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18th January 2016
3

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HealthChat 
Former Secretary of State for Health and now Chair of the Confed
Stephen Dorrell

Excitement 
News and Comment from Roy Lilley
Let's take stock.  Trusts are being asked to wear their underpants over their trousers and:
  • Claw back and reverse a £2 billion deficit
  • Deliver the first year of £5 billion of Carter Review efficiency savings
  • Slash spending on agency staffing
  • Deliver planning guidance
  • Come up with a local five year Strategic Transformation Plan
  • Get targets back on track for A&E, ambulance wait, elective treatment and cancer
  • Improving one year cancer survival rates
  • The seven-day 'thing' and a strike
  • Sort out an approach and deliver two new mental health access standards
  • Jack-up the dementia diagnosis rates
  • Transform care for people with learning disabilities
  • Improve quality
  • Introduce a new system of publishing avoidable mortality rates
  • Do Vanguard stuff
They then must leap tall buildings in a single stride and:
  • Cope with out-of-control demand and sort out delayed transfers of care that social service can't sort out for themselves. 
The financial prospects for adult social care could not be worse and are set to deteriorate further.
 
The King's Fund tells us by 2020 there is a social care funding gap of between £2.8bn and £3.5bn.  Councils, being able to set a 2% precept on council tax for social care, will work in the better-off areas but not in the areas where demand is likely to be highest.
 
There is an all-around financial squeeze like never before.
 
However, let's look on the bright side:
 
There is the prospect of a share of £1.8 billion of sustainability funding (but with more strings than a marionette) and Monitor seems to be getting the message - giving the Trusts a good kicking does nothing but give them a sore toe.
 
On the other hand:
 
The CQC have lost touch with reality and want to charge shed-loads for out-of-date reports that no one takes much notice of anymore.  Everyone is in the same boat.
 
There is one ray of hope; Lord Cater is going to show us how to buy cheaper bog rolls.
 
Everyone is running around saying the NHS must change.  I'm not sure from what to what?  They forget, organisations don't change. The people in them change and they only do that when they can see what they did yesterday is no good for today.  Even then they'll need to see the 'how'.
 
It's not enough to want people to do their best, they must first know what to do and then do their best.  Asking them to 'do everything' is as useful as asking a canoeists to do a handbrake turn. 
 
Can the Trusts see the wood-for-the-trees?  Do their best?  What started as the pursuit of excellence has become a quest for survival.  Is it about brilliance or existence?
 
Overload leads to paralysis.  If the task is too big, too complicated and too much... they give up.  The status-quo is seductive.  If they give up, management becomes more raucous.  More top down.  Cajoling gives way to insisting and gives way to bullying.

Bob Alexander's demand for Trusts 'to cut head count' so that he can balance the books is the crassest, most stupid, ill judged piece of idiotic, bullying management I have seen in years.  I suggest he starts with the entirely superfluous TDA and himself.  His 80's style of Doc Martin management is totaly out of place.  This style of manage led us down the M1 to Mid-Staffs.  
 
The NHS is sliding, slow-motion, into a ditch.  Management by 'more stuff' is not management.  It is desperation.
 
Being in control means having realistic expectations.  Being truthful about prospects.
 
The first trick is to make problems so interesting and their solutions so positive and productive, everyone wants to join in, roll up their sleeves and be part of the answer.  Make everyone involved feel fulfilled, valued and satisfied with their work.
 
We need to get relationships with the people right and then we can set about making the organisation right.   Show them that the task is not beyond them.
 
There are some things you can't put on a PowerPoint slide.  I think it was Edwards Deming who said 'eliminate fear and management by objectives'.  

He is right.  Staff should contribute ideas and concerns equally; forget objectives and look at the processes and measure them... not the people. 

It's time for management by vision, ideas and excitement.
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Medicine for Managers
Dr Paul Lambden
'...this is the first of a two part series that looks at the whole issue of the use and misuse of anti-biotics.  Dame Sal (what a Gal) will like this.
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 The Academy of Fabulous NHS Stuff 

A forest of good ides
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Fab-Fact Friday
This is the best set yet!  The Great British Bake-Off and Indian food! 
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News and Stuff
News boy
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HealthChat
We are taking  
HealthChat and the 
Fabulous Academy 
on the road.
Come and join us , 
we are live in 
Liverpool
11th February at  
Aintree University Hospital.
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New Health Chat
Prof Sir Mike Richards
Chief Inspector of Hospitals 
1st March 2016
King's Fund 5.30pm
You don't want to miss this - do you?
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Stephen Dorrell
Former Secretary of
State for Health
Chair of the Confed.
'the reforms were the biggest mistake of the Parliament'
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Conference
Immunopathology and Immunotherapy - to go boldy
Looks interestning
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Gossip
shh
This is what I'm hearing;
if you know different,
tell me here
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>> I'm hearing - HFMA seems to have found a new voice.  Their President told the Public Accounts Committee that 'competition has got in the way'.  Three cheer for that!
>>  I'm hearing - the 100 hour pharmacies are not delivering much value?
>>  I'm hearing - Virgin won the Community health services tender in Kent;  Virgin rated 3rd on quality at 95.4% and were the lowest on price at just over direct costs with no allowance for agency costs.  If this is correct why award them the contract; they'll go broke trying to deliver or just not deliver. 
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Guest Editorial
Dr Christopher Johnson
Writing as a cancer survivor and a patient.
Very interesting must-read.
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Need inspiration, a good idea or solve a problem
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