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11th December 20
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The Future of Primary Care - Is there one? 

HealthChat with Mike Bewick, Clare Gerrada and James Kingsland.

19th January - HealthChat evening - details here 

I'll drink to that
News and Comment from Roy Lilley

It's late. I've lost track of the time. There's just me, a white screen and a pool of orange light from the desk lamp. A glass of Penderyn sits, its amber refraction dancing across the papers.

 

The processor is humming; the only other noises come from the strange creaks that homes make when they are settling down for the night.

 

It's funny how loud a keyboard sounds when there is no other noise. Clickety-clack, the tattoo from the backspace and the full stop ending the polyrhythm with a flourish. I feel obliged to type quietly. I don't know why; there is only me here.

 

Actually, what I really want to do is to hammer the keyboard. Stab the life out of it. I want to type a huge big loud YESSSSSSSSSSSSSSSSSS!

 

At last there is a word that may be making a comeback in the health lexicon. A word we all might get used to typing. The word is SUCCESS. Speaking at the HSJ's lecture evening Tarzan said his officials will create a 'success regime to help struggling Trusts.

 

Wow... my fingers have frozen.

 

Success and failure are two sides of the same coin but they have very different currencies. Tarzan is a manager's manager and 'gets' the difference. There are sound, technical reasons and the difference is important.

 

If the NHS is truly in pursuit of excellence then we have to understand failure. Why things go wrong. Properly understand. Technically called root-cause-analysis.   It can be tedious, methodical; search and sort. Takes ages. More important; fixing the problem, in the disaggregated NHS, doesn't guarantee preventing it occurring elsewhere.

 

For as long as I can remember the NHS has focused on error detection, punishment, bungs and bullying to scrape problems off its shoes.

 

Technically getting stuff wrong is called negative deviance.  That's what the NHS looks for. Focus on ND... what has gone wrong. We don't ask what happened and why, we ask who did it. In consequence, people who make mistakes and errors will try and hide them for fear of sanction, embarrassment at being called a failure and for fear of the beatings that follow!

 

It takes forever and a fortune to unearth mistakes and dig them out. You'll be like the man with a metal detector on Chesil Beach. Where to start? You'll have no idea where to look until errors pop up and then it is too late. No one likes to admit they made a mistake. Particularly if a nightmare of sanctions and disapprobation is to follow.

 

There is another way, the obverse of the coin; positive deviance. Bradley et al, Marra's study and this neat up sum from Lawton and friends describe building on success;

 

'Identifying role models with demonstrable strategies to tackle common problems'.

 

People are sometimes willing to share their successes, hence they are easier to find. Just ask. However, in a repressive environment (like today's NHS) people would rather keep their heads down and go unnoticed.

 

Remember what happened to The Watford CEO, Sam Jones, on the night she won the HSJ CEx of the Year award? The next morning the CQC turned up with its army to find reasons she wasn't that good after all.

 

I'm pretty sure Tarzan gets all that. 

 

The NHS has no way of finding success and is fearful of boasting about it. There is no central, easily accessible repository of good stuff. No one knows what good looks like.

 

When we do find what we like the NHS is hopeless at diffusing it, sharing it, widely. Everett Rogers tells us how to do it across one organisation but not across 400 hospitals with a 'not invented here' mentality.

 

It is worrying that we haven't yet figured out a way to analyse complaints NHS-wide. I find even more worrying we don't get close to even counting the compliments.

 

If we spent as much time on celebrating success as we do crowing over failure the NHS might be a better place.

 

The Penderyn is still there. A jumbo jet rumbles across the night sky.  The processor has whirred into silence. The desk lamp clicked off.

 

Success regimes... I'll drink to that. 

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roy.lilley@nhsmanagers.net 

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Dr Paul Lambden
Postnatal Depression
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News and Stuff
News boy
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>> Ooooh we've touched a nerve with the CQC - Behan didn't like the way we reported the Jill Finney court outcome so he got his lawyer Bertie Leigh from Hempsons to ring me up.  Bertie, according to his website is known as "the top dog in clinical negligence defence work, a  phenomenal lawyer and charismatic speaker."  I don't know about that but I found him a nice enough chap.  (Also on his website I noticed a very succinct briefing on the Duty of Candour, worth a look.)  He said he preferred the Telegraph report, as being more accurate, so here it is.  We were wrong to say Finney won in Court, she didn't; the case was settled.  I was delighted to chat with Bertie, over the merits of the case, and probably spend 750 of the 'top dog's' time to go on the CQC's bill.  I wish we'd had longer Bertie.  I think a PR guru might have said David; 'if it looks like you lost, you've probably lost', man-up and move on.  Is there anyone at the CQC Board holding the executive to account?  Anyway, what do I know?  I'm not a lawyer nor a PR guru.  However, I am delighted to have been given the opportunity to highlight the CQC once again.  Thanks David and Merry Christmas.  Perhaps you'd like to come and do a HealthChat evening and tell us how it's all going?  The floor is yours.
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Clinicians and Managers
Interesting IHM survey about the relationship between clinicians and managers and its impact on patient care.  Who should be the primary decision makers.

Please take a moment to take part. 

Click here.

We will publish the results later.
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Dr Rodney Jones
Another of his starting papers.
Medical Bed Occupancy and Cancelled Operations.
Cuppa Builder's read.
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Coming soon
HealthChat Evenings
Dame Julie Mellor
Health Service Ombudsman
Under fire for her handing of NHS complaints - this will be a really interesting evening.
And
Booking Now
The Future for Primary Care
Mike Bewick,
NHSE primary care boss
 Clare Gerada
former head of the RCGP and leading GP
James Kingsland
President of the NAPC.
King's Fund - 19th January
39.95 + glass of wine and a chat.
Is primary care teetering on the brink of collapse?  What does the5YFV have by way of solutions.  This is a must-go-to conference to hear, chat and quiz the seasoned experts. Come and play Dragon's Den; are you in our out of primary care. 
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>>  I'm hearing that things are so bad at Skipton House, NHSE London's HQ, that this is being attached to all invitations to visit: Just to let you know that following NHS guidelines, we are only able to provide water as refreshment. Please bring anything else you may need.... I will be taking a bottle of Penderyn.         
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