11th May 2015

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Dr Mark Porter

In conversation with Roy Lilley

Chair of the BMA - just how relevant is the BMA; does anyone listen to them?

Health Chat at the King's Fund 18th June Details here.

An idiot
News and Comment from Roy Lilley

How did the pollsters get it sooo wrong? Having spent a chunk of polling day talking to some, I can tell you. When you tell a pollster what you are going to do, you can; lie, tell the truth, say you don't know or give an answer that makes you feel good, or look good.


Pollsters know all that and 'adjust for it'. They throw-in what they know about you, some history and clever guess work... the machine whirrs and spits out the answer... the wrong answer!


Pollsters who asked you what you just did (exit poll) are more likely to get nearer the truth, less adjustment needed and likely to be more accurate.


Managers know measuring inputs is a mug's game. Measuring outcomes is 'proper'. And, why the Friends and Family Tests is a farce. For reasons of fear, fudge and little in the way of measurable frankness, the F&F Tests is blether. We don't even underpin it with a reality check algorithm.  


So, we are where we are... his nibs is back in Number 10; 'spit-spot', working on his gang for the next few years.


The Tory manifesto was NHS-lite. Lansley air-brushed away.  Promises unmeasurable or undeliverable. Wrapped in the 5YFV; £8bn to keep the lights on (unfunded), 24-7 services (in the middle of a horrendous staffing crisis), bash health and social care heads together in the name of the Better Care Fund and some fluffy bits about mental health, dementia and cancer.


We'll know later today who the new SoS will be.  Who ever it is, the in-tray is the same pile of grief it was on the 6th May: deterioration of performance against targets; 2/3rds of Trusts unable to balance their books... half of them with 'quality' problems. Surviving on bungs and bullying.


I'm waiting for the phone to ring and if I am the new #SoS4NHS I will call for a packet of Hobnobs, a cuppa-builder's, open the window across Whitehall, take a lung full and shout;




We need to stop, think and recalibrate.  Here's a turn of events that spells out, why... 


Just before the election a Trust had a visit from the CQC. Insiders say it cost £600,000 for an army to spend a week 'inspecting' a complex Trust; evaluating outputs by the use of old data, observation and anecdote. The report will say care is good 'but'...


We ignore the fact that management is a science. The NHS is a 'causal-system'; outputs depend on past and present inputs. In English 'the buts'.


Buts = Y(t0) where it depends on x(t) for values of t<t0

Just for the MBA and Masters readers!


In the case of this Trust:


 Buts (as a proxy for quality) = availability of beds / the obduracy of CCGs x the availability of suitably qualified, affordable staff.


Buts = everything outside the control of the Trust (upon which we measure the Trust).


The 'but' is why we need to shout STOP; dial-back and recalibrate.


Stop all utterly pointless CQC inspections, telling us the obvious about outcomes and concentrate on fixing the inputs. That means a focussed campaign here and overseas to recruit, return, train and entice more good people to work in the NHS. And, redesign and reskill a modern workforce tailored to the needs of today.  Trusts cannot do this alone; it is a national problem to be solved by involving overseas embassies, trade delegations, international university networks and the employers. HEE is not nimble enough to catch-up.


Stop all contracting and marketization. It inhibits and slows down change and puts up costs. And, trusting care to the lowest bidder, in the cheapest place is a bad idea which threatens safely and quality. Figure out what we want and put things in place to make sure we get it (from wherever) all the time, every time, until we don't want it any more. If it's innovative, integrating, different... get on with it.


Stop pretending the £8bn does anything more than keep the lights on. They tell me an hour of NHS working full-pelt comes in at about £12m. To deliver the hundreds of staff and resource needed to add over 100 hours a week of full blown activity will need a shed load more money that the NHS does not have.


Stop all targets; recalibrate output measures in the light of the input reality Trusts are facing today.


Stop fiddling with health and social care boundaries.  Get a blank sheet of paper and redesign the relationships between NHS and Social Care, but beware, it may not be any cheaper; Whistle a happy tune and you'll get people marching in step but remember...  someone still has to pay for their boots.


The NHS must catch its breath. It busted a gut in the run up to the election.  Now it's time for some home truths. 


Doing what we are doing isn't working; piling up debts and performance problems. Kidding ourselves we can keep kidding ourselves.


To keep doing what we know doesn't work is the work of an idiot.  The last person we need in Richmond House is an idiot.


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Where are all doctors going to come from? 
18th June 2015
King's Fund
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>>  I'm hearing - the BMA are wondering why they spent all their money on a pre-election, impact free advertising programme, the name of which I can't remember.
>>  I'm hearing - several have written about the Lanc's Trust bosses and their £25k pay rise. Here.  I think it's time for the chair and the NEDs to move on.  They've lost the plot methinks.
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Interesting conference
25th June Birmingham.
Gordon Greenshields
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'Consequential Impact Tax'
Interesting discussion paper around lifestyle behaviour.
Cuppa-builder's read.
Dr Rodney Jones
Are emergency admissions contagious?
Fabulous analysis - must read.
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