12/11/2009 by Patrick Keady.

One of the headlines on www.hsj.co.uk today, caught my eye. Managers anger at O’Brien’s name and shame threat.  And then it began to make sense. Mike O’Brien and David Nicholson seem to be speaking the same language!

In each year since 2000, Mike O’Brien and his colleagues in the Blair/Brown Governments, increased their funding of the NHS in England by almost 7% (on average).

And now we are preparing for annual funding increases that will be much closer to 0%. David Nicholson told us earlier this year that the NHS needs to find £15bn-£20bn of savings by 2014. The NHS has two options.

The first is to hit the target and miss the point.

By reducing inputs - cutting staff, closing buildings and increasing waiting lists. Its refreshing that Mike O’Brien does not want to see budgets and services slashed in response to the public sector funding squeeze.

Hitting the target and missing the point would be costly. Patients would not be interested in why NHS services were being cut. They would not want explanations as to why there were less staff on-duty.

Patients expect a return on their investment - for the National Insurance Contributions that they have and/or are making. And my guess is that patients will continue to expect better healthcare.

The second option is to hit the target …. and to hit the point.

By reducing waste in core processes, such as diagnosing, treating, and communicating with patients. By getting the care of patients right first time. By reducing unnecessary readmissions.

By ensuring that clinicians and managers feel empowered to achieve results, to make changes, to take decisions, to drive service improvement, to actively deal with risk.

The NHS is likely to reduce waste in core processes, when Directors of Finance and their colleagues become even more actively involved in process improvement and removing waste. When they continue allocating serious investment in the development of improvement capability. By continuing to focus on cost per unit, and not expecting increased funding from the Government or elsewhere.

My guess is that Mike O’Brien will not ‘name and shame’. Because the NHS will actively work to reduce waste in its core processes. And that the NHS will find the £15-£20bn of savings by 2014. And because Mike O’Brien and David Nicholson will continue to speak the same language.

Posted in Innovation, Creativity, Risk Management, Patrick Keady, NHS, David Nicholson, Strategy | Print | No Comments »

11/07/2008 by Patrick Keady.

I was interviewed for the NHS60 celebrations that took place at Wembley Stadium on 1st July. The NHS60 - 1990’s - Managers interview was one of six, that were broadcast on Sky 168, as part of  the NHS Live Annual Conference. The six interviews were rebroadcast on Sky 167 in the days following the Conference. They are now streaming on the Department of Health YouTube channel. You can see the individual interviews by clicking on the appropriate link:

• 1940s - Before the NHS - Roy McIaney, John Taverner
• 1950s - Children - John Taverner
• 1960s - Nursing - Marie Jaswal, Olwen Al Bermani
• 1970s - GPs - Dr Pravin Shah
• 1980s - Paramedics - Doug Wisener, Dr Mohammed Akhtar
• 1990s - Managers - Patrick Keady, Olwen Al Bermani

Posted in Gas Street Works, Darzi, David Nicholson, Patrick Keady, Wembley, Safety, Patient, Governance, NHS, Health and | Print | No Comments »

23/05/2008 by Patrick Keady.

Josephine Ocloo

Krista Ocloo, was born in 1979. Her congenital cardiac abnormality was successfully repaired at an NHS Hospital, shortly before Krista’s second birthday. She went on to enjoy a happy and normal childhood and early teen years. But in 1995, Krista started to complain of chest pain. In January 1996, she was admitted to the same NHS Trust for an exploratory catheterisation.

Krista’s mum, Josephine, was assured by the NHS, that Krista was perfectly all right and that an appointment would be booked for another check-up. Krista was discharged but the appointment was not scheduled until January 1997.

On 5th December 1996, Josephine found Krista at home in bed …….. Krista was dead. The post-mortem revealed death from acute heart failure.

Josephine Ocloo, relayed her story to the 600 delegates at today’s Patient Safety Congress. The Nursing Director next to me, stopped taking notes. She placed her notebook on the floor and gave her undivided attention to Josephine Ocloo. Josephine then described how she tried to get answers from the NHS Trust. Josephine wanted to know why Krista had died. SheJosephine described an NHS that was at best, unhelpful. Around me, I saw some tears, I heard lots of sniffles …… and there was very little note-taking.

Krista died before the introduction of Clinical Governance, the Turnbull Report, Choice and Competition as we know it today. But what can today’s NHS do to ensure that all of today’s patients get a better service than Krista received 12 years ago? Professor Bernard Crump (Chief Executive of the NHS Institute for Innovation and Improvement) asked delegates for their thoughts. He asked them to identify which one of the following can best improve patient safety

1. Regulation and Standards
2. Commissioning, Competition and Choice
3. the personal motivation of NHS professionals, leadership

David Nicholson, Chief Executive of NHS England, told us that delegates and the NHS in general, needs to be clear about the services that we want to deliver for patients. He added that techniques such as PDSA, Lean etc, together with new behaviours, will help.

Don Berwick, President and CEO of the Institution for Healthcare Improvement, added that improving healthcare needs to be embraced in every hospital, by every GP practice and by all healthcare professionals. Professor Cecil Helman alerted us that the definition of health, continues to change. Since the NHS was established in 1948, the definition of health has fragmented into physical, psychological, social and spiritual. David Dalton Chief Executive at the Salford Royal NHS Foundation Trust, joked that his organisation was ‘crap at implementation’. He then added that his Trust reduced Clostridium Difficile infection rates by 70% in 10 months. The Trust achieved this by empowering staff to identify the problems that they wanted to deal with, and giving them the necessary support. Sir Liam Donaldson, Chief Medical Officer, suggested that in 2018, infection prevention might be achieved with the help of sensors, that there might be voice operated electronic prescribing, checklists in surgery and an aviation-style ‘black-box’ in operating theatres. Peter Walsh, Chief Executive of Action against Medical Accidents, pointed out that NPSA Being Open, is only guidance. He urged for a major uptake of training in NPSA Being Open. Rashmi Shukla highlighted the characteristics of a safe system. Eamonn Kelly identified how World-Class Commissioning, the Assurance Framework and the Standard Contract for Acute Services can improve services. Katherine Fenton challenged the role of Strategic Health Authorities, adding that it needs to shift towards motivating their PCTs and Trust improve. Sarah Andrews added that while NHS targets can be useful, the NHS will benefit from celebrating it’s achievements. Gerry Marr from NHS Tayside highlighted how data owned by Clinicians is being used to show decreases in Hospital Acquired Infections. Data from Clinicians in Tayside, will be used to confirm a 15% reduction in mortality and a 30% reduction in adverse events. Martin Fletcher, Chief Executive of the National Patient Safety Agency highlighted Royal Gwent where there is a 95% compliance with hand hygiene, more than twice the average compliance of 40% in England and Wales. This high level of compliance was achieved because of strong leadership, the use of an effective implementation tool, the measurement of outcomes and providing feedback to staff. To be a Regulator or not to be a Regulator, that was the question! Paul Philip (General Medical Council), Sarah Thewlis (Nursing and Midwifery Council), Gary Needle (Healthcare Commission) and Simon Gregor (Medicines and Healthcare products Regulatory Agency) were all proud of their roles as Regulators. But Professor Bruce Campbell (National Institute for Health and Clinical Excellence) and Professor Dame Joan Higgins (NHS Litigation Authority) emphasised that their Organisations were not Regulators.

And what responses did delegates give to Professor Bernard Crump’s poll? 3% of Delegates voted regulation and standards as the most effective approach to improving Patient Safety. 2% went for Commissioning, competition and choice. The other 95% opted for the personal motivation of NHS professionals and effective leadership.

Is it a coincidence that in the 12 years since Krista’s death, we have seen a plethora of activity in the areas that received the fewest votes? – regulation, standards, commissioning, competition and choice.

It is refreshing that based on the messages from these speakers, that effective leadership and the motivation of staff is leading to dramatic improvements in parts of the NHS.

Posted in Safety, David Nicholson, NHS, Governance, Health and, Patient, Strategy | Print | No Comments »

18/05/2008 by Patrick Keady.

After watching the BBC2 programme Wild China, I was left wondering if there are similarities between NHS teams and the fishing team featured in the programme.

The BBC2 programme introduced men in their 70’s and 80’s. They chant and dance on rafts and are assisted by their well-trained team mates ….. a group of Cormorants. Between them, the team catches up to 30 decent-sized fish in a morning.

On Friday morning, the NHS England Chief Executive published The Year 2007/08. In his annual report, David Nicholson confirms that NHS England is on track to reduce waiting times to one sixth of what they were 10 years ago. By the end of 2008 all patients will wait less than 18 weeks from the date that they are referred by their GP, to date that they are treated.

In the opening paragraphs, the Chief Executive mentions that NHS England went through one of its most significant restructures in 2007/08. With the introduction of Modernising Medical Careers, 30,000 NHS Junior Doctors were left to compete for around 23,000 posts. About half of the pre-merger Strategic Health Authority employees have gone. Up to half of the pre-merger PCT employees are no longer there. And in the 2006/07 financial year, 1000’s of NHS Trust employees became surplus to requirements. Do we know where these people today?

NHS England successes during 2007/08 include rates of MRSA bloodstream infections in acute hospitals being reduced by 50%. All NHS patients in England are now free to choose where their elective care takes place. The median waiting time for diagnostic tests is 2.1 weeks, compared with 6.1 weeks in April 2006. All patients wait less than 4 hours in Accident and Emergency Departments.

While these are fantastic improvements, Mr Nicholson adds that more needs to be done. Lord Darzi’s plans for the next 10 years, are being published. They provide an excellent opportunity to bring about real and lasting improvements for all patients in England. The Chief Executive acknowledges that his job - and that of every leader and member of staff in the NHS - is to seize this opportunity and to make it happen.

The fishermen in Western China seize their opportunities too. But the Cormorants on the Lee River are aware. They keep a tally of the number of fish they catch, up to 7. And after that, they expect to be rewarded, or they withdraw. We know that NHS staff are keeping a tally too and that it has far exceeded 7! The reward that NHS staff often want is simply to be thanked for yet another job well done. NHS staff value job security, job satisfaction, good working conditions and appropriate training.

Many NHS organisations are responding well to the expectations of their staff. The NHS is clearly improving its services to patients. But after one of the NHS’s most significant restructures, an important challenge for all NHS organisations is to continue motivating and acknowledging the successes of their employees.

Posted in David Nicholson, NHS, Personal Development, Strategy | Print | No Comments »