The NHS …Warts and all .. Is still great

I have been away from the National Health Service (NHS) for almost 4 years after a long career of over 35 years working inside it.

The NHS is the third largest employer in the world after the Chinese Army and the Indian Railways.

The NHS celebrated its 60th birthday in July 2008 having been created as part of the radical, reforming Labour Government of post Second World War Britain in 1948. The NHS was a fundamental part of the new Welfare State.

The founder of the NHS was the eloquent Welsh MP Aneurin Bevan. Among Mr Bevan's many wonderful quotes was this one that I love most;

‘No longer will wealth be an advantage nor poverty a disadvantage. Healthcare will be provided free of charge based on clinical need and not on ability to pay.’

Call me old fashioned if you like but this statement from the great man underpins why our NHS is still the envy of many parts of the world.

What we forget sometimes in Britain is that our health service is a UNIVERSAL service provided to all citizens based on clinical need.

It has been good for me to be away from the NHS for almost 4 years because I have been able to see the service from ‘outside’ and I admit I have sometimes been critical of what I see.

However in recent discussions on Tom Peters Blog I’ve been delighted to see so many people praising the NHS. Dare I suggest there have even been some envious glances from our friends across the pond that we have a well established and (generally) well-loved universal healthcare system?

I will continue to criticise the NHS where it fails patients and their families but let me be clear about something.

Until I see hard evidence that a privately funded healthcare system provides at least as good a service to the WHOLE population of Britain as the NHS currently provides I will continue to promote the NHS as the right way to organise the healthcare for the ENTIRE population.

It is simply not good enough to make shallow unproven throw-away woolly statements like ‘the market must decide.’

One key criterion of how a country should be judged is surely how it treats it most vulnerable and most ill citizens. In Britain I feel we can and should be very proud that successive governments since 1948 have not seen fit to move away from universal healthcare provided through the tax funded NHS and I for one hope we never do.

To Centralise or to Decentralise .. That is the question ...

Once upon a time when I worked as a manager in the National Health Service (NHS)we were doing some community development work in a rural area of Devon called Dartmoor.

We wanted to ask local people their experiences of local health services and also get their views about how services might be improved.

We decided to hold meetings with residents in the three biggest towns on Dartmoor and a couple of small villages to get what we thought were representative opinions from people living on Dartmoor.

We duly wrote the report of our findings and held a series of meetings to discuss those findings with local people. I remember very clearly going to a village hall in deepest, darkest Dartmoor in a very tiny village called Lustleigh to talk to the locals about our findings.

They asked me whether our research had included opinions from people living in Lustleigh – population about 150 people (plus a few sheep) I replied that we had drawn conclusions from meetings with a cross section of people who lived on Dartmoor, including some who lived in a larger village less than 3 miles away where we had held one of our metings with local residents. The ‘Lustleigh folks’ immediately became indignant and objected that the views of people living in a village 3 miles away should in any way be seen to represent of the views of people living in Lustleigh. They were right of course and we were wrong.

The point of this true story is to get your opinions about the merits of centralisation versus decentralisation - local or national - and what do we actually mean by all these terms.

We can also include in the discussion the relative merits of centralisation and decentralisation within management and organisations.

In the UK National Health Service there are genuine attempts to get decision making down to a more local level and there are still many critics who believe too much power is vested in central government.

This posting has been promoted by my friend David Wike and I would be fascinated to hear comments from readers with different experiences and opinions about preferred options of centralise or decentralise the power.

For instance; what, if anything, needs to remain central? Or alternatively – what just cannot be decentralised?

Thanks David – I hope we get some responses

In Record Time!

Earlier this evening at Coombe Abbey, Annie completed the 5k Race for Life in her fastest time in four attempts. She completed the course in 31 minutes 40 seconds which beat her previous best time by about 90 seconds

It poured with rain for the entire race!

Annie finished in the top 100 or so in a field of 2500 women

Well done darling – I’m very proud of you!

Two dogs and a man - Good to be back!!

Supporter Number One - Bertie - The Ahhhh factor dog!

Supporter Number Two - Rusty - known by his friends as 'The Boss!'

Annie - The star of tonights Race!

After what has been probably the busiest three weeks of my career it is wonderful to be relaxing at home today with my fabulous wife Annie.

At last I’m able to start to catch up on Simplicity Blogging. Apologies for infrequent postings in the last three weeks – I’ve missed the discussions - but I’m back and raring to go!

As I write this on an overcast wet Wednesday morning (England is still wonderful in spite of the weather) in Shakespeare’s County, there is about 8 hours to go before Annie runs the 5k ‘Race for Life’ for the fourth consecutive year

No pressure of course but it’s not too late to sponsor Annie’s fund raising efforts for Cancer by clicking here.

Our two dogs Rusty and Bertie and me will be providing moral support this evening (complete with umbrella) at Coombe Abbey near Coventry ....

So best of luck darling – hope the sun shines!

Smoking Ban Works!

Generally speaking I am not a fan of governments telling us what to do. Quite the opposite in fact, I am a great believer in citizens determining their own future through community development and ‘bottom up’ planning.

However there are times when direction from above is very effective and this week we’ve seen a great example.

The smoking ban in public places is one year old this week and it is reported that 400,000 smokers have quit since the ban was introduced.

That is fantastic news.

I think we should celebrate it and thank the government for the positive leadership. It’s not a party political point scoring thing on my part – just a statement of fact.

Sometimes we just have to be told what is good for us.

The joy of being appreciated

Regular readers of my Simplicity Blog will remember a few weeks ago I posted my thoughts on the Pain of Learning. This was about some poor feedback we had after one of our Trust Me I’m a Patient workshops.

This morning in my email inbox came this from the person who commissioned our latest Trust Me I’m a Patient workshop yesterday morning.

‘Thanks so much for such a fun and useful workshop. I had a great time and am really pleased it went so well. The few people on my floor that also attended were still buzzing when they got back – it was the talk of the office for the afternoon! Feedback was fantastic and it was wonderful to see everyone engaging and having fun’.

So my posting today is not about the pain of learning but about the joy of being appreciated.

Say 'thank you' to someone today - they will enjoy the feeling - you might just make their day. And I suspect you will feel good for doing it

Whistle Blowers - Brave or Trouble Makers?

I’ve just been reading a harrowing story in the Daily Mail about abuse of elderly patients in a nursing home. That is a terrible indictment of staff supposedly offering care for these vulnerable people.

Here is an extract from the Daily Mail story:

‘Elderly patients were tied to beds to stop them moving around and others were lying in their own filth. The frail and vulnerable were being bullied by more aggressive residents and there was food rotting on dirty work surfaces. All this in a home staffed by trained nurses.’

What is arguably even worse is that the Nurse (Philip Brown) who ‘blew the whistle’ on this abuse to the appropriate authorities had to wait 7 years to see action taken against those he named as responsible for the abuse.

Although the care business is a very emotive area the act of ‘whistle blowing’ is important in all businesses. Those who ‘blow the whistle’ are described in my experience as either brave or trouble makers. I prefer the word 'brave.'

Happily I’ve never had to be the whistle blower in any situation in my career which probably means that I have been fortunate enough to work with and around people who have integrity and professionalism. I am very pleased about that.

If ever I am faced by unethical practices I hope and believe I would have no hesitation in blowing the whistle. My feeling is most of us would do that and accept the consequences, however personally damaging those consequences can be - like being ostracised by colleagues and being labelled a trouble maker thus restricting future employment opportunities.

What is your view on whistle blowing?

Make Us Citizens and Watch Us Grow

One of the most joyful periods of my career in healthcare management was when I was working alongside adults with a learning disability and their families. This period from about 1979 to 1988 was the most satisfying time of my entire career.

People with a learning disability are often misunderstood by society and at that time, I and two other colleagues formed a team that was charged with the responsibility to close a large hospital that housed 140 patients and re-housing those people into smaller homes in the local community.

I've lost count of the number of public meetings I had to attend as fears in the local neighbourhood resulted in negative publicity about these people. Many local people believed the 'patients’ were dangerous. The most oft voiced opinion was something on the lines – ‘I agree with the principle of these people leaving hospital but I think they would be better situated somewhere else in the town rather than in our locality.’

I am delighted to know things have changed somewhat in the last 20 years because of the battles fought by many parents who refused to accept that their child should be locked away in some isolated asylum away from society.

I remember reading a report many years ago about the fight for people with a learning disability to have the right to vote. The title of that report was ‘Make us Citizens and Watch us Grow’ – I love that title and unfortunately I have never been able to find the report anywhere despite numerous Google searches!

Some of the nicest people I ever met in my life had a label placed on them by society that read ‘learning disability.’

That period of my life was without doubt the most influential in forming my views about disability and stereotyping. I like to think I keep an open mind about these things.

The best advice I had on the subject was from a wonderful Doctor I had the pleasure of working with for 4 years. He said to me the first time I met him;

‘Just spend time with the patients and their families and keep an open mind – that is all I ask of you as a manager.’

What brilliant advice.

Race for Life

Cancer touches all of us in one way or another.

On Wednesday 9th July my darling wife Annie will be running the 5 km 'Race for Life' in Coombe Abbey, Coventry. This will be the fourth successive year Annie has run the race.

'Race for Life' is an all women’s race dedicated to raising money for Cancer research. Thousands of women all over Britain take part every year and millions of pounds are raised.

If any Simplicity Blog readers feel inclined you can sponsor Annie - and thereby Cancer Research - by going to this page to make a pledge. Or click on the 'donate' word on the 'just giving' notice in the right hand side panel. I know we are all constantly asked to give to good causes and I hope you don't mind me plugging this brilliant charity on my Blog.

Lucy Johnson

In the words of Lucy's parents;

''Buried under bandages, wires and tubes galore,

lies a fighter of unmatched strength'

Through my Simplicity Blog today I am asking anyone who reads this to remember in your prayers a little girl fighting for her life in the US.

I’ve got to know Dick Field in the last couple of years through my writing and through Simplicity Blog. Dick works in healthcare in the US military and so we have things in common, not least we are both Grandfathers. Dick’s Grand daughter Lucy Johnson is currently fighting to survive a double lung transplant. Little Lucy is 8 months old and been awaiting a double lung transplant since December.

After the diagnosis of Lucy’s rare lung disease her family were informed shortly after her premature birth that Lucy’s only hope of survival is bilateral lung transplant, and this was performed at St. Louis Children's Hospital just a few days ago. Lucy continues her battle and as Dick says ‘I believe this little girl is being saved for something special.’

There are many people throughout the US and beyond who are now praying for Lucy. Regardless of religious beliefs I ask all readers of Simplicity to find some time to pray for this little girl and ask your friends to do the same.

You can read more about Lucy at this link http://www.carepages.com/AboutCarePage?id=125313 where you can register for updates on Lucy’s condition. Once you have your registration you can search for LucyGwendolynJohnson and you will then be able to access a message board and updates as well as many photos of her short life that has been spent entirely in hospital.

We may not be able to offer hands on practical help for Lucy at this time but we can all pray - and God of course hears us.

Enthusiasm Rules OK!

As a 'mature adult' I have to say I get more than irritated when youngsters are criticised. I am very optimistic about my future being in the hands of the young people of today.

How fabulous it is when we see a youngster with real passion to make a difference. Yesterday Annie and I met such a youngster working in the National Health Service.

She is only 23 and it is just so obvious from her whole demeanour that she really wants to make a difference for her patients in the caring role she fulfils in the National Health Service.

She works with some very challenging clients and yet she approaches her job with such brilliant enthusiasm and optimism. I pray that she never loses those qualities and I just hope ‘the system’ does not beat that innocence out of her and wear her down. We simply cannot afford to lose people like this.

We need people like this young woman more than ever before in management and leadership positions because it seems to me there are far too many people either burned out, tired or demotivated .... or worse still .... all three!

Trust Me I'm a Patient

Today we delivered the first of a series of 25 ‘Trust Me I’m a Patient’ workshops across the South Central part of England in the National Health Service (NHS) between now and the end of June.

This workshop is about winning hearts and minds of front line staff, clinicians and managers working in the NHS about greater patient involvement in health services.

Annie and I work together in these half day workshops and that just adds to my joy. Not only does it feel like we are trying to help NHS staff and managers to increase customer involvement but the fact I am working alongside the woman I love makes it doubly enjoyable – life does not get much better than this. Annie is first of all a wonderful wife and also a brilliant professional. Thank you God!

If you are interested you can see more about our workshops at my Website - click here

The first workshop today was in Southampton and it went well. We had excellent feedback in the evaluation.

One down 24 to go ….

Electronic Patient Records

I said I would return to the subject of the introduction electronic patient records in the National Health Service.

I will nail my colours to the mast from the outset – I am a great fan of electronic notes. I actually believe most clinicians working in the NHS are also fans in principle.

I look forward to an electronic system that means wherever I am as a patient in the UK (or indeed wherever I am in the world) the health professionals involved in my care can log in and see my health record wherever I happen to be. I am convinced this will improve patient safety and could save lives.

The main concerns appear to be about security of information and whether our information is safe or not.

This has been highlighted in recent scandals in other government departments such as the Tax Office and Child Benefit where CD’s containing personal information have apparently been ‘lost.’

It goes without saying we need to make sure there are strict safeguards built in to the NHS electronic patient records system to ensure no such ‘accidents’ happen with our personal health records.

I certainly do not want a system that is so insecure that my health records may end up for public viewing!

There are also concerns about who will have access to view patient’s notes within the NHS. Will all staff for instance have access to all patients’ notes? The short answer is no. Modern software easily enables restricted access and the issue of access to non clinical staff is less of a security risk than we currently have with paper notes.

I will share a story to illustrate my point.

When I was 16 years of age I joined the NHS straight from school as a very junior clerk. One of my first jobs was in the medical records department. As a 16 year old - and very green around the ears - I had total access to all the patients’ notes of that particular hospital. That is how secure/insecure patient’s paper notes are in reality in a hospital. So the idea that paper records are more secure than electronic records is totally flawed in my opinion.

Also there are numerous examples over the years of paper notes ‘getting lost.’

I share concerns of all who worry about the security implications. I think we have to make sure whatever electronic system the NHS finally plumps for gives the patients the guarantees they need about security.

I hope patients support the principle of the electronic record because this is definitely the way forward.

Qualifications or Experience?

For 3 years between 1996 and 1998 I studied for and obtained my MA Management (Healthcare) at the University of Plymouth. I completed the course through day release whilst holding down a busy senior healthcare management position.

When we started the course there were 10 students. At the end of three years only 3 of us had stayed the course and completed our dissertation.

Ten years on I am very proud that I stuck at my Masters and saw it through when the easy option would have been to give up. I can say there were many times during the 3 years when that option was very attractive.

After my graduation a colleague at work asked if I thought the Masters made me a better manager. I had difficulty answering the question then and I still struggle with it.

I got my Masters as a mature student – I was 43 when I started the three year course. I think doing the Masters as a mature student had advantages because I had already gained many years experience as a manager by that time.

I would certainly never ‘knock’ anyone who obtains qualifications – I know how hard it is and what a toll it takes on the student. On the other hand I feel there is equal value to learning by doing.

What are your views about the qualifications versus experience debate? – I’m still unsure

Our Mental Health is precious

Three of my favourite films are;

*A Beautiful Mind
*One Flew over the Cuckoo's Nest
*The Dream Team’

All are powerful films portraying the challenge of people who have mental health problems being fully accepted by the rest of us – the supposedly ‘normal’ population.

In ‘A Beautiful Mind’ Russell Crowe brilliantly portrays the mathematical genius John Nash in his battles to rid himself of the images and voices that haunt him as he struggles to cope with his own genius.

Jack Nicholson in ‘One Flew Over The Cuckoo's Nest' is fantastic and I feel this film should be compulsory viewing for all employees working in mental health care. How the rights of people are completely stripped in an old fashioned institutional setting is emotionally harrowing. But the ‘inmates’ rise gloriously if tragically above it all in the end.

‘The Dream Team’ is a touching and moving story of how four inmates from the local mental institution are left to fend for themselves in the centre of New York after their Psychologist is mugged. The ‘inmates’ have to cope with life in the City for a few days. It is a remarkably powerful film tinged with comedy and poignancy.

We all walk a very thin line between staying mentally healthy and becoming mentally ill.

People who have mental health problems need to be understood and helped - not shunned by society.

What is Accountability?

The next three months will be the busiest time I’ve had since becoming a self-employed person three and a half years ago. It feels good.

When I left the National Health Service it was a bit of a risk. The truth is the time had come for a parting of the ways. I am able now to see clearly that I was no longer good for the NHS after 35 years and the NHS was certainly not good for me.

I had become stale, disillusioned and dull. I still had loads of energy to offer but I felt tired.

I pledged to myself that a return to a 'contract job' on a full time basis on someone else’s payroll would be a defeat for me.

So far I have managed to eat every month for 40 months as a freelancer.

I still feel that the last thing I would ever want to do is return to some office based job in a large organisation.

I love working from home. I love my freedom. I love my self-imposed rules. I love my new accountability.

Let me say some more about this word 'accountability.'

I left surely the most ‘layered’ management structure in UK business in the National Health Service. You would think therefore I would have felt ‘accountable’ in that environment. Not true.

I now realise I am truly ‘accountable’ to the person who knows me best – and that is the person I see in the mirror. That is REAL accountability. Holding yourself to your own standards is a real test.

If I deliver for my customer I look in the mirror and know that I did a good job. If I fall short that guy in the mirror will let me know. The mirror test works for me.

The accountability I now have is like hanging - it concentrates the mind.

To whom are you accountable?

Dress Code in Business

I am genuinely grateful to Jim Baker for his comments recently about my dress code for the Fox TV Interview and it has prompted me to publish a new posting on the subject.

Jim’s view is that I should have worn a jacket and tie because this was a business interview. I completely understand Jim’s view and of course I respect that argument.

Jim deserves a proper response from me rather than a brief reply in the comments section

For many years in the National Health Service – from age 16 right through to about 35 I ALWAYS wore a shirt and tie at work and often a suit. It was kind of expected if not said. I guess it was just the way things were.

As I got older and a bit more confident I guess I also became braver. I decided I would take a more casual approach to dress. I always took a tie to work but if I had a day when I was not going to meet any patients or their carers I wore an open neck shirt and the tie stayed in my office desk. I then started to wear t-shirts if we had no important meetings. Most of my male colleagues did wear ties and I was invariably the odd one out at meetings. My dress code actually became a bit of a discussion topic in the office.

I felt a whole lot better one day when we had a meeting with 10 family doctors – a group of very revered professionals. Paul – one of the most highly respected doctors arrived for the meeting on his bicycle wearing shorts and a t-shirt. One of his colleague doctors David was even more casual in a tracksuit and trainers having just been to the gym in his lunch hour. I actually felt ‘over dressed’ in my casual trousers and t-shirt! My recollection is the meeting was as effective as it would have been had all participants been wearing jacket and tie.

I noticed gradually over the next few years that more and more men started to discard the tie unless we were in important meetings or there was some special occasion.

Then there was the advent of something called ‘dress down Friday’ which I never understood. People were allowed to dress casually on a Friday – I still don’t understand the logic of that. If it’s ok on Friday why not every day Monday–Friday?

I think it is fair to say the dress code is now much less formal in office settings where there is no direct customer contact and I warmly applaud that.

Wearing an open neck shirt and smart casual trousers is acceptable in almost all settings as far as I’m concerned.

I believe managers can be trusted to dress how they feel they should dress bearing in mind they are representing themselves as well as the organisation.

We can trust people to make the right call in my view.

Let me say up front I am not advocating anarchy here – I am just saying trust your managers and your staff.

And finally if we should be expected to wear a jacket and tie because it is a business setting what does that tell us about business? … That we all must look the same? That difference cannot be tolerated? That conformity is the Holy Grail?

I repeat that I am grateful to Jim for raising this issue and I am not saying for one nanosecond that I am right. I am expecting dissenting views as well in the comments on this posting.

Over to you.

The same old, same old .....

And so a new year back at work starts in earnest today.

Have you noticed that when the pressure is on politicians in Britain they always fall back on the good old NHS to score them a few points with the public?

Anyone with an IQ above freezing point will realise it’s not a co-incidence that as Gordon Brown struggles to establish himself with voters he turns to the NHS to boost his popularity with voters.

Today Mr Brown tells us that patients will be given the opportunity to have screening if they are concerned about any aspect of their health - for instance heart disease.

Don’t get me wrong I welcome such initiatives because I have argued for over 20 years the government must spend more money on ill-health prevention and promotion of good health.

And this not a slur on Gordon Brown – I like the man and I am life long supporter of the Labour Party.

What irritates me is the blatant use of the NHS for political ends when it suits politicians. It’s the same old stale politics I’m afraid.

Where are the new exciting politicians in Britain - or even just someone with a personality?!!

I don’t see a single MP who makes me feel that 2008 will be any different than the same old drab, stale politics?

I hope I am wrong.

An old chestnut!

I have posted about this before but things don’t improve.

Payment of invoices is important for small business. It’s crucial for sole traders.

Waiting 8 weeks for payment of an invoice is just not good enough but the National Health Service (NHS) continues to make people like me wait that long before money actually appears in my bank account.

I know the excuses about large organisations and their ‘systems’ and ‘procedures’ - I’ve heard them all. The most annoying thing for me is that I know these long waits are not how it has to be.

When I worked as a manager in the NHS I took it very seriously to make sure small businesses payments were hurried along – whatever the 'system' and the ‘procedure’ may say. I would often make a phone call to the finance department to say something like - 'This person is self-employed and needs the money urgently so please make this payment as a one-off rather than let it get delayed in the system.'

It always worked for me and any manager in the NHS can do that.

These payment delays prove to me the NHS is still not sensitive to individuals.

All systems have to be flexible in my opinion. All it takes is for one manager to take personal responsibly for making sure payments happen. It really is that simple – it is a mindset thing – all it takes is for a manager to rattle the cage a little bit on behalf of the ‘small person’ by not accepting the ‘system’ or the ‘procedure’ as the way it has to be.

I’m really not surprised it doesn’t happen and it tells me everything about the NHS.

'Not Invented Here'

I was working in the North West of England on Wednesday as a facilitator at a large consultation event for the North West National Health Service.

I bumped into a good friend, author and business colleague Malcolm McClean who is the founder of the dynamic organisation Bear Hunt

During the event on Wednesday Malcolm came up with a wonderful expression that I will now steal and use in my work in healthcare (always crediting Malcolm as originator of course!)

The expression is: ‘Not invented here’

What Malcolm is driving at is the reluctance of managers and clinicians inside the NHS to welcome ideas from outside the NHS. He described how the NHS is producing various reports and documents about wanting to be a world class service.

Malcolm has been leading a fabulous initiative aimed at improving the mental health of young men by developing projects in partnership with professional football clubs in various parts of England – mainly the North West.

The project targets young men who are at risk of suicide due to mental illness. It has been a hugely successful venture with stories of young men whose lives have been turned around thanks to this project. It is an evidence based success.

Delighted with the way the project has gone, Malcolm wrote to all of the 302 Chief Executives of Primary Care Trusts in England asking them to consider the project in their own geographical area.

He had 7 replies. That means 295 Chief Executive could not be bothered even to respond to Malcolm.

And yet .... the NHS says it wants to be a world class service.

Malcolm has reached the conclusion that ‘Not invented here’ is an NHS syndrome.

I think he may well be right.

Apart from anything else – how come 295 Chief Executives do not have the decency to even acknowledge or reply to Malcolm's letter?

Despite working 35 years inside the NHS until 3 years ago I am still hurt and embarrassed by such bad manners and another sad example of how the NHS simply does not walk its own talk.