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Urgent: What to call our Review - any ideas?

I met with the Chief Officer of the Joint Framework Partnership of Commissioners, who sits in a Governance Senate with joint stakeholders across the local health economy including the CCGs and Trusts, and regional representatives of NHS England.  Having discussed the agenda for our next joint commissioning meeting with social care representatives from neighbouring authorities, we decided to discuss process a bit more.

Just as the meeting was ending, we decided that we needed to launch a regional review of the acute provision as soon as practical.  Given it is Healthier Together to be Fit for the Future, and as Better Care is Better Value, but it always prescient to take a Forward View that realises Care Closer to Home, we decided it is important to name the review appropriately.

Can colleagues help us out with a proposed name for the review?  Please note the following criteria for any names:

1.  It needs to be content-less.  Any suggestion that services may be rationalised, or moved, or working hours extended, unsocial hours pay amended, clinical practice altered, jobs rationalised etc, however subliminal or logical, will automatically rule a name out.  So please keep it inane, and banal.  The idea is not to be accurate, it is to be bland.

2.  We like alliterations and parallelisms.  We love "Better X, Better Y."  Perhaps you can insert two of Care, Value, Services, Health or Lives for X and Y.  That is a sure-fire way of getting a good one.  It also gives you 20 possibilities.  It sounds a trivial problem; the reason we did not jump at it is that the problem is not coming up with the possibilities - it is ensuring that it has not been used before.  So we would need you to do a comprehensive search of previous reviews to get the right answer.  If you can automate this procedure, then you can sell this naming convention to regional health economies around the country.

3.  We love the Future in all its guises.  Because we are all about the future.  Hands-up anyone who is planning for the past?  If you have just put your hands up, then you either work in Manchester (where you are redefining District Health Authorities), or you have it all wrong.  It is all about the future, the forward, the road ahead, the advancement of medicine.

4.  It needs to be - at most - 4 words.  Any more, and most of us cannot really remember.  And everybody in five Trusts (combined workforce of 30,000) will all be saying it 20 times a day for 3 years.  That is 600 million times, and if it has an extra word, and it takes a quarter second to say that extra word once - that is over 40,000 hours wasted!!  That is not efficient - and even though we don't want to say it in the title, we all want to be efficient.  Who has 40,000 hours to waste over the next 3 years!  There are only 26,000 hours in total in the next 3 years - so you better be inventing a time machine if you want to waste that sort of time.

5.  It needs to have cool initials - like R2D2 or C3PO.

All suggestions on a postcard please.

Update on Sue Lewis and Barts!

I am back . . .

Sorry for the prolonged absence.  3 snotty-nosed children, a high-maintenance husband and the job (CQC inspections, commissioning - or absence of commissioning, contracts - or absence of contracts,  meeting targets - or not meeting them, etc etc) mean that I do not get the time I used to in the past.

Enough about my high-flying life.  Let's get onto the topic at hand - which is the intertwining of two of my most popular blog subjects - Barts and Sue Lewis.

Believe it or not, Sue Lewis - who I wrote about in connection with her resignation from Royal Surrey (Was the recently dismissed Royal Surrey Hospital employee connected to the board? and
MM plays a part in Senior resignation; but takes no pleasure from it), and Barts - which I wrote about at length in connection to the resignation of Mr Goodier (Noble resignation or convenient excuse to focus on greener pastures and Response to story about Barts) became intertwined.  I am annoyed I did not write about this earlier!

Sue was - for a short time - appointed as the Deputy COO of Barts!  You can see more of this from her Linked In profile.  This goes into her role there.

But as with a lot of things associated with Barts, it did not last.

Thought I would update the blog.

As a coda, I must make an admission.  I took issue in my previous posts with reporting Mr Goodier's resignation as purely based on cuts at Barts and the London.  History, it appears is seeming to prove me wrong.  Mr Goodier's resignation seems to have been indicative of broader malaise at Barts and the London.

Not even me, with my perfect make-up, can get everything right.

Two questions for the Shelford Group

Lots of us have issues with elitist groupings.  There have lots of issues going against them - primary among these is the fact that they are elitist.

For example, take the G-14 grouping of the top European football clubs such as Paris St Germain, and Bayern Munich (this grouping existed between 2000 and 2008).  They used to boast things like that they had won the Champions League 41 out of 51 times; 2004 was the first year that a G-14 member was not in the final; between them they had won the league title 250 times . . .

Lots of us have lots of issues with these sort of things.  First, not many of us are surprised that if you form a grouping of the most successful teams, then those successful teams are by definition going to have won a lot.  It is not rocket science.  Secondly, not many of us appreciate smug people who revel in their self-importance, and do not look closely at the what caused their important.

Now, let us look at the Shelford Group - the group of 10 self-aggrandising NHS Trusts  - all with academic links, all with tertiary services, all with self-importance.  This is what they say about themselves on their website: "The Shelford Group comprises ten leading NHS multi-specialty academic healthcare organisations. We are dedicated to excellence in clinical research, education and patient care. We aspire to demonstrate system-wide leadership for the benefit of patients and the prosperity of our country."

My response is "Yes" in the literal sense.  And "So What" in the emotional sense.  Yes, you may think that - but who does not.  Which Trust is not dedicated to clinical research or education or (surprise here) patient care? Who does not aspire to that gibberish.  The very fact that a PR person could write that down without getting you to challenge your own beliefs and strategies shows how vacuous it is.  Which then results in "So What?"

Given the Shelford Group does not mean anything; can I come down to the 2 most important questions I have for them:

1.  What are you going to call the grouping now? Now that Gareth Goodier has moved from Shelford (where he used to live) to Melbourne (allegedly Ringwood), the reason for calling it the Shelford Group is no more.  I am happy to take suggestions in the comments section.

2.  Do the chief executives within the group without a knighthood/ damehood get looked down up? Tim Smart, Bill Shields, Mike Deegan and Keith McNeill may be able to tell us.  Again - Tim, Bill, Mike and Keith - via the comments section, please.

Now, for let me rearrange the monthly performance reports or perform some other equally pointless task.

Stop press: King's announces halt to navel gazing; announces review of navel gazing

I wrote in November 2011 about how Academic Health Science Centres are there to create jobs and then announce strategic reviews of themselves.

It appears that King's AHSC has come to a dramatic conclusion: to review (as part of the previously discussed - and now 18 month strategic review) whether nothing should change.

Keep refreshing this page (for c. 24 months - continuously) to find more breaking news.  Ladbroke's have apparently stopped taking bets that they will announce another period of navel gazing soon.

Why the Manchester's Healthier Together programme is flawed

One of the strands of Greater Manchester's Healthier Together programme aims to tackle A&E attendance at the edges of core primary care hours. The problem is that the approach is flawed.

As the HSJ reports, A&E departments see a spike in attendance for minor illness between 7pm and 10pm. This is just after GP surgeries close. So the theory is that by opening for longer hours, primary care can deal with these illnesses, reducing A&E demand.

The theory is right, the solution is wrong.

I am not saying that opening longer hours will not reduce minor illness attendance at A&Es. It may well do. Clearly, if you are ill you would rather attend a local surgery than a distant A&E.

What I am saying is that it will not reduce system costs. System costs are determined by number of points of healthcare delivery and capacity and access of those points. By increasing capacity and access, you do not reduce costs.

In addition, you will stimulate latent demand. With all illnesses, there is a level of uncertainty as to whether the illness is serious or can be ridden out. If the cost of allaying that uncertainty is a 4 hour A&E wait and a long round trip, the risk of bad illness has to be high - and so many people are currently not attending A&E because of this cost. Reduce the cost, and see increases in attendance.

What is more, other problems get exacerbated. People who would never attend A&E, will take up the cheaper access. The athlete foot that does not go away - let's sort it out with the GP after work, rather than going direct to a pharmacy. That cough that is a bit irritating - best understand what it is.

Lastly, it is not sustainable. A couple of years down the road the NHS figures out that costs have increased (for the reasons outlined above) and decides to cut costs by reducing these enhanced services. This results in a further increase in A&E attendance. That takes a couple of years to understand and another region goes- let's try what Manchester tried.

All of this sound far fetched? I would encourage you to look at what happened in London's Polyclinics and Walk-In centres; and at what is happening to London's A&E attendance.

New research shows that hospitals could save £83bn on toothpicks

Hospitals are squandering £83billion a year paying too much for toothpicks and surgical gloves.

An investigation found that some are being charged fifteen times as much as others for the same items.

Top notch researchers from Overcharge & Company and PoorWorrisome Crap & Old looked at ten NHS trusts and found some hospitals were paying £120million for a box of toothpicks while others paid only £1.20.

Some were charged £23 for a box of condoms which cost others just £13. Some trusts were paying £17.50 for new
knees from poor human donors in China, while other Trusts are using plastic implants costing £787.

The study was outsourced to my six year old daughter, who rang around asking people at random. Most did not work in the NHS, and many did not even know anybody who did. But everybody was included to keep the study objective.

Our neighbour, Hugh Jaccount said some hospitals were reluctant to tell others their fees as they were competing for patients. Mr Jaccount works in the local benefits office.

He added: 'This analysis raises serious concerns about price variation and spending in the procurement of NHS supplies.

'At the root of this problem lies the lack of transparency in the market, leaving trusts unable to make cost-efficient decisions about purchasing supplies.


My daughter has the following suggestions:

1. Buy a very expensive project from Overcharge & Company for c. £250,000
2. Distract your staff to boredom by getting them to educate Overcharge's underage consultants how the NHS works
3. Spend organisational energy focusing on purchasing, rather than the operational efficiency of staff - which is a much bigger cost.
4. Call in PoorWorrisome Crap & Old when the Trust is challenged by Monitor