Wednesday, August 26, 2009

Friend of Simplicity - Dr Phil Shute

I am delighted and indeed honoured to have as my 'Friend of Simplicity' Dr Phil Shute. Phil is a General Practitioner (Family Doctor) in Torbay, Devon, here in England.

I've known Phil for about 20 years, initially as my own Family Doctor and then as a professional colleague in the National Health Service (NHS). When I was a healthcare manager in the NHS Phil and I worked together as a team on ground breaking community health development in a very deprived part of Devon. I have to say (because Phil is far too modest to say this) that Phil was the leader, the inspiration and the driver for the project.

As a professional colleague Phil is simply a pleasure to work with and speaking as a patient I can truly say my life is richer and better thanks to his skills, support and understanding.

Good men are few - Phil is a VERY good man.

I know Simplicity readers will enjoy Phil's straightforward no-nonsense views and I look forward to receiving many comments. It is brilliant to get a medical perspective on some of the issues we regularly debate on this Blog from such a highly regarded doctor.

Trevor - Phil – thanks so much for agreeing to take part in my series of ‘Friend of Simplicity’ interviews. Can you briefly outline your career to date?

Phil - Hi, Trevor - My career to date: State Primary, State Grammar, both in Plymouth. Academically diligent and not brilliant. Older than my years, was always seen as the responsible one who could be relied upon to do an honest job, equitably and without disadvantaging anyone else. Captain of sports teams, glittering schoolboy rugby career......... got me into St Mary's Hospital. London (my academic record would not have stood out).
Career at medical school above average, never considered anything other than a career in General Practice, though was offered many more "glittering open doors" when in hospital posts.

Did "Publish" whilst still a student (only one in the year so to do..... BMJ - British Medical Journal too!)
Always felt that in whatever speciality I spent time as a student or qualified doctor that I was restricted by specialities; I was always holistic in my outlook, still am, probably more-so. Both house jobs at my teaching hospital..... Sounds prestigious but the first post I landed through rugby connections, the second by my reputation as an honest workhorse. Proud of that, still am.

GP training scheme in Barnstaple (back in Glorious Devon) wonderful place to have worked. Teaching Hospital jobs can be a bit self-serving, chasing small print and not enough substance... look great on CV's but less learning experience.
Absolutely adored my time in Barnstaple and as a trainee in Bideford. Won the GP research prize locally and then awarded the Royal College of General Practitioner National Trainee research prize for 1985, Published again, JRSM - Journal of the Royal Society of Medicine this time.

Settled in General Practice in Torquay; still there; avidly "into" research in the early days, gave highly regarded paper but realized that chasing publications really wasn't the path for me; just a work horse. I now teach students at the Peninsula Medical School, not because I'm an academic but I'm in a great practice for teaching with a wonderful body of honest patients whom students ought to see.

Have been involved in many schemes and initiatives, proud of many of them. Not least the Gym we have within the practice.... first in the UK and "state of the art". The way we funded it was seminal and inspiring..... Just shows that when you have a body of good ideas someone, sometimes, listens and really splendid things can happen. Our area - Torbay (population 110, 000) is a fitter place as a result.

Similar things happened a few years back when we kick-started a local "Health Gain Initiative" looking right outside "Health" for a change into the broader field of "Welfare" (not the benefits system, but what patients really needed)

Very proud of my work in sport to this day. I'm a medical advisor to the Amateur Swimming Association, and as a medic and technical official and club manager. I facilitate sport from grass roots level up to World and European Cup levels and World Championships; from the youngest kids up to veterans.

I have a regular column or two in local papers where I exercise my skills as a sports journalist.

Trevor - I’m very interested in how Doctors view management. As a Doctor what do you look for in a manager in healthcare?

Phil - I look to management in health care to free up my time to work the coal face, to facilitate patient care and to make up for my own inadequacies in management, I frankly don't expect to manage in any other way than "Policy".

My 360 degree appraisal flagged that management was not my forte, a view with which I'd concur.

My own approach to management is the same as it was when I was captaining sports teams.... I led and hopefully still lead by example, not dictat. I have always gone the extra mile for colleagues and patients; will always put my body on the line. I expect managers with whom I work to do the same.

The managers within our Practice do just that, and I'm very proud of how we all get by in the face of a quite dizzying workload. If I've been influential by my example it would, I hope, be honesty, integrity, compassion and hard work. I'd love that to be said about our practice; all aspects, management, reception, patient experience, clinical expertise. I don't manage, but in a quiet way I'd like to think I lead in some ways.

Trevor - As you know Phil I am very interested in the study of leadership. Can you identify someone you would describe as a leader that has inspired you in your career and what qualities did that person have that made them stand out from the crowd?

Phil - Leadership is a true gift, and believe it or not, it's seldom evident in day to day medicine. It's probably far more in evidence in day to day management, where leaders can set an agenda. In clinical practice our patients set agendas.

I was first inspired by a teacher in my primary school, year 6, a fine man, towards the end of his career in teaching who always put his pupils first, was authoritative, firm and directive and unflinchingly fair.

I was next impressed by my captain when I first played rugby for Devon aged 17, the captain was 18, full of testosterone and adrenaline, a bit feckless, but who was so totally superior to everyone else on the field. You couldn't help but follow him, he was "everywhere". He went on to captain England and even the British Lions. Clearly others were similarly impressed.

The professor of medicine at St Mary's Hospital, London was the best and most gifted physician I've ever seen to this day. He weekly conducted his "Open Round" in the biggest lecture theatre at St Mary's and it was always packed. One or two of the registrars or senior registrars would select a patient unknown to the Prof and the consented patient would be wheeled into the theatre. Without taking a history, and without access to any "imaging" and investigations, solely by examining the patient meticulously (and talking us students through the process) he would seek a diagnosis and teach us all his clinical method in the process. It's the most impressive thing I've ever seen. Skills like this are not so valued these days as imaging and diagnostics has largely taken over; good, as that means diagnosis is available to everyone irrespective of which doctor is looking after you, BUT there is no substitute for genius.

Trevor - There has been a lot of publicity recently about radical reform of the US healthcare system. I would love to hear your views about that and in particular the publicity that has come from some parts of the US media and US politicians who openly and heavily criticise the UK National Health Service.

Phil - I don't know a lot about the Health Service in America other than they pay more than twice as much as we do and as result there is much more provision than we have.

Much of the NHS bashing coming out of USA is ill-informed. Much of the NHS bashing is engendered by lobbyists in the pay of astronomic profit-takers in the USA. They should re-examine their service if it has the inequality of access that I'm led to believe.

We have a service that has evolved around our patients and has probably had more thought put into it.
We undoubtedly provide better value for money, our productivity is astonishingly high, we are ethically driven and our system, whilst far from perfect, is worth looking at if not worth adopting (well.... no-one else has adopted our system)

Trevor - What are your views about the development of electronic health records and patients having greater access to their own electronic records?

Phil - Patient-held electronic records would be splendid but I suspect would be as accessible when needed as their NHS card or NHS number (i.e. almost universally mislaid or filed under "lost") forget it.

Universally available health records would be splendid but the truth would upset a lot of information holders. Bureaucratically it would be a nightmare.......... I'd spend all day and every day talking people down from their anxieties and clinical work would be totally paralysed.
Political correctness gone insane.

People only want to know what's in their notes when something goes wrong, OK they can have them if that's the case when it becomes appropriate for the patient.

We've already got that system.
I think it would be an even bigger waste of money than ID cards (I'm not anti-ID cards). Just because we can do it, even if it's a good idea, doesn't mean we should. I'd rather spend the money on clinical care.

I'm reminded of a report on our local in-patient psychiatric unit where the quality of care for detained psychiatric patients was not even mentioned; but of course there had to be universal access to legal representation for all detained patients. It was, of course, written by lawyers.

Whose idea was the electronic record with universal access to data? What a security nightmare? I know the intentions are noble but if this isn't "1984" what is?

Trevor - I know that you and I agree we must look way beyond healthcare professionals such as doctors and nurses to improve the health of the population. It is everyone’s business. What would your vision of a healthcare system that promoted health look like?

Phil - This is like "Life, The Universe and Everything"
There is no doubt that health equates to wealth in many societies. So much research relates poverty to ill-health and in this respect it's the poverty and life-style link that results in increasing morbidity. We can't rule out poverty but we can start to address equity of access to health care, at least we can in the NHS (Not in the American system).

If we're talking life-style then education/example and opportunity/provision is the way forward.
There are more 50metre swimming pools in Paris than in the whole of Great Britain. We're better at swimming than the French, that's because they're French; but more Frenchmen swim than Britons and their rates of heart disease are way better than ours.

It's no good the government telling people to take more exercise if they've grown up not doing it, don't know how to do it and there's no where to do it.
If there was a single measure we should consider, it's what the Scots are doing with alcohol, and which I've been advocating ever since it was proven beyond doubt 50 years ago that the only 2 factors which reduce alcohol related problems and morbidity is price and availability. We should charge according to alcoholic content and not discount, and reduce the number of licensed premises or restrict access to them.

Trevor - Are there major differences in the patients expectation in 2009 than when you started work as a Family Doctor and if so what are they?

Phil - There's far less demand for home visits than when I started.... more people have cars (though not that many more), education is working, patients are actually more realistic in their demands.

But the main reason is we make ourselves far more available in many different ways. 30% of my consultations are now over the 'phone. In many instances this is far more appropriate. A whole new set of consultation dynamics has become apparent. We used to be looking for body language as a diagnostic tool, but patients are inhibited in our consulting rooms and have had to drag all the way to get to you and then get coughed-over in the waiting room; how valid is their body language going to be? Patients often give far more relaxed and less inhibited consultations in the comforts of their own homes and favourite arm chairs over the phone.

We are all offering "advanced access" and it's MUCH easier to offer "same day appointments" negating the need for home visits.

People are a little more pro-active and advice-seeking, but still not as much as we'd like (the 'phone is particularly good for this).

The government is much more demanding than our patients.

Trevor - Finally and based on your experience what are three key pieces of advice you would give to a young Doctor now starting their career in medicine?

Phil – Yep – here we go

1. If you don't like hard work get out now

2. Work is what you are. It's no good having your ego first and the work as an unfortunate if necessary poor second place. Medicine isn't a job, it's not a vocation, it's a way of life. You eat and sleep and breathe and drink it; you can't deny this. It defines you, regulates you, establishes your value-bases, controls you. This is not scary at all. You have a valuable knowledge base, a good income (but it's not easy money), respect and respect for others. It is a privilege to practice medicine and to be invited and welcomed into other people's lives; value their lives and hence your own.

3. Take yourself seriously.......... but not too seriously; surely you are an important person in the lives of many patients........ But you're not family and you're not God.

Trevor - Many thanks Phil – I appreciate your words it is always a pleasure and an education to listen to you.

Saturday, August 22, 2009

What have you LEARNED as a manager?

Time of a bit of reflection. What have I learned in a long career in management?

Here are ten things I’ve learned:

1 The best managers spend time with front line employees listening to their stories.

2 The best managers talk regularly to customers.

3 Gaining a management qualification does not necessarily mean you become a better manager.

4 Stretching the rules as far as you can – and even breaking them occasionally - gets things done.

5 Returning to the front line and doing real work is good for any manager.

6 Never believe what other people tell you about the folks you are managing – judge people yourself.

7 Trust employees – only a few people will stitch you up – most people want you to do a good job.

8 Make decisions – people respect you for doing something rather than doing nothing.

9 Ask for help – people will always offer help but they have to know you need it.

10 Never be afraid to say ’I don’t know’ – you are not expected to know the answer to everything.

What have you learned from your management experience?

Wednesday, August 19, 2009

"I'm Proud of the NHS"

I've set up a Facebook Group called "I'm Proud of the NHS" - you can join at this link

Thursday, August 13, 2009

The Big Healthcare Debate

The US is currently in the midst of heated and controversial debate as President Obama tries to introduce big changes to the healthcare system. I am not qualified to criticise the US healthcare system but I do wish the President well in his efforts to introduce radical change.

We too need change in the National Health Service in this country. Change is constant and the demands for healthcare continue to outstrip supply worldwide.

What has been very irritating on this side of the pond (to me at least) has been the barrage of myths and scaremongering about the NHS from politicians and media in the US who clearly know very little about our NHS. There are numerous right wing doomsayers trying to scare people in the US about the 'dangers' of universal health care.

I am always the first to admit the NHS has its faults and I am as critical as anyone when things go wrong for patients and families.
On the other hand I have yet to see evidence from any credible healthcare research organisation that shows a universal healthcare system anywhere in the world that is better than the UK National Health Service. Universal is the key word.

The following quotes highlight why we in the UK can be proud of our service despite its deficiencies.

"In the US-based Commonwealth Fund's 2008 healthcare rankings of six top developed nations (Australia, Germany, Canada, New Zealand, United Kingdom and United States):

The United Kingdom ranks top overall - and ranks above the US in all but one measure - yet has the lowest healthcare spend per head of population.

The USA ranks sixth overall - ranking bottom on five of the nine measures along with having the lowest life-expectancy and highest infant mortality rates by far - despite spending more than twice what any other country spends on healthcare (and, at $6,102 vs. $2,546, almost three times the spend in the UK), per head of population."


And yesterday from world famous Professor Stephen Hawking in the Daily Telegraph:

"Professor Stephen Hawking defended the National Health Service from attacks by the American Right, claiming that he would not be alive without it. The British physicist spoke out after Republican politicians lambasted the NHS as "evil" in their effort to stop President Barack Obama's reforms of US health care which will widen availability of treatment but at a cost to higher earners who will pay higher insurance premiums. "I wouldn't be here today if it were not for the NHS," he said. "I have received a large amount of high-quality treatment without which I would not have survived."


I don’t think the people of the US need fear universal healthcare if it comes your way. Even David Cameron the leader of the Conservative Party in the UK said this today:

Tory leader David Cameron, who has pledged to protect the health service from public spending cuts, also sought to distance himself from Mr Hannan's comments when he was tackled about them on a walkabout in his constituency.

He told BBC News: "I support the NHS 100% and the Conservative Party supports the NHS 100%.

"We are the party that gives the biggest amount of support to the NHS. It is incredibly important to my family. It is incredibly important to this country."

He vowed to "nurture the NHS" if he came to power, "and improve it and make sure it is there for everyone in this country".


Finally I want to say that this unusually long post is not meant to try and persuade US citizens about anything. Clearly it is the decision of the people of the US and those who govern to design their new healthcare system.

I would just ask my many friends in the US not to believe the nasty, unfair, unjustified and often simply untrue madness that is being written by right wing media and politicians on that side of the pond about our National Health Service in the UK.

All my friends in the US are rightly concerned about the crisis facing their healthcare system and I hope that by sharing the best practice on both sides of the pond we can mutually find the right answers to what is actually a world crisis in healthcare.

Regular readers of Simplicity Blog know that I will I will defend the principle of universal healthcare with my last breath because I think it says a lot about my country that access to healthcare is not dependent on wealth.

Ian Sanders - The Juggler!

My friend Ian Sanders - author of two great books that I have reviewed on Simplicity Blog is featured on this terrific interview. It lasts eight and a half minutes and is well worth a look.

Well done Ian - keep up the good work.

Sunday, August 09, 2009

Friend of Simplicity - Rosa Say

Today’s Friend of Simplicity is Rosa Say who I have known for about 4 years and who lives in Hawaii – are we all jealous of that or what?

Rosa is a prolific writer and a passionate advocate of lifelong learning. I am sure you will enjoy hearing from Rosa and visiting her various links.

Trevor - Hi Rosa - Tell us about your career to date and where you are based.

Rosa - I live in Hawai‘i and primarily work there, but I am fortunate in being able to accept invitations to speak and teach elsewhere in the world too, fortunate in that I love my work and love to travel.

I also do quite a bit of virtual work. After three decades gaining my professional experience in the Hawai‘i hospitality business, I founded three different companies, one for coaching and consulting, and two for writing and publishing. All three are dedicated to the mission of the Managing with Aloha™ movement: I help managers and leaders create and maintain healthy workplace cultures by way of value alignment and achieving their full potential in those professions and personal behaviours.

Trevor - You always seem to be ahead of the game with internet technology. What excites you most about communicating through the internet/blogging/twitter etc?

Rosa - The learning is what excites me most, followed closely by the now global nature of how we can communicate and collaborate.

Technology gets our physical and geographical limits to disappear, a true godsend when like me, you live on the most remote land on the face of the earth, yet want to be connected with like-minded people and thought leaders wherever they might be.

Lifelong learning and the adoption of technology are choices we all can make, yet in my case I’ve come to consider them both my innate talents; they are strengths begging me to capitalize upon them as much as I can, and so I do: I believe that working on our strengths is the way we live within a sense of thankfulness while we serve others in our best way possible.

A huge fringe benefit for me is that I find both learning (of all kinds) and technology to be great fun!

Trevor - What is your latest project?

Rosa - My newest business creation is that third company just launched in January of this year, named Writing with Aloha. It is the product-creating arm of Ho‘ohana Publishing, and it takes the teaching and coaching services of Say Leadership Coaching and converts them into product packages. The goal is to scale what my MWA training and coaching delivers, and deliver it to a wider audience in forms which are much more affordable for them.

Trevor - What advice would you give to young people coming into the world of business in 2009?

Rosa - Understand how lucky you are right now and close your ears to any negativity you hear.

True that this may be a very painful time for many people, however there are incredible silver linings to the dark clouds! I find it very exciting that we are no longer able to rest on our laurels and must reinvent and newly create better business models, and young people today are in prime position to optimize those advantageous conditions. My advice to them is to focus on their innate talents and put them to work: We don’t employ people; we employ their strengths and harness their potential.

Trevor - Tell us about your writing Rosa and do you have any plans for more books?

Rosa - Yes I do! I have a manuscript in draft right now which focuses on a very specific concept within Managing with Aloha which I call our ‘language of intention.’

Where MWA had focused on management, my next book will take on what I believe to be the crucible challenge of leadership. I know I have kept my MWA readers waiting for this, however I don’t think I could have written it before now and have it be good enough, meaning useful enough; we don’t need another lofty impractical leadership book. As they say, “the world conspires” at times so things happen when they should.

Trevor - Do you have any plans to visit the UK?

Rosa - You can bet I do have those plans Trevor; I just can’t yet say exactly when that will be. I am hoping it will be within a year at the most. Perhaps a book signing when my next book is released?

Believe me, it is not just a wish, hope or dream; I fully intend to visit and stay for a good amount of time; the prospect has been a very compelling one for quite some time now.

As you know Trevor, one of my projects is the Joyful Jubilant Learning network of the Ho‘ohana Community, and I’ve long thought of the UK as the more central place to hold our first global convention because of the key players most involved.

Trevor - Where can people find out about the services you provide Rosa?

Rosa - I invite your readers to visit for more about what I do. It includes an overview of all my work in the business community, and the site will always highlight my current projects. August of 2009 will be my 5th year writing on the web, and to celebrate, I have newly created - it is already live for those who would like to take a peek before our August launch. Both sites offer links to my blog Talking Story. Thank you for your Aloha here Trevor, I sincerely appreciate being able to meet those in your Simplicity community.

Wednesday, August 05, 2009

Don Henley magic

Question - Has there been a better, more versatile male voice than Don Henley in the last 30 years of Pop?

I am unashamedly biased but there just is no competition in my opinion. Here Don sings his classic "The End of the Innocence." This track is on "The Very Best of Don Henley" - a new Henley album and he sounds even more perfect 'live' than on the album - surely a sign of genius at work!

Tuesday, August 04, 2009

More wisdom from Tony Benn

Regular readers of my Blog know I am a great fan of Tony Benn - now 84 years young. I managed to get hold of a copy of one of Tony's speeches called "The Use and Abuse of Religion."

This speech was at Oxford University in 2006. Tony had been a student at Oxford in his youth during which time he was elected as President of the Oxford Union.

I just wanted to share a few highlights that illustrate the wisdom of one of the greatest British politicians of the last 100 years.

University Sermon by the Rt Hon Tony Benn PC

The University Church of St Mary the Virgin on Sunday, 14 May 2006

"Adam Smith was the founder of one of the greatest religions of all; those who worship money. Archbishop Dow Jones, whom I’ve never met, works twenty-four hours a day on his averages. Dow Jones tells us every day on the business news how society is doing by measuring what is happened on Wall Street."

"When we heard that God told the President to go to war, and that man Moussaoui who was sentenced to life imprisonment last week in America for being involved in 9/11 had said “We are the soldier of God, you are the army of Satan”, you realise that the same language is used by both sides."

"I remember once when the Russians and the Americas had a space race, to see who could land on the moon first, the Russians landed a space vehicle on the moon. It was like a World War I tank, with caterpillar tracks and it went across the surface of the moon, and I had a letter from a constituent in Bristol that I have never forgotten. It said “Dear Tony, I see that the Russians have put a space vehicle on the moon. Is there any possibility of a better bus service in Bristol?” Now, you can laugh, but it was a very, very sensible question. With a fraction of the money that you spend on war you, everyone in Africa with Aids could get drugs and the United States could have a health service. When you have to make a moral judgement the scientist cannot help you in his capacity as a scientist."

"I read the other day that if everyone in the world had the same living standards as the Americans it would require the resources of 33 earths to do it; 33 times as much oil and food and water. That reinforced for me the idea that the human race are like survivors in a lifeboat, after a shipwreck. Imagine a little lifeboat with a few people in it with one loaf of bread for there are only three ways that you can distribute in those circumstances. You sell the bread so the rich gobble it up, you fight for it so the strong gobble it up, or you divide it up and share it."

"It is the motivation of moral teaching that encourages you to want to do it yourselves. These words appeared in the Charter of the United Nations, I heard them 61 years ago, I was on my way back as a pilot from the Middle East in a troop ship coming back to this great university to resume my studies and I heard the preamble to the Charter and it said “We the peoples of the United Nations” – it didn’t say we the coalition of the willing, or we the free world, or we the international community, “We peoples of the United Nations, determined to save succeeding generations from the scourge of war which twice in our lifetime has caused untold suffering to mankind”. That was the commitment that we made, and this generation has to discharge that commitment because, dare I say, there is no moral difference between the stealth bomber and the suicide bomber. Both kill innocent people for political reasons, and that I believe is in defiance of everything that was being taught by Jesus and the great religious leaders whom we have been celebrating in this wonderful University Church today."

Saturday, August 01, 2009

61 years later - Thank you Mr Bevan

I watched a BBC documentary this week about the founding of the National Health Service NHS in 1948.

It filled me with pride to hear about the fighting spirit of the great Welshman, Aneurin Bevan, Minister of Health, in the great reforming Labour Government immediately after the Second World War. Mr Bevan had worked down the coal mines of Wales as had his Father before him. He was from working class stock and very proud of it.

Mr Bevan steadfastly refused to give up the battle to set up the NHS despite opposition from powerful lobbies like the medical profession. The Conservative Party under the leadership of Winston Churchill violently opposed the setting up of the NHS in the House of Commons. That tells me a lot about the Conservative Party philosophy which has not really changed of course since those days. Whilst they make the right political noises to capture votes I'm sure they would secretly love to privatise the entire NHS.

Mr Bevan famously said that no longer will wealth be an advantage nor poverty a disadvantage. He said that healthcare will be provided free of charge to all based on clinical need and not on the ability to pay.

These principles still apply today - 61 year later and I for one will fight to my dying day for those principles to remain intact.

Despite what cynics and scaremongerers might try and tell us it is possible to have a government funded universal heath care system and patient choice at the same time. Those people who can afford to pay for private healthcare in the UK have that choice (they have ALWAYS had that choice).

What the wealthiest people in Britain DO NOT HAVE is any more of a right to free NHS treatment than the poorest member of our society. Isn’t that wonderful?

Despite being a great advocate for the NHS I have also always acknowledged there are many problems in the NHS. It is far from perfect. I still however have a sense of great pride that in Britain we can say we have a free healthcare service for the most vulnerable members of our society and it is guaranteed regardless of wealth status.

Surely one way any nation can be judged is how it guarantees to look after its most vulnerable citizens regardless of their ability to pay.