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16th April  2015
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Sir Robert Francis

In conversation with Roy Lilley

Whistle-Blowing, Complaints, the CQC and Local Guardians   

Health Chat at the King's Fund 18th May Details here. Tickets selling fast.

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News and Comment from Roy Lilley

Ok, go with me on this. Draw a circle. The circle represents a hundred quid. Now mark out a slice of about a third - like you would a Deep Pan Hawaiian.

 

That Pizza bit will represent about 30%; equal to (more or less) the back-office, kit and caboodle, running costs of the NHS. The 70% bit that is left over is, roughly, the equivalent of the staffing costs.

 

So, if the pressure was on to find savings of, let's say 5%, of the 100, what could you do? You could hammer the running costs and save 5% of 30 = 1.50. Or, you could attack the staffing costs and save 3.50. There-in the NHS problem on a plate.  Will Cameron really axe 2,000 nursing jobs

 

The Commonwealth Fund has told us the NHS is probably the most cost efficient health system in the world but the pressure is on to find more savings. More savings even after the calamitous impact of the last round, inspired by McKinsey's ideas and cursed forever with the epithet; 'The Nicholson Challenge'.

 

Faced with the quest for the Holy Grail of running health services on the smell of a five pound note, rather than an actual fiver, we are embarked upon the Vanguard Programme.

 

Vanguard; the cars were produced by the Standard Motor Company in Coventry from a year after the birth of the NHS to 1963. Since then cars and car production has changed out of sight. Custom and practice torn up, new training for new skills and the production process reengineered along the whole pathway. Fabulous improvements in productivity.

 

Along the way Henry Ford instituted the $5 workday... a significant wage in its day, creating loyalty and a new middle class of consumers with enough money to buy the cars they were making.

 

Now, thanks to continuous improvement programmes, Ford, world-wide, makes 16 vehicles every 60 seconds and the assembly-time for a single vehicle is about 90 minutes.

 

From a post war standing start, by 2010, Germany produced +5.5 million cars a year; the U.S 2.7 million. The average auto worker in Germany made $67.14 per hour; the average in the U.S... $33.77 per hour. And, BMW, Mercedes-Benz and Volkswagen are very profitable. In Germany there is no race to the bottom.

 

The German constitution creates work councils in every factory; management and shop floor work together.

 

How? Workforce design, open minded management, training, system design and (make a note) an open, lean, learning, right-first-time delivery culture with no reliance on inspection.

 

What has the global car making industry got to teach us? We'd be fools if we said nothing.

 

I know... patients are not cars, outpatients not pit stops, GPs are not production lines and medicine isn't engineering... but.

 

Go back to the Pizza. Our biggest problem? Workforce costs. Obviously, a lot of NHS staff don't get paid well enough. There is a horrible imbalance between the value we place on the front-line of care, the AHPs and others and management and the board-room.  Whistleblowing and quality issues tell us relationships are often poor.  And, I am far from sure HEE get the urgency, the significance and the import of workforce in the equation.  It looks to me their answer is more of what we do now. 

 

Cheese-pairing a few pounds off supply-chain with 'another strategy' is a mug's game. Answer to that; set a 'percentage-of turnover-cap' limiting what Trusts can spend on the Pizza slice and leave them to sort themselves out.  Investment in systems has made the automotive industry leaders in manufacturing.  Where is the investment in health.

 

The bigger issue is the 70%. We are unlikely to cope with rising demand with fewer staff. We have to deal with the people issues and that means productivity. Productivity doesn't look so good.  Answer? Not more sweating and 15 hour days... 

 

Fixing this means; recognising the workforce was designed at a time when 58% of working men went home for their lunch and when they were 67yrs, after a sort illness, died of something the NHS could do nothing about.

 

Maybe, after 60+yrs, the staffing fundamentals of the NHS are redundant. NHS Careers list 96 workforce headings and that gives us plenty of scope to be smarter about how we do things.

 

The Vanguards are busy merging services, cutting admin and running costs, but they are trapped in a training and workplace environment that will make it near impossible to  do what really needs to be done.

 

If we redesign care we must redesign the skills to deliver it.  We have a willing workforce but it is the right workforce?

 

After 60 years we've changed how we make cars for the better; shouldn't we change how we train people; to make people better? 

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Sir Robert Francis,

in conversation with Roy Lilley 

Details here 

Let's find out about complaints.

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Sir Robert Francis
In conversation with Roy Lilley
18th May 2015
King's Fund
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