11th March 2015

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Health Chat

Dame Julie Mellor, Parliamentary and Health Service Ombudsman in conversation with Roy Lilley

King's Fund 15th April Details here

Worth every minute
News and Comment from Roy Lilley

The NHS is full of acronyms and daft ideas what to call projects. Pioneers, beacons, pathfinders and a load more that befuddles my brain-box just to try and remember... so I won't.


Today, the NHS has a 'Vanguard' to add to its list of project names. Originally from the medieval French, avant-garde. Vanguard could just as easily be The Village Vanguard, one of New York's great jazz rooms. There again there is the Vickers Vanguard; the turbo-prop plane that gave way to the jet era and was relegated to freight carrying. NASA adopted the name for one of its early, ill-fated, rocket programmes.


Apposite, perhaps, that another Vanguard was born a year before the NHS. In 1947 the Standard Motor Company announced the Standard Vanguard family saloon, named after HMS Vanguard... a winning name in post war Britain.


Enthusiasts claimed that the styling of the Vanguard had been influenced by the Russian GAZ-M20 Pobeda, developed in 1943 and went into production in 1946. Personally, I think its round bulbous features were nicked from the American Plymouth.


The dictionary definition of Vanguard is:


"... a group of people leading the way in new developments or ideas."


... and that's just what we have. NHS Vanguardistas;  enthusiasts giving it a go.


Two hundred and sixty brave organisations applied to be a 'Vanguard Geography' (new term, I like that) and just under thirty were chosen. The hearty souls applied to do something I don't really understand and they were chosen by each other to get on and see what they can do.  Some of them are already top performers but so what.


Isn't it fabulous! Vanguard. No one understands it. It takes ages to explain; new models, multispecialty, integrated, enhanced, bridges, informed. Not even Tarzan can do it. There is no central theme or plan or plot or proposal. It is just people doing fabulous stuff that they know will work for them... and you know how I like Fabulous Stuff. This is the work of anarcho-syndicalists.  It doesn't get any better!


This means no policemen... but it doesn't mean no rules. It may mean no government but it does not mean no governance. This doesn't mean centralised dictate instead it means libertarian left.


How delicious it was to hear Labour's Andy Burnham, on the wireless, trying to extricate himself from the politics of the straight jacket, only for his explanation, for why he didn't like 'Vanguards', to wrap him up and padlock his arms back in a self-embrace.


Vanguard has taken the NHS well beyond politics. It has taken it to a new place that says politicians have made enough of a mess, top down, thank you; now it is time for the service to show what it can do, bottom up.


The boundary between primary and secondary care has been made properly porous by multispecialty working.  Vertical integration; if that's your thing, is now possible. At last there is an understanding that the NHS might be a national service but national doesn't have to mean neutral or vanilla. Geography, demographics, education, environment, social class, economics, town and country all scream variance.


Variance demands we vary our approach to make the best of what we have work, where it works best and how. Variance means we can find out what's good and what moves the box, marked average, up the graph


Vanguardistas will test the nerve and the courage of the system. Vanguardistas will leave the centralists and the control freaks sitting on the porch watching the sun go down.


If the Vanguardistas can deliver they will show the way to, not just better services but reveal how they did it. Vanguardisimo is a collegiate movement, sharing what is best and experimenting to find it.  Vanguardising is risky and dangerous.


The NHS was born when we died, of something or other, at 60, after a short illness. Today the NHS cradles and cares for us until we are three score and thirty, perhaps more; struggling with a dozen ailments or more.  We must make our place in the vanguard of healthcare remodelling, world-wide.


Vanguard is not about fragmenting the NHS it is about taking a fragile service and giving it new foundations. The Vanguardistas will produce variations in approach and outcomes but without it we will never know how good the rest could be.


Vanguardistas will drive a coach and horses through Monitor's view of a world, born when Peppa Pig was created. Vanguardistas will create a geography of healthcare in a landscape the flat-earthers will never read.


Vanguard will be trouble, controversial, fought over, undermined, envied and shouted about.


It will be worth every minute. 


What exactly does the Health Ombudsman do?

Find out - I'll be talking with the

Health Ombudsman Dame Julie Mellor - details here


Have a look at the  

Academy of Fabulous Stuff;

Problems looking for solutions - solutions looking for problems.

Make a note; be a sharer this week. 



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Full List of 'Vanguard Geographies'... note the new language; plus background and quotes from the Three Blind Mice and the usual suspects.
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Dame Julie Mellor
Parliamentary & Health Service Ombudsman
In conversation with
Roy Lilley
15th April 2015
King's Fund
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