21/11/2008 by Patrick Keady.

While it seems obvious now, I’d never thought about equality and diversity like this before. Today I learned that equality and diversity affects all of us. Whether its because of gender, race, sexual orientation, bullying, home circumstances, nationality, disability, harassment, age, sickness absence etc.

Run by the Garnett Foundation, today’s session was all about exploring equality and diversity in relation to recruitment and selection. Using a range of interactive approaches, we practised and developed our interviewing skills. While professional actors played a number of diverse parts.

During lively interactive workshops, we explored staff retention and working cultures that foster inclusion and diversity. The training event provided a safe learning environment to highlight areas for improvement in our knowledge and understanding and also to share learning.
While I had heard a lot about the Garnett Foundation,  today’s training session met my expectations, and more.

Posted in Governance, NHS, Safety, Patrick Keady, Legislation, Patient, Strategy, Personal Development, Health and, Uncategorized | Print | No Comments »

15/10/2008 by Patrick Keady.

I chaired NHS Risk Management today. Organised by the Health Service Journal, NHS Risk Management was their first conference that focussed exclusively on risk management.

Birmingham’s Centennial Centre was oozing with energy and attendees including clinical governance managers (10%), safety and health practitioners (15%), risk managers (35%) and directors (40%). And the delegates came from the full spectrum of healthcare organisations: SHA/other (5%), Foundation Trusts (10%), Independent Healthcare (20%), Trusts (30%) and PCTs (35%).

While I’ve been practicing in risk management for 20 years, I had mixed expectations of the conference …… and thankfully it was an enjoyable and informative conference. Here were some of the highlights for me.

Mark Burns, the Safety and Security Adviser at Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust reminded us of how risk management is now directly linked with Corporate Objectives. Trusts are more aware of their risk appetite - the level of risk that they are happy with. And he reflected on how reactions to incidents have improved – senior managers today ask ‘what happened?’ In the past, they would have asked ‘who did it?’

Linda Handley-Wright, the Risk Manager at Derby City PCT expanded on the theme of culture. The key is to make risk management interesting, using LEAN principles and engaging the right people. Linda added that organisations need to address different learning styles – including scenarios, what if’s and linking risk management with other initiatives via training needs analysis. In Derby, they’ve taken Standards for Better Health as the basis of something much better - they’ve produced the Healthy Derby 10-year plan aimed at improving health, commissioning and engagement.

And engagement was a key message from Dr Anne Dyas, a Consultant Microbiologist at Worcestershire Acute Hospitals NHS Trust. Dr Dyas urged that ‘we (people involved in managing risks) must get out there and teach. To be prepared to defend changes in practice with robust evidence’. She warned that changes introduced simply for public relations reasons will not be sustainable. Jobs done in haste will probably be done badly. Dr Dyas added that data is only as good as those that gather it – she warned against multiple data sources. Most extra tasks need extra hands and extra equipment. New initiatives must support the task (of infection prevention and control) and not add to it. And do Dr Dyas’s views work in practice? Definately. Dr Dyas’s team oversaw a significant reduction in MRSA and CDiff at their Trust and this helped them win the 2008 Oxoid Infection Control Team Award.

Anne Cleminson (Trust Secretary) and Steve Bradbury (Risk Manager) from Mersey Care NHS Trust described the key elements of Assurance at their Trust - getting buy-in from key stakeholders, Committees that are fit-for-purpose, an effective Assurance Framework and good communication. And the Trust’s biggest champions are the Non-Executive Directors because of their creativity and innovation.

Ian Strudley, Head of the Health and Social Care Services, Health and Safety Executive, reminded delegates that HSE is all about reducing the real risks – upto 250 people die every year at work in the UK and many more have serious injuries and ill health. HSE reduces the real risks, by balancing risks and benefits. He gave examples of how HSE is working in partnership with organisations such as the Healthcare Commission – agreeing the Concordat for joint working between regulatory and inspecting bodies. HSE works with the NHS Litigation Authority – workshops on stress management standards. And with respect to managing violence and aggression, it works with the NHS Counter Fraud and Security Management Service.

Stephen Williamson, the Corporate Health, Safety and Risk Adviser at University Hospital of South Manchester NHS Foundation Trust reminded us of what the ideal health and safety management system looks like - setting the policy, organizing, planning for action, measuring performance, auditing compliance and review. Steve reflected the views of many delegates with respect to NHS Patient Safety First – that it will succeed with Executive ownership, and clear commitment from clinicians, managers, corporate and support functions.

Gary Hay and David Firth, partners at Capsticks, gave an overview of key legal compliance and regulation. They described the risk-related legislation in place, CNST claims, the NHSLA risk management standards, employment legislation and stress at work. No real surprises there. And then they introduced a case-study about a patient scalded in a bath – and delegates faces lit up. The case study renewed the energy of the audience. The case study felt real and it gave the delegates and opportunity to contribute.

And then the controversial (and most thought-provoking) presentation – on World Class Commissioning. Controversial because it was close to home for many of the delegates. Roger Hymas from Humana, had recently completed a secondment as Director of Commissioning with Hampshire PCT. And he reminded us that on 4th July, the Financial Times proposed that the PCTs be turned into one giant health insurer. Roger highlighted eight ‘tests’ for insurers – and PCTs meet three of the tests, don’t meet another three and possibly meet the remaining two.

Roger identified his top-10 risks facing the NHS. And in reverse order they were:

10. The NHS will run out of money in the longterm, and not before the next general election (possibly June 2010). 2008 is the year when demand is running ahead of budgets and at the same time, PCTs are spending just 15% of what the private sector spends on managing Commissioning – the suggestion here is that PCT Commissioning functions need to be better funded and by implication, they need a greater range of skills in their teams.

9. Practice-based commissioning will not gain traction. While it is estimated that only a third of GPs will be willing and able to make practice-based commissioning deliver in the way that PBC advocates suggest, by increasing PBC activity, the NHS has the potential to redistribute significant amounts of money – with GPs switching patients from one Acute Trust to another.

8. Block contracts remain impenetrable to PCT scrutiny and validation, including mental health block contracts - see Risk 10 above about PCT Commissioning functions.

7. PCTs need to invest more in management systems. In other words if PCTS don’t put aside money to invest in management systems, they’re unlikely to get control of their PCT finances – links with Risk 10 !

6. The supply side will shrink - reducing competition and choice. This will be a consequence of Trust mergers and some of the private sector providers (including ISTCs) retreating from NHS provison

5. Patients need more encouragement to play their role in re-shaping the market. Consumer surveys consistently show that consumers want choice. Patient Choice has much more to do, if it is to achieve its potential.

4,3 and 2 - Is Monitor encouraging Foundation Trusts to be too aggressive in developing their financial strategies (?) through:
- the pursuit of earnings before interest, tax, depreciation and amortisation as a key measure of success.
- the building of significant capital reserves on FT balance sheets
- service line analysis which could lead to huge distortions in provision

PCTs that transfer money to their local FT and other providers are transferring the financial risk to themselves! They are also in danger of losing control of Commissioning. Armed with the management tools developed by Monitor, FTs may choose to cherry-pick the more financially profitable specialties and procedures. And FTs could choose to unilaterally decommission services, putting patients at risk.

1. WCC will not move fast enough - or fail.

What a thought-provoking presentation to end the day. And it suggests that provided PCTs implement robust risk management processes and they invest in management systems, then World Class Commissioning is likely to become a reality.

Posted in NHS, Safety, Patrick Keady, Governance, Legislation, Health and, Patient, Strategy | Print | No Comments »

23/09/2008 by Patrick Keady.

With Dr Hassan Khimji and Professor Chitta Choudhury at the RSPH launch.

I was invited to the launch of the Royal Society for Public Health this afternoon. This new Royal Society is dedicated to the promotion and protection of collective human health and wellbeing. It will advise on policy development, provide education and training services, encourage scientific research, disseminate information and certify products, training centres and processes.

Professor Alan Maryon-Davis in the inaugural chair and the chair elect from April 2009 is Dr Selwyn Hodge. Professor Richard Parish is the chief executive.

Held at the Royal College of Obstetricians and Gynaecologists, many key leaders participated, including:

-    Dame Suzi Leather, chair of the Charity Commission
-    Sir Derek Wanless, author of Securing our Future Health (2002) and Our Future Health Secured? (2007)
-    Sir Ronald De Witt, chief executive of Her Majesty’s Courts Service and executive director of the Department of Constitutional Affairs corporate board
-    Professor Mala Rao, RSPH Ambassador to India
-    Dr Fiona Adshead, Deputy Chief Medical Officer
-    Dr Linda Degutis, president, American Public Health Association
-    Dr Georges Benjamin, chief executive, American Public Health Association

Hazel Stuteley OBE introduced herself as a ‘Sir Derek Groupie’, resulting in the first of many laughs during her presentation. And between the jokes, Hazel gave us a number of very serious messages. She reminded us of the famous Mary Mead quotation, ‘never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it’s the only thing that ever has’.

Hazel told us of how a small group of thoughtful committed citizens in England’s poorest County (Cornwall) did just that ……. in Falmouth. In a true example of multiagency working (health, police, education), significant reductions were achieved in asthma, teenage pregnancies and postnatal depression. There were big improvements in child protection. This and much more was achieved with excellent value for money too – less than 50 pence a day, for each resident.

The Royal Society for Public Health is the result of a merger between the Royal Society of Health and the Royal Institute of Public Health. Membership of the new Royal Society includes professionals from health protection, environmental health, the health professions including medicine, health & safety, food hygiene, nutrition, health promotion, teaching, research, social care and more.

Click here and here for more details of the launch

Posted in Public Health, Safety, Governance, Patient | 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 »

29/06/2008 by Patrick Keady.

The NHS is 60 on Tuesday. Happy birthday to a British treasure that is respected at home and around the world.

And tomorrow, Lord Darzi publishes his views on how the NHS can enhance that respect by delivering even better healthcare over the next 10 years. Further changes in NHS strategy are quaranteed. And as we know, implementing strategies can be challenging. Which reminds me of a research paper that I read recently. Based on the views of 35,000 people, the paper highlights just four areas that make (or break) the effective implementation of strategies.

My view is that by focusing on these four areas, professional groups, SHAs, PCTs and Trusts will be well placed to respond to Lord Darzi’s challenges. The four areas are information, decisions, motivators and structure. Here’s my initial thoughts on how NHS organisations and people working with NHS patients, can be better placed to deliver even better healthcare over the next 10 years.

Information - that important ‘competitive’ information gets to Boards, PCTs, SHAs and the Department of Health, more quickly – from patients, staff, independent healthcare providers, charities. That information flows freely across professional and organisational boundaries. NHS employees and other people employed to work with NHS patients, understand the real impact of their day-to-day choices on patients. Middle managers and clinicians have access to the information that they need to measure the key drivers of their service. That sources of conflict are acknowledged and responded to appropriately.

Decisions - reducing uncertainty will ensure that all people working with NHS Patients, understand the decisions and actions that they are responsible for. People will be clear about the impact of their decisions. They will be happy to be held accountable. Senior clinicians and managers will continue get involved in decisions at speciality/Departmental levels. The culture moves further towards ‘persuade and cajole’ and away from ‘command and control’. Human Resources, Finance and other corporate roles further change their behaviour to support Specialities and Departments.

Motivation is the third driver. Performance will focus more on outcomes – differentiating between high, adequate and low performers. Career advancement and salaries will be strongly influenced by the individual’s ability to deliver on their performance commitments. Even when an NHS organisation has a bad year, and one of its Specialities or Departments has a good year, the Speciality/Departmental gets a bonus – the team earns greater autonomy and financial support to further develop their Speciality/Department.

Structure. Increasingly, promotions will be from one position to another on the same level in the hierarchy. Fast-track employees can expect to be promoted upwards, at least every three years. Middle managers have a minimum of five direct reports.

So there you have it - my thoughts on four drivers that will help translate Dr Darzi’s thoughts into reality. Having worked with the NHS for 17 years, I know that we have the ability to achieve this. My gut-feel is that we will exceed! Here’s to even better NHS outcomes over the next 10 years.

Posted in NHS, Safety, Darzi, Governance, Patient, Strategy, Health and, Uncategorized | Print | No Comments »

11/06/2008 by Patrick Keady.

I was interviewed today. About what it was like to be an NHS manager in the 1990’s.

The interview was recorded. With just one day’s notice, preparing for the interview, was interesting. While I knew that there would be three people in the studio – interviewer, cameraman and me - I was aware that a lot more people were likely to see the video. This is when I thought …… oops, gulp, do I really want to participate in the interview! So I realised that I needed a plan. But what might it look like? Well after some thought, these are the actions that I came up with:

1. looking at the interviewer, not on the camera
2. dressing in NHS manager uniform ….. the suit
3. being aware of my posture
4. speaking more slowly than usual, so that I had more time to fully express my thoughts
5. predicting the likely questions that I might be asked
6. identifying the key messages that I wanted to get across about what it was like when I was an NHS manager in the 1990s
7. switching the mobile phone off, removing coins from my pockets and asking that the TV screen set was switched off, so that I could not see myself being interviewed
8. having examples prepared, so that my messages were personal to me
9. expecting the unexpected, flexibility would be a bonus
10. being an active participant - because the camera (and audience) would see everything - posture, energy, facial expression
11. taking a brisk walk beforehand - to get the adrenaline flowing

So did the plan work? While I haven’t seen the video, I was happy with how the interview was managed by the interviewer and cameraman. These guys clearly knew what they were doing. I will post a link on this blog, after the interview is broadcast.

Posted in Wembley, Gas Street Works, Patrick Keady, Safety, NHS, Health and, Patient, Governance, Personal Development | 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 »

22/05/2008 by Patrick Keady.

In my last contribution (18th May), I concluded that an important challenge for all NHS organisations, is to continue motivating and acknowledging the successes of their employees. But I didn’t suggest how Organisations can make this a reality.

Today I saw an excellent example of how NHS Organisations can do just that. I was one of 600 delegates at the 2008 Patient Safety Congress. An impressive contribution came from a speaker not listed on the programme, the Prime Minister, Gordon Brown.

He acknowledged that NHS staff and partners are not thanked enough for their commitment to patients. Mr Brown reminded us that NHS staff are the pride of the UK. He shared with us how the NHS cared for him , following a rugby injury, sustained at the age of 16. He told us that he was grateful for everything we do. A Consultant Anaesthetist in the audience put his hand up to his eye. The Chief Executive sitting in front of me, cleared this throat.

Mr Brown’s short visit was was unexpected. But his contribution was effective because he acknowledged the commitment of NHS staff and he shared some of his personal experiences with us. Click here to see Mr Brown’s address to the Patient Safety Congress 2008.

Posted in NHS, Safety, Governance, Patient, Health and, Personal Development | Print | No Comments »

09/05/2008 by Patrick Keady.

It continues to surprise me, when I read articles in the papers about (in their words) “health and safety Nazis”, “health and safety Gestapo” and “health and Safety Taliban”. The papers seem to assume that we’re ‘bureaucratic’ Sharon’s or ‘tick-box’ Kevin’s. Perhaps I’m a ‘risk assessment’ Patrick ….. RAP for short!

Joking aside, health and safety professionals rarely make the decisions that lead to the headlines. These headline-grabbing decisions are usually made by people looking for an reason not to do something ….. something that they don’t want to do anyway! These non-health and safety professionals make decisions in the name of health and safety that unnecessarily stop people’s fun and makes life unnecessarily difficult. And I’ve found an exception. Bulmers in Clonmel (Ireland).

Bulmers sacked eight staff for “serious health and safety breaches” that were captured on a mobile phone and published on www.youtube.com. SIPTU, the Trade Union representing the staff, said it would not be appealing the decision of the company unless asked by individual employees to do otherwise.

The dismissed staff lost their jobs after footage taken at the Bulmers plant showed workers wearing high-visibility vests jumping into moving forklifts, setting driverless vehicles moving across the warehouse floor and then sprinting after them, spraying fire-extinguishers and somersaulting from stacks of crates onto cardboard boxes.

Click here and to read more and click ‘Working Hard at Bulmers’ to see the YouTube footage.

Posted in Safety, Governance, Health and | Print | No Comments »