14th July 2015

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Lord Darzi

Health Chat 15th July - King's Fund - London

 Details here.

Pursuit of Excellence
News and Comment from Roy Lilley

Rheology... that's the answer. Well, actually; thixotropic rheology. And, if that's the answer, what's the question!


"What science was it, in 1955, that enabled Leonardo Marrafino to appear in the annals of personal hygiene history?"


Unless you are a complete anorak I doubt you'll know what I'm talking about!


Marrafino invented stripes in tooth paste. Rheology is the science behind how the stripes retain their shape after being squeezed into and out of the tube. No matter where you squeeze the tube, the red, white and blue stripes still stream out of the nozzle.


From the beginning of a new tube, to when you've squashed it under the loo-seat lid, rolled it out with the tooth-brush, or folded it like a concertina... red white and blue, all the time, every time. Consistent, reliable and dependable. No matter where you squeeze the tube.


The NHS could do with a bit of rheology. Variations in care, the differences in outcomes and the disparities in performance means, if you squeeze the NHS tube you might get a white bit, a blue bit, a blue and white bit or a white and blue bit. Inconsistency is the enemy of quality, the ally of waste and the friend of inefficiency.


If the NHS is to up-its-game and deliver step change improvements in productivity 'inconsistency' has to be a word we don't need to use anymore. Bed-stays, outcomes, costs; the red white and blue in the toothpaste. Wherever you squeeze the NHS we should get the same 'good stuff'.


The problem; struggling with the day to day, it is not easy to know what 'good', I mean really 'good-stuff', looks like. The CQC turns up, spends 300k to tell you, you're not good. They have no ownership of the problems that make you 'not good'; many of which you can't deal with, anyway. So why beat yourself up?


A Post-Bennett-Monitor might be able to perform an altogether different function. New Monitor could become the repository of 'good', the provider side, go-to-place for what 'good' looks like. Global good-stuff, even.


I know, from the huge growth in interest in the Academy of Fabulous NHS Stuff, there is an appetite to do good stuff and share it.


Commissioners can turn the screw but only the supply-side of health can deliver the sustainable efficiency gains we so badly need.


Good should be our common purpose.


The extent of variation from best practice is not known, yet it is the only thing that matters. To make an enemy of the bad we first have to make friends with the good. We regulate for the bad but who encourages the good, can tell you what 'good' looks like or where to find it?


Just what does good look like? If we knew we could redesign systems to deliver 'good'. If we are going to redesign for 'good' we must recognise provider boundaries are not 'good' and design systems that don't have boundaries, or interfaces. Seamless systems, integrated and joined-up.


CCGs were supposed to commission for 'good' but it is hard to detect any upscale inroads. They are still mired in internal disputes, sizing issues and money worries. Commissioning isn't getting even close to 'good'. It is content with more of last year for 4% less.


Would customers have demanded the iPad, would book readers have insisted on Amazon or any of us called for a Google?   Who saw beyond small ad's and envisioned EBay? 


Innovations come from the supply side. Ideas, concepts and designs make us walk towards the good stuff we haven't dreamed of.  It's the bad, clunky, clumsy, clumpy stuff we walk away from.


If we hold our nerve the Vanguards might become the iPads, Amazon and Googles of healthcare; fresh ideas, real innovation and services shaped and packaged in ways we haven't dream about. But, they can't do it mired in contradictory pressures, conflicting incentives, cashing with regulators.


Doing the same stuff better isn't doing 'good stuff'. Doing better stuff is doing 'good stuff' and that should be our single, focussed common purpose.


Monitor has no place in the post Lansley NHS but it could have a role; remodelled, with a leader who could convince us they weren't there to be excellent at pursuing us for doing bad stuff but existed to show us the good stuff, sharing in our common purpose... the pursuit of excellence.


Academy of Fabulous Stuff;

Have you looked at the fabulous stuff?

New 'shares' every day.

Make a note; be a sharer this week



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