to find ways to do it for us with laws and regulation.  Well, good luck with that.

If this is your ‘thing’, the OECD have a much better read, it’s their ‘Update 2017’.

Here are some sobering factoids for you;

  • More than one in two adults and nearly 1 in 6 children are overweight in OECD countries.
  • Social inequalities in overweight and obesity are strong, especially among women. In about half of the eight countries for which data are available, less-educated women are two to three times more likely to be overweight than those with a higher level of education.
  • In the last few years, some OECD countries have relied on fiscal policies to increase the price of potentially unhealthy products to encourage a healthier diet such as in Belgium, Chile, Finland, France, Hungary and Mexico.
  • Comprehensive policy packages, including not only communication but also school-based interventions, interventions in primary care settings, and broader regulatory and fiscal policies, provide an affordable and cost-effective solution to tackle obesity.

Read it for yourself.  The undertone; none of this is really working.  It’s a slippery slope everywhere.  To be honest that doesn’t tell us very much either but the graph on page five is a stonker! Here it is…

primary_care_training_overweight chart
primary_care_training_overweight chart

Obesity in children 3-17yrs.  In the UK it peaked in 2005 and went progressively down, to 2012 recovered a rise and is flattening now for boys but building for girls.

Do you know why?  I have no idea but we need to know.  Before we embark on another cockamamie policy to ‘do something’, we need to understand the ‘something‘ we are trying to fix.  What can we learn from this?

Are we trying to fix social inequity, education, family life… what?

What happened in 2004/5?

Same sex marriage was affirmed in the US.  Canada’s PM appointed a gender equal cabinet.  NASA found water on Mars.  The Church of England woke up and appointed a female Bishop and the WHO announced the Ebola epidemic, over…

… I doubt any of that has a bearing on our kids.  In 2012 we had the Olympics on our door-step.  What happened to the legacy?

What happened in 2005?  What happened in 2012?  Was it the end of the Sure Start policy?  Was it the bite of austerity, families resorting to cheap food and food-banks.

Was it parents working their backsides off, with zero hours contracts and the schools taking on the role of proxy-parents?

What happened to our kids in 2005 that we must make happen again?

Forever and for now…

It’s Monday morning and for NHS managers everywhere, it could be the beginning of the most important week in your career.

It is the week when you should be very, very afraid.

It is the the week when you need to be making yourself a promise.  It is the beginning of the week when you become a new manager.

For all the wrong reasons the town of Gosport with its eighty-odd thousand population will be forever etched into the history of the NHS.

There’s been a hospital there since 1889.  Now, we all know about it.  Is there a Gosport where you work, a possible Gosport, a potential Gosport?

How do you know?

Over four hundred people, perhaps 600, have died as a result of inappropriate opioid treatment.  In plain English, they have been killed in what should be one of the safest places in the world, one of our hospitals.

Nurses knew what was going on.  They reported it to managers.  What the nurses knew made trouble for management… hence the nurses were trouble makers.

The nurses told the management who did nothing… a complete gutless failure.

If managers are to have any sense of responsibility, any understanding of the difference between running a place and administrating it, they could and should have acted.

Asked the questions;

‘Tell me doctor, why do so many of your patients die?’

‘You are not a doctor… you wouldn’t understand.’

‘Yup, but I am a son, a grandson, a sister or wife.  I also have a bit of common sense and I can add-up… so, tell me doctor… why do so many of your patients die?’

‘Because I deal with the oldest, frailest and sickest…’

‘Then let’s compare you with other doctors who deal with old, frail and sick people…’

… bullying, meddlesome, butting in?  No, it’s called management.

Forget the GMC, doctors regulating doctors… forget the courts… too ponderous.  Forget the police, they’re busy filling in forms at the police station.  The pharmacist…

This is the week when you and every other NHS manager, should redefine your career.  This is where you know… managers have to mean it. Or what is the point of managers.  We would be better off with self managed teams…. save the money.

Covering things up doesn’t make them go away…

Separating someone with an axe to grind from those with a point to make is your job.  That’s when good managers earn their money.  Exercise judgement.

This is the week when you say; we are going to make this place the safest place on god’s earth.  What ever it takes.

There’s talk about culture.  Forget it, it’s an excuse.  Whoever talks about culture doesn’t understand how organisations work.

Culture is big and somebody else’s job.  We only change culture when we change the climate.  We can change the climate because we are our own eco-structure.

  • We are what we are prepared to walk past… ignore.
  • We are who we are prepared to listen to, or ignore,
  • We are who we hang out with.

We are either the person who barks, ‘Don’t bring me bad news… I just need this done…’

… or, we are the person who says; ‘Tell me. I’m listening, let’s look at the data, what do I need to know.  Help me understand’.

You are the person who understands; integrity trumps everything.  You can only build a career on ethics and honesty, without them, you will only ever do a job.

Managing up and bullying down.  Is that you?

Regulation, fear of prosecution, ostracisation, changing jobs, court cases, pressure and aggravation versus looking the other way, keep your nose clean.  Say nothing.

This is the week we change all that.  If Gosport is for anything, it is for that.

This is the week the Board opens its doors.  This is the week when a whisper becomes a shout.  This is the week when whistle blowing is no more.  The week when the clarion call of honest doubt, uncertainty, criticism and hesitation becomes the fulcrum point of change.

This is the week we learn we must turn the blame culture into learning.  The week we listen to hear and the week we start again and mean it.

If Gosport is for anything it is forever and for now.

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roy.lilley@nhsmanagers.net

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