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18th September 2015 3

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New Health Chat

1st December King's Fund 5.30pm

Janet Davies CEO and General Secretary of the Royal College of Nursing.

Discusses the future of nursing, safe staffing, Vanguards and the 5YFV

Tickets... here.

Houdini

News and Comment from Roy Lilley

There's a book. I have a dog-eared copy. When it was published it broke new ground. The author was a business man, who had a proper job and knew a thing or two. He is what, today, we would call 'authentic'.

He served in the US navy in WWll and in Korea. In between he got a degree in podiatric medicine. He worked on missile systems, with The Martin Company and later ITT where he became the director of quality.

In the mid-60's he gave us the concept of 'zero defects'; a management-led program to eliminate flaws in industrial production. It somehow morphed into a performance goal rather than a programme. I think, today, people struggle with it.

The man is Phillip Crosby and the book, Quality is Free. When Crosby ran the Pershing missile programme he reduced component rejection rates by 25% and scrap costs by 30%.

The book, written in the 60's, became a huge best seller, particularly because, later, the US automotive industry was plunged into crisis as the home market lost sales to Japanese, superior quality goods, mainly cars... something largely due to the influence of the father of management gurus Edwards Deming (He of 'you can't inspect quality into anything') who was working in Japan.

In a nutshell Crosby tells us four things:

Quality is 'conformance to requirements'. I say; figuring out what you want and putting things in place to make sure you get it, all the time, every time, until you don't want it any more.

Quality is about prevention. Echoes of Deming, here. Inspecting to find fault is too late and a waste of time. In the NHS; the damage is done. You can't fatten a pig by weighing it

Zero defects. In our world; don't wrap existing services around a patient and call it patient centred. Do that and you'll wrap all the existing flaws into the new system. Answer; start with the patient, 'what do they want', and work backwards. Start with 'perfect', or 'zero' and as you work backwards you'll expose the fault lines in what you are doing now.

'Measurement' of quality is vital. We pay a price for non-conformance. In English; doing stuff twice costs. Crosby gave us DIRFT; 'do it right first time'.

Crosby came to mind when I read the HSJ's Crispin Dowler's excellent article on the Tinker-man's legacy. I won't spoil it, it is a must read, but boiling it down to the absolute essence Dowler says Hunt is focussing on quality and safety and the other risk, 'the money thing', side-lined.

Hunt doesn't quite say 'quality is free' but he does say 'safer care is cheaper care'. He bumps against 'big efficiencies to be found in better rostering' and gives a nod to the ballooning Carter aficionados struggling with why we can't buy cheaper bog rolls.

Perhaps the Tinker-Man has read some Crosby? Are the crippling financial problems of the NHS likely to be solved by safer care? No, but instinct tells us there must be something to it.

NHS 7 day operation? Saving up symptoms or treatments for Monday makes Monday a day to avoid. Safe staffing? Yup, but the ludicrous red flag system we use now is probably dangerous.

You can make your own list of pressure points, bottlenecks and all the rest.

Can we solve any of these issues for 'free', with 'better rostering and smart efficiencies'? We want to say yes, don't we? We want to be optimistic and you only have to look at The Academy of Fabulous Stuff to see the NHS is a fountain of innovation and good ideas.

But, don't we need a reality check?

When I look at places where there are performance issues I ask everyone just one question; 'tell me the one thing that needs fixing'.

What is the 'one thing' for the NHS? Time after time, at the bottom of all quality issues we come back to the same issue; shortage of staff. Wards, care homes, community, the same thing; not enough staff to deliver safe, quality care. Over 80% of trusts struggle and fail to reach 'fill rates' for staffing targets.

The mismanagement of workforce planning, austerity, the clunky HEE, out of date curricula and 'keep doing what we did ten years ago' has got us into a mess.

I fear, without investment, this time, Crosby will be of little help. Maybe we should try Houdini.

Have a good weekend.

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News and Stuff

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>> New Junior Doc's contract - imposed by DH; coverage from the HSJ, scroll down to the comments.

>> A resilient NHS - very well crafted blog; The Paradox of the Wound Healer...

>> Seroxat - unreported harm?

>> Trust takes of libraries - what a good idea!

>> Longer appointments needed - for GPs to help with choice.

>> Premises costs - threaten London GP access; I suspect this is likely to be repeated in other places throughout England?

>> Health Check contract - torn up mid-year.

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HealthChat

1st December

King's Fund 5.30pm

Janet Davies

New boss at the RCN

King's Fund 1st December 5.30 pm.

Don't Miss this - huge interest.

Details here.

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Guest Editorial

Have professionalism and trust in the NHS been destroyed by regulation?

Sir Cyril Chantler.

Absolute must, must read.

Here

Sir Cyril will be joining us for a HealthChat later in the year - details and tickets, soon.

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Gossip

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>> I'm hearing - IT Tsar, Tim Kelsey is leaving NHSE and taking his family for a new life in Australia. He leaves the future of NHS IT better defined and the sector more optimistic than it has been for a long time. We wish him well.

>> I'm hearing - mystery over Cambridge CEx stepping down. He says he doesn't want to go and there is a huge ground swell of clinical support for him to stay. Why is the Board all but silent? We know the money and quality reports are going to be grim; are the Cambridge Board in denial and too posh to fail?

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Need inspiration, a good idea or solve a problem

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>> Kings Fund - loadsa good stuff on this portal.

>> New national living wage - effect on the care home sector.

>> IT whistle blowing - really interesting story.

>> Do something different - be an RAF medical reservist.

>> Broadmoor problems - all stemming from not having enough staff.

>> Firearm applications - GPs 'should supply medical reports'.

>> Cancer - data collection failure.

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