25th October 2016

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Dr Sir Sam Everington
GP extrodinaire!  In conversatin with Roy Lilley
In conversation with Roy Lilley
9th Novemberr 2016 - King's Fund - tickets here. Half price for IHM members.
I'm not so sure
News and Comment from Roy Lilley
The NHS is nothing if not a Fad-Fest.  The latest management technique seized upon as the panacea.  The Holy Grail that will make the NHS as efficient as a Swiss watch.
Right now we are in the grip of Dave Brailsford's aggregation of minimal gains.  The philosophy of 'little stuff matters'.
His theory is an obsession; team members used clinical wipes and hand cleansers to reduce the likelihood of anyone catching, or spreading, a cold which might have disrupted training...  setting-back fitness.
No point in having slippery Lycra, ergonomically designed pedals and wind-tunnel tested handlebars if riders are off with the sniffles.
Brailsford is right.  But not unimpeachably, universally right.
If you want a better, competitive cycling team, he is right.  He is right within the constraints of the conventions and rules. If you want to get from A to B on a bike, fast, he is right.
The accumulation of little improvements only works if you accept that the rules preclude anything really new.  Change the rules and you can get from A to B faster on a bike with an engine, or a rider fueled on steroids. 
That is why this fad may not be the right for the NHS.
The assumption is; if everyone in the NHS did their bit, a little bit better, the service would be a whole lot better.  The fault in that argument is to assume we want the NHS to continue on, in its present form... better or not.
Look at it this way; if the bobble hats had focused their efforts on making reel-to-reel tape easier to use we might never have ended up with cassettes.  If we had stuck with the convenience of cassettes and just worked on stopping the thin tape from stretching and jamming we wouldn't have CDs.
If we had been satisfied with that we wouldn't have iPlayers and eventually Spotify.
Focusing on making what we have, work better, can cut us off from the real change that moves goods, services and people on.
If Hoover had managed to come up with a micro-filter bag, that cleaned itself overnight, James Dyson wouldn't be sitting on his millions.  If laptops had longer lasting batteries, lighter and smaller, workable keyboards... I wouldn't be typing this, sitting on a train, using an iPad.
If the NHS can find a way of coping with demand by polishing, tweaking and oiling the components of its systems we never will do what we really need to do... redesign healthcare.
For instance; the idea that we can solve our problems by making primary care take on more of the heavy lifting from secondary care is, frankly, ludicrous.
Generally, premises are too small, geographical distribution too chaotic, unit costs too high.  The majority of surgeries can't carry out near-patient, simple blood-tests; samples carted off to a lab by a bloke in a van.  Very few can do diagnostic imaging; we are obliged to take our mysteries to hospital for a picture.
Hospitals, like supermarkets are open 24-7 and have everything, primary care, like the high street, is not and has somethings.  There are not enough GPs and never likely to be.
Aggregating the costs of primary-care back-offices ignores the fact that primary care is owned and run by independent contractors who will resist the idea.
If every component of health service provision were polished to perfection it wouldn't overcome the biggest problem of all; the interfaces between the parts of care that end up with patients shunted from pillar to post and racking up costs.
Our system of healthcare is a treasured inheritance.  It is also a difficult legacy.  The legacy of negotiations going back to 1948, when the unwilling medical profession was dragged, reluctantly, into a nationalised health service.
Self-employed contractors shoehorned into a faux-employed framework resulting in every tiny change requiring negotiation, contract variation, rows, palaver and more money.
The NHS is an environment where the management of information by the use of technology or any digital access for patients is considered remarkable.  Everywhere else it is considered routine.
We have to ask; do we want minor gains or huge change?  If we started with a blank-sheet would we design healthcare as it is now?  

The NHS; the world heritage site of public services... a coral reef of practice and process added to, almost daily.
Polish to perfection, of course.  Precision?  Why not?  But preservation at the expense of pushing the boundaries of innovation... I'm not so sure.
I will be talking about this and other topics tonight, with the author of 
Matthew Syed, 
at the Kings Fund. 
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