02/12/2009 by Patrick Keady.

Stephen Ramsden achieved so much at his NHS Foundation Trust. Just six weeks ago, the CQC rated Luton and Dunstable as the best acute trust in NHS East of England. HSJ reported today that he will be leaving the trust in the spring of 2010 after 12 years in the post.

And with 12 years as Chief Executive at his FT, he is a shining NHS example of what makes successful organisations …………successful.

Led by Jeff Immelt, CEO at General Electric, a study found one key trait that is common in all successful companies. Their managers stay in place for along time.

Staying in place for along time, gives them space to extend their abilities, to learn much more about their organisation, to develop the critical connections that make their organisations perform better.

This is what Stephen Ramsden did, as a Chief Executive at Luton and Dunstable. Medical staff become successful because they take similar speciality-specific steps to extend their abilities, to learn about their speciality and to develop critical connections.

Immelt also found the converse, asserting that ‘the places where we’ve churned people like reinsurance, are the places where you will find we’ve failed’. We’ve had examples in the NHS where people are ‘churned like reinsurance’.

We need more Stephen Ramsdens, not less!. And in turn, they need the support of their Boards, their employees, SHAs, Monitor, Governors and other key stakeholders.

Chief Executives need the time and space to get to know their organisations much better, to extent their personal abilities, to develop critical connections, to understand risks and how to manage them effectively.

And in return they will be better placed to ensure that their NHS organisations wrestle with the very real risks of escalating demand and constraining resources.

About Patrick Keady

Patrick helps NHS organisations make better decisions. A former NHS Director of Governance and Strategy, he received awards from the BMA and IOSH. Patrick is a Company Director, a Trustee at a Chartered professional body and Editorial Board member at a peer-reviewed Journal. For more information, click www.betteroutcomes.org

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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.

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17/07/2009 by Patrick Keady.

Listening to Evan Davis on BBC Radio 4, I was particularly interested in the language of his guests.

James Dyson introduced himself as the founder of vacuum cleaners that work better.

Marta Lane Fox, recently appointed Champion of Digital Inclusion, is working to make life better for the six million economically and socially disadvantaged people in the UK that have no access to technology.

And Adrian Ringrose  the chief executive of a company that enables public sector organisations do what they do, by doing all the bits that these organisations don’t want to think about.

When introducing ourselves in the NHS, we tend to use different language. And this episode of BBC Radio 4’s The Bottom Line promised a lot. It was a discussion about creativity and innovation.

To be good at innovation and creativity, Martha Lane Fox said that boldness and self-confidence works for her. James Dyson added that innovation for him is caring about solving problems and taking little incremental steps to get there.

And Adrian Ringrose gave his insight into the public sector. He suggested that it is more important to do what we do in the public sector - by the rules, rather than focusing on the end game.

A generalisation perhaps, he reminded us that it is the end point that matters and we are more likely to get there by building on our mistakes.

And my guess is that this point resonates with you and many leaders in NHS risk management, governance and safety. I enjoyed this edition of BBC Radio 4’s The Bottom Line and I know that you will too.

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12/02/2009 by Patrick Keady.

‘Without a national study, politicians and health professionals go into denial ….. we don’t have a problem’. This was one of the comments for Sir Liam Donaldson when he opened the Patient Safety Research Portfolio Conference this morning at the Royal College of Physicians

Speaking to a selection of the researchers that participated in the 36 patient safety research projects undertaken over seven years, at a cost of about 70p per NHS England employee per annum. He outlined his vision of the ten contributions that patient safety research offers to improving healthcare, as follows:

•    increasing awareness of patient safety - with clinicians, provider organisations and commissioners
•    understanding the causes of patient (un)safe-ty – and in relation to sleep deprivation, Sir Liam reminded us of the importance of the 48 hour week - clinicians are more likely to kill patients when they are tired.
•    more research in the young discipline of patient safety will enhance safety and improve productivity
•    establishing conceptual concepts - to enhance the ‘poverty of concepts in patient safety’
•    developing solutions – including improved design in healthcare, a recurring theme throughout the day
•    setting standards for information – before and after studies, randomised control trials etc
•    informing evidence based care
•    evaluating progress including checklists - twice as effective as education
•    nurturing researchers
•    and promoting leaders in patient safety

Professor Richard Lilford oversaw the Patient Safety Research Portfolio from its inception and this morning, he highlighted some of the successes of the programme. These included Professor Nick Barber’s discovery that nursing homes openly welcomed the prospect of his team observing medication errors and recommending improvements – their willingness could be related to the significant amount of time that care home staff spend in medication-related activities.

The day was chaired by Professor Paul Barach, one of the best Chairs that I’ve seen at a healthcare seminar/conference. He has has a very rare ability. He keeps the audience interested, even during the ‘graveyard shift’.  And he ensured that all 17 leaders in patient safety research, delivered their presentations in less than 4 hours. Now that is a rare achievement.

Citing an (unnamed) study elsewhere in the world, we heard that 9% of clinicians wash their hands before they touch a patient in the operating room and 17% do so after they touch the patient. Enter Professor Sheldon Stone summarising the successes of the Clean Your Hands campaign – and reminding us of the rationale for the campaign - 8% of patients acquire healthcare associated infections and their mortality is six times higher. Direct contact by hand is the main route of infection and Sheldon delivered this very serious message, in an entertaining way.

Chris Fuller described HHOT – the hand hygiene observation tool and Professor George Hanna told us about the checking procedures developed by his team for naso-gastric tubes. Dr Rebecca Lawton highlighted the success and lessons learned in evaluating non-luer spinal connectors.

While risk metrices represent risk and are almost universal in healthcare, Professor John Clarkson highlighted their limitations - they lack a systematic approach. And this is why he and his team are developing a toolbox for healthcare, that will include risk assessment models and tools and a process for escalating the higher risks.

Dr Karin Lowson’s insight into single hospital rooms, was topical and revealing. Patients in single rooms are more satisfied. They are less likely to acquire infection experience medication errors during their hospital stay. That said, some patient in single rooms are more likely to die and experience depression. And the risk of an adverse event and length of stay are about the same for patients in wards and in single rooms.

Much has been said about enhancing the patient safety agenda on the curricula of healthcare professionals. And recommendations as to this an be achieved, were provided by Dr Pauline Pearson and Professor Amanda Howe.

Professor Ian Watt gave an overview of how patients can ensire that clinicians deliver safe patient care – by making sure that the treatment is appropriate for them, that the treatment is as planned and in accordance with the appropriate protocol, and identifying how the health system can be made safer.

Dr Ken Catchpole shared his line of enquiry in operating theatres and elsewhere in healthcare. And he has four key questions. Is the healthcare team’s approach consistent with achieving high standards of care. Is what they are doing acceptable for Ken and his family. Does what the team are doing have to be like this. Is this the best it can be? Simple questions, revealing answers.

And Professor Mary Dixon-Woods outlined six rules for governance in operating theatres. The organisation is geared to promote patient safety. Protocols are deployed appropriately and everyone serves their spirit. Optimum communication. Minimal distraction and interruption. Effective authority and accountability. Reporting patient safety incidents.

Professor Justin Waring is in the process of summarising the outputs from the PSRP under the broad headings of the nature of patient safety, sources of risk and safety, and identifying the future direction for research.

And Martin Fletcher was the final speaker, talking about the science of safety. The NPSA Chief Executive sees the patient safety research agenda developing by networking the researchers, funding more PhD students and running another UK patient safety research conference.
Some of the many highlights for me were hearing about the science of safety, Ken Catchpole’s approach to enquiry in patient safety, how patients can be more assertive, updating the curricula, design of hospitals and non-luer spinal connectors, prospective analysis, competency based training in naso-gastric tubes and handwashing, observing hand hygiene, the benefits and weaknesses of focusing on improving culture and CHUMS.

With many thanks to Sir Liam Donaldson, Professor Lilford, the PSRP team and all of the researchers for making this fantastic conference a reality.

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

08/12/2008 by Patrick Keady.

I received a phone call today from a Company that is undertaking research on behalf of the Department of Health. And they wanted to know what I thought of the Department’s website, www.dh.gov.uk

An interesting question. I am happy with the credibility and content of the website but my only gripe is that some information could be easier to find.

Then I was asked to suggest the sorts of changes that would entice senior people in NHS Organisations to access the website more frequently. My guess is that www.dh.gov.uk could take more of the initiative. With weekly or daily emails, podcasts, text messages and more RSS feeds.

It could include sharing buttons on its webpages so that readers have the opportunity to recommend the pages that they like best - twitter, delicious, stumble and others.

But perhaps the single biggest change that the website could make is to be the ‘click of choice’ to getting information on the NHS. I gave the example of the Annual Health Check, where some information is on www.dh.gov.uk, www.healthcarecommission.org.uk, www.npsa.nhs.uk and on the websites of PCTs and Trusts. In other words, www.dh.gov.uk could enhance the value of the information already on its site by providing links to related information on other websites.

In response to my views on the homepage, I believe that the colours are appropriate, with green meaning health and burgundy representing seniority, the Board if you like.

And in terms of layout, it could ‘borrow’ elements of the style of www.bbc.co.uk which is easy to navigate, uses more colour and changing pictures.

Overall I’m happy with www.dh.gov.uk and I’m delighted that the Department of Health has chosen to incorporate views from it’s website users, before it launches the new upgraded www.dh.gov.uk

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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 »

12/11/2008 by Patrick Keady.

NHS Live has done it again! They promised lots. And then they’ve delivered so much more. Their latest outing, NHS Innovation Live, took place today at the Queen Elizabeth II Center, London.

Designed as a platform for sharing and celebrating some of the many achievements in today’s NHS, the event was hosted by Kathy Sykes, Professor of Sciences and Society at Bristol University and a Trustee of NESTA (National Endowment for Science, Technology and the Arts). Kathy has a knack for being in the right place at the right time. Not a stranger to the media, I like her balanced approach. Kathy is open to the people that she meets, while not loosing sight of the scientific rigour that she has been immersed in throughout her career.

Gill Hicks gave today’s keynote address. Gill lost both of her legs from below the knee on 7th July 2005. Gill told us about the hour or so that she was trapped in a London Underground carriage, her three cardiac arrests before she got to hospital, the make-shift stretcher used to get her there, the Paramedic who challenged discussions to pronounce Gill dead, the Consultant that told her ‘you will get better’, the nurse who got her to the hospital hairdresser just a week after the bombings, the cafeteria staff that chatted with her every morning, the physio who coached her back to her independence and the many other NHS staff that helped her through her recovery.

Interlaced with lots of humour about being Australian and some of the funnier experiences during her recovery, Gill held the mirror up to the 600 delegates at NHS Innovation Live. And what the delegates saw in the mirror, was a former NHS patient that was truly grateful for the services that the NHS provides. What they saw in the mirror was more than sufficient for many of the delegates that had travelled from near and far. And there was so much more to come.

They had many choices. Which two of the twelve breakout sessions would they attend. Did they want to learn how to release the innovator In themselves, or how social innovation can create a new model of health for men. Or maybe they wanted to know more about how Royal Bolton Hospital adopted LEAN Thinking. For the geeks, they could hear about generating and using patient stories to improve the NHS via Web 2.0 technology. Performance people could hear how an SHA is intelligently using information to the manage performance of its PCTs and Trusts. Other choices included how social and cultural background contributes to health beliefs and attitudes to mental distress, the excitement of setting up a social enterprise organization, how to nurture an idea and transform it into something really tangible and effective, exploring the role of charities and other third sector organisations in health innovation, using observation to find out what people do and how they carry out their work, improving understanding and the experience of patient and staff, and understanding mental illness from the perspective of service user.

Yet another excellent NHS Live event – well done to the NHS Live team. Why not sign up for their next event. Its free and they’re at www.nhslive.nhs.uk

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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.

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09/10/2008 by Patrick Keady.

‘The most difficult time for us is when we come up with ideas that no one else has done. This is a key moment. To start to do something about it’

Sir Ranulph Fiennes Bt OBE, The English Mutual Lecture, 9th October 2008

I was one of the lucky 730 people that attended Sir Ranulph Fiennes’s lecture at Worcester Cathedral, in aid of The Wealth of Happiness Foundation. Described by the Guinness Book of Records in1984 as the “World’s Greatest Living Explorer”, Sir Fiennes gave us an insight into what motivation means to him.

Since his birth in 1944, Ranulph served with the Royal Scots Greys, the SAS and the Sultan of Oman before taking up a career as an expedition leader.

He was at the forefront of many exploratory expeditions - the British Expedition on the White Nile 1969; Transglobe (the world’s first surface journey around the world’s polar axis) 1979-82; North Polar Unsupported Expedition (furthest north unsupported record) 1986; Anglo-Soviet North Pole Expedition 1990/91; co-leader of the Ubar Expedition (which in 1991 discovered Ptolomy’s long-lost Atlantis of the Sands, the frankincense centre of the world); leader of the Pentland South Pole expedition 1992/93 (which achieved the first unsupported crossing of the Antarctic Continent and the longest unsupported polar journey in history).

People’s motivation was the principal reason why Sir Fiennes accepted people on to his teams. And his motivation? He told us that in Antarctica, he could sack someone from his team but that it’s very difficult to get rid of them! Ranulph defined motivation as the sum total of everything that happens to us since childhood and how we react to it. And his motivation? Trying to stay ahead of the rivals. He added that you’ve got to be first; it’s no good being second.

Despite suffering from a heart attack and undergoing a double heart bypass operation just four months before, Fiennes completed seven marathons in seven days on seven continents in the Land Rover 7×7x7 Challenge for the British Heart Foundation (2003) – Patagonia (South America), Falkland Islands (Antarctica), Sydney (Australia), Singapore (Asia), London (Europe), Cairo (Africa) and New York (North America)

Speaking after the event, Fiennes said his cardiac surgeon had approved the marathons, providing his heart-rate did not exceed a 130 beats per minute; Fiennes later confessed to having forgotten to pack his heart-rate monitor, and as such does not know how fast his heart was beating.

Sir Fiennes showed many photos but my favourite was a chameleon. He told us that the colour of the chameleon could blend into the background. In green vegetation, it can change to green and in red vegetation it can change to red. But if the background was multicoloured (e.g. a tartan rug), then even the Chameleon would have a problem blending into the background!

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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.

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