22nd May 2015

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Dr Mark Porter

In conversation with Roy Lilley - this is warming up to be a really good 'conversation'!

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.

A culture thing 
News and Comment from Roy Lilley

I've got an earworm and I don't see why I shouldn't try and get rid of it to you! Pass it on.


In the days when being 'number one' meant something, early1984, this song topped the Billboard Charts. It went on to be number one in 16 countries. The song? Karma Chamelion.


Karma, Karma, Karma, Karma, Chameleon.... Are you hooked yet? If not try this! Have I gotcha?


Why am I hooked? Well, I can never write about this particular topic without the song whispers in my ear. The topic? Culture. Karma Chameleon is the work of Culture Club.


What are we going to do about our 'culture-club'? LaLite has been banging on about changing it; everyone talks about 'changing culture'. In this last month I must have sat through three (maybe four) presentations where senior, serious players have stood up and pronounced the NHS needs 'a change in culture'.  I always want to stand up and shout; 'HOW?'


I could just as easily shout 'why'. We have a dedicated workforce of highly qualified, vocationally charged professionals who work their socks off, battling targets, regulators and demand. Guess what... they do it on a Monday, a Tuesday and every day of the week and weekend and then come back and do it all again next week, next month and year after year.


For me, that says the culture of the NHS is hardworking, dedicated, devoted and enthusiastic. What more do you want? What exactly do you want to change?


If I could change anything it would be Boards. Boards that don't monitor, analyse and act on complaints. Boards who listen to the management bugle and are deaf to the earnest whistle blower. Boards that read a balance sheet but don't read, in the eyes of the front-line, what economies and 'new ways of working' mean for the people who actually do the job. Boards who shake the hands of the front-line but don't pick up the vibes.


You can't change culture because it is determined by the climate. The climate is set by example. In some places there are some pretty poor examples.


I am thoroughly, totally and utterly against the excesses, damage and costs of inspection but every time a clodhopping inspector uncovers a howling error my argument is defeated. I am invariably asked; how else would it have been discovered. Answer; by the Board, if it was doing its job.


It is not staff, hospitals and the frontline that should be put in special measures. It is the Boards and particularly the non-executive directors and chairs. Those NEDs who are neither use-nor-ornament.   NEDs who don't hold the executive to account because half of them can't count... at least not well enough to read a set of accounts and figure out what story the spreadsheet paints.  NEDs who don't want to hear from the patient facing front-line of care. 


Of all the people in the organisation it is the NEDs who can change the climate.  As a Board member I would want to be sure all the people working in the organisation could answer a clear and unequivocal 'yes', to these five questions:

  1. Is what I am doing safe and secure for the patient, me and the organisation?
  2. Am I acting with integrity?
  3. Am I working to the professional standards that are set for me?
  4. Am I happy to have what I am doing, right now, appear on the front page of a national newspaper?
  5. Five years from now, will I be seen as having done the right thing?

There can be no hedging, dodging or fudging. The answer has to be a five card, royal flush; yes, yes, yes, yes, yes. The answer has to be spoken and read in the eyes and the body language of the organisation. If there is any scintilla of doubt, raise hell until you find out why and fix it.


Boards can create the weather; that changes the climate and one day might create the right atmosphere to plant the seeds of a new culture.


Karma, Karma, Karma, ooh, ooh, ooh ooh, aah, aah.  Got it?   Sorry. It's a culture thing!


Have a good weekend.  


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18th June 2015
King's Fund
New HealthChat
Lord Darzi
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This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - the DH has been allocated Parliamentary time 'for a short Bill'.  I wonder what it could be?
>>  I'm hearing - Alwen Williams has bailed out of the evaporating TDA to become the CEO of Bart's Health.
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>>  I'm hearing - there were 646,904 baby deliveries last year and there were 26,317 midwives.  I make that about 26 babies a year for each midwife.  Or about 2 babies a week?  What's all the fuss about? 
>>  I'm hearing - come October you'll be able to sign on with a GP wherever you like. 
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