9th March 2016

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Jim Mackey boss of NHS Improvement Tickets here 
We have moved to a bigger room and have just released a further allocation of tickets

A bit of a result
News and Comment from Roy Lilley
I had a great trip this week; to Sheffield Northern General FT.  I got there a bit early and had a look around.  I am always in awe of estate's directors who are able to keep such a mixed bag of buildings in such good shape.
There have been hospitals in Sheffield since the mid 1700's.  The history of public health can be tracked and traced through hospital buildings.  For the poor, for women, for fever, for children.  Each building a flag in history of how health services have developed.
The Northern are doing a great job.  They have a unique way of generating improvement and change ward, by ward.  We will bring you the inside track through the Academy pages in the weeks to come. 
People love change when they are in charge and the Northern have put the front line in charge.  Like all good ideas, it is simple and just 'works'.
I used to be a top-down changer.  I got involved in the the Thatcher Reforms and that gave me a taste for moving the markers over the map and putting the pins in the charts.
It's taken me a while to come to the conclusion, almost everything I thought was probably wrong!  All the major changes I have seen and been involved in have been fun to do, exciting to be part of but not made two pennyworth of a difference.
Even the lunacy of the Lansley reforms, 'big enough to be seen from outer space' haven't made any difference.  We still have district health authorities (Called PCTs and later CCGs), and hospitals (called DHG's and Trusts and FTs) and some people in Whitehall who shovel memorandums, guidance, instructions and billet-doux on us...
All that effort, money and energy to keep us in the same place with a different sign on the door.
I've learned real change; change that works and lasts, has to come from the people who are doing the job.  That's why Sheffield are so far ahead of the game.
I was talking to some of their front line; we said if, with one initiative, a ward could save £100 a week that's not a lot but better than nothing.  If a hospital has 30 wards that becomes £3k a week and in a year that is £156,000.  There are 157 Trusts in England.  If they all did it we are looking at £2,449,2000.   Start thinking ten initiatives, or twenty.
Start thinking saving, not money, but pressure ulcers or falls.  See what I mean.  If you want to change the things that matter, start with the front line and work backwards.  Don't start with the top and work down.
Only rarely does a top down initiative work.  We should be much more sparing in our grand designs.
This week saw an exception.  This week a 'top-down' change has been announced and is welcome.  It will be very tricky to implement and I have no doubt the naysayers and the know-betters will trash it but I think it is long overdue and we should get on with it. 
The Tinkerman has announced medics will have a second look at events preceding a patient’s death.
It is in the territory of a case-note review of every death, regarded by many as the gold-standard. There is a huge amount to be learned from this.
As the Guardian reported:
"All deaths in hospital will be examined by a second doctor unconnected to the patient's treatment, in a move intended to improve care and help bereaved relatives understand why their loved one died."
From 2018 doctors acting as expert medical examiners will review and confirm the cause of all the 250,000 deaths a year that occur in hospital. They will be medics who already work at the NHS trust but in another department to the one in which the patient died.
Having a second look at the events leading up to a death might find pressure sores, poor nutrition or even mistakes in care.  The policy will apply across hospitals and care homes.
This has been a long time coming.  It was first legislated for by Labour in 2009, following the Shipman Inquiry.  Later Robert Francis called for it in 2013.
Change at both ends of the scale.  Each, as important as the other. 
I think that is a bit of a result.
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Jim Mackey
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In conversation with Roy Lilley
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Huge response to this event- we have added more tickets and moved to a bigger room.
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>>  I'm hearing - increasing frustration about the strike from Trust Chief Executives; expect a move.
>>  I'm hearing - the BMA are in a fix over their threat to take the Tinkerman to judicial review.  They complain he has not done an impact analysis of the new contract and is therefore in fault of process.  They seem to have overlooked the fact the contact has not yet been written or published.
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