3rd August 2015

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Sir Robert Naylor

One of the longest serving leaders in the NHS, running one of the biggest Trusts.

What's life like at the top? Find out; in conversation with Roy Lilley; King's Fund 16th September 

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News and Comment from Roy Lilley

The secret to 'change' is to make people feel they are in charge. People don't like change 'done to them'.


Of course, there is a lot more to it. The 'vision thing'; what does 'changed look like'? Re-structuring: opinion seems divided; never restructure at the start of the change process or... a 'burning platform' gives every incentive.


Then there is the 'elastic bit'. Stretch a spring and when the pressure is off it will return to its original shape. Making change stick is a trick people often miss out. The NHS is a good example of changing and then springing back to old ways.


Change champions can help; early adopters who stick their necks out... have a go. Then, there is the no little matter of understanding the reasons why change has to happen and recognising change is for the board-room as well as the front-line.


Don't expect people to build you a new organisation, process or system with giving them the tools to do the job. Oh and communicate, communicate and communicate and then review, review and review.


Sounds easy. It is; until you try!   I've seen several major reorganisation attempts and to be honest; the NHS looks pretty much the same to me...


"... get sick, go to the GP, if she can't fix you... off to hospital. If they can't fix you, expect a tertiary referral. If that doesn't work... back to the GP who will tell you what they should have told you in the first place... go and see the nurse."


It's still the same except that today there aren't enough GPs, hospitals are choc-a-bloc, there aren't enough nurses and the money's running out. So, somebody has to change something.


The only show in town; the Vanguards. The problem... they are not on show. I've no idea what a Vanguard looks like.


Well, I didn't. Now I do. Now we all do. With no fanfare, no press, no hoop-la, we now know. We have the book. No doubt the movie and the T-shirt will follow; they are GPs, community services, social care, acute, the whole route map of care.  Ms Jones fleet of Vanguards are motoring. 


In a surprisingly readable 31 pages the rules have changed.   The future looks different. A handful of Trusts are going to have a go at redefining the NHS.


There is vertical integration, capitated, population based budgets and a flavour of 'can-do, go-do'. There is even a nod to the idea the NHS doesn't have all the answers and we might learn something from healthcare systems in other countries.


And, a surprise; an Ambassadors' programme.  A clever twist on sharing the best amongst the rest.


The report has the usual sprinkling of 'engagement' and 'stakeholders' and all the other nomenclature that decorates the mantelpiece of the Le Tache's drawing room; strip that away and it is a good read.


More than that, I'm ready to say... it is an inspirational read.  For Vanguard, read change.


What is required for change? This is where we came in.

  • People feeling they are in charge; Vanguards are ground up ideas

  • Visions; yes, a plenty. Enthusiastic visions.

  • Re-structuring: oh yes, restructuring and the burning platform is certainly burning!

  • The 'elastic bit'; once these ideas are in place there is no going back.

  • Making change stick; if ownership is the glue, the Vanguards will stick.

  • Early adopters; board-rooms to the front-line involved.

Tools for the job? Yes, support and tools for the job in the shape of £200m. Targeted and a much better idea than the Health Foundation's transformation fund bun-fight.


I have a double helping of the pessimist, cynic and sceptic gene. I must be getting old; the Vanguards inspire me and I wish them well.


Is there a fly in the ointment? Yes, two. The enemy of the Vanguards could be the old-guard. Two remnants of a reform the NHS neither wanted nor needs.


First the CQC; they can't inspect care pathways and the Vanguards are all about care pathways.  So, expect them to delight in finding things wrong with the leadership of the embryo organisations or spend millions hunting down a drinking glass out of place.


Second; Vanguards probably break all the rules; competition, choice, boundaries, everything the H&SCAct was designed to enforce. The biggest enemy of the Vanguards could be Monitor.


Ed Smith the new Monitor chair and whoever becomes his Chief Executive must scrape the memory of David Bennett and his madness for markets and enforcement, from their boots.


They must step forward and help make this work.


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Sir Robert Naylor
One of the longest serving CEOs of one of the
 Biggest Trusts
At the heart of strategy and policy for over 25yrs.
What does the future hold for the Vanguards, strategy, regulation, funding.
Come and hear him in conversation with Roy Lilley 
King's Fund
16th September.
Book before you go on holiday, it will be a sell out.
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>>  I'm hearing - the HSJ is reporting (£Walled exclusive)  Northumberland CCG planning to hand over its budget and most functions to a provider led ACO.  This will be one of the first developments that will directly challenge Ed Smith's Monitor.  I wonder what he will do?  Keep an eye on HSJ Twitter account, they sometimes release stories later in the week.  Or, do what I do; subscribe!
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