Bullseye…or a shot in the foot?

© Andres Rodriguez | Dreamstime Stock Photos

The recent reports of A&E waiting times are an about face worthy of Alice Through The Lookinglass…”Shock 250% rise in patients waiting more than 4 hours in A&E: Six-month total soars by 146,000 – as Labour says crisis is worst in 20 years” from the Daily Mail.

Apparently, since the Government took over the “4 hour wait target” for A&E patients introduced by Labour in 2002, waiting times are supposed to have rocketted.

Not long ago, in the days of Labour, the Press were tutting over the fact that the 4 hour wait target was causing patients to be left in ambulances rather than being brought into A&E departments for the clock to start ticking…now it’s missing the target that is the issue.

The Guardian further explains that “NHS failed to meet four-hour A&E targets for past two months” and that 93.3% of patients have been dealt with under the 4 hours instead of the required 95%…and this is with 1 million patients more being dealt with than in a similar period last year.  Ahhh…that explains it then…there are just too many people presented at A&E…

The Scotsman seems to have it right with their stirring story “A&E patients told: If it’s not an emergency, visit GP” and quite right too. Its the worried well that cause prolems not only in emergency situations at A&E but also with England’s new 111 Service where the volume of call to this urgent number have brought down the systems.

If I was in A&E with a life threatening problem and the guy next to me was being treated for a cut finger as he was nearing the 4 hour wait target I’d be pretty vocal. Surely it’s the triage professionals that should be making the decisions about who is seen first? About who is emergency and who is urgent?

They could always install direct lines to the 111 Service in the A&Es for those who are fed up of waiting.

 

 

 

Darwin Strikes Again…

© Dana Rothstein | Dreamstime Stock Photos

I’m sorry to bring this up again after all the uproar has died down…but there are lessons for all of us from the Paris Brown affair.  I think Police Commissioners everywhere will be feeling the strain of this one for a while yet…but for the rest of us the worst may be yet to come…

As managers, we must be left with the unease that a member of our staff might cause our company name to be linked with the disreputable, damaging reputations and ultimately costing jobs.  Of course, this is covered off in company policy…but can we ever be sure that “one of ours” isn’t going to have their moment?  Is it our head on the block, too?

As employers, the recruitment scene subtley changed when social media became a source of addtional information about prospective candidates. Thanks Yahoo, you may have spoilt it for us by explaining to people that vitriolic tweets can catch up with them… and yet there are still people out there who appear not to care what impression they give and employers can manage to avoid them.

As parents, what if our precious offspring follow Ms Brown’s lead and broadcast their immaturity to the world…the world that you and they hope will one day offer them a living. How do you get over something like this?

At Quicksilva I usually say “Recruit for behaviours as you can always teach skills” and this is becoming accepted by more and more businesses as the competition for jobs increases.  It is sad to see so many young people who do not have all the skills needed to communicate in the workplace as reported in The Guardian.

So, once they have these skills, how do we teach them about the consequences of using them?

 

 

 

Legs 11 (1)…thoughts on the NHS lottery

It's a lottery out there...Don’t you just despair over the constant stream of NHS bad news? It’s like a lottery out there if you’re sick…
The main cause of recent Press hysteria is the NHS 111 Service…and yet reading the various articles there is no consensus amongst journalists about what really is the problem. Of course, there is “The Computer System”, that baddie from the sci-fi genre of the 50s and 60s. If you are my age you will recall that computers are violent towards humans and are looking to take over the world.
There is no grasp that today’s services are brought to us through many systems working together (or not) and in the case of the NHS 111 Service I imagine there to be Call Centre Systems, Triage Systems, Patient Record Systems…which has failed us? Or are we blaming them all?
The BBC talks about high call volumes. Is that the Call Centre system causing the long wait? Or is it the staffing levels?
While the Daily Mail sees the Triage System as possibly the main problem…or could it be that staff with only 10 days training, who are so desperate they admit “I don’t know what to do”?
Reports of IT crashes are common in all reports and maybe that was a reference to the Patient record System…or maybe not. Or could it be that as usual a Government project of this size is suffering from flawed planning, know-nothing procurement, poor project management and inadequate testing?
All of the above I suspect, the bigger-is-best policy wreaks havoc again, it never changes and it never will until leaner, meaner, providers are given the chance to prove themselves on Government projects.
I feel a twinge of sympathy for the solution designers as, having worked for years within Government, call volumes have probably been vastly underestimated. The NHS 111 Service is designed for “urgent” calls; the NHS 999 Service for “emergency” calls. However, if you give the public an easy option, they will take it…and hey, who wants to wait two weeks to see a GP?

Love like you’ve never been hurt…outsource like there’s no one watching

The Virgin rail deal and the G4S security contract for the Olympic Games has brought government procurement to the attention of the general public…people who would not normally have outsourcing outcomes on their radar.

Over my career of 30-odd years in the public and private sectors, I’ve been involved on both sides of the fence as contractor and outsourcer…poacher and gamekeeper. We used to say, “this is not our core business, let’s find someone to do it for us”. The assumption would be that a contractor whose business it actually was would have the skills and expertise to be able to do the work cheaper and better than we could.

In those far off days we used to have the concept of the “Intelligent Customer”…this was a tiny group of knowledgeable staff who stayed within the outsourcing body, able to oversee the work of the contractor and to monitor performance.

Roll forward 30 years and as civil servants became more relaxed with having “someone else” do the job the concept of the Intelligent Customer seems to have disappeared…along with any pretence of monitoring and management of outsourced delivery.
Channel 4 News asks “Do you know who runs your world?”…and the answer is probably “No”.

Government departments are now just “kitemarks” with approved contractors wearing the “badge” of the organisation they have replaced….the skills have been lost in government and there is no going back.

Very few people realise that they are now dealing with private business operators and their rights to question the service and get a response have vanished. Transparency is one of the biggest issues…freedom of information does not apply.

Some of the biggest companies…G4S, Serco and Capita have been awarded business to the point that they are bigger than many government departments. The supply chain is deepening and so many public sector staff have been transferred to the new business providers that the culture has been imported along with them…they are becoming indistinguishable from the civil service they have replaced.

In fact, they could well be in a similar position to that of 30 years ago…asking themselves “is this our core business?”

If the difference between public and private sector workers cannot now be seen by the public how blurred has the line become for those who remain behind in government? How close are the links? And can the taxpayer ever know what sort of deal their getting?

Buy Cheap, Buy Twice

© Vangelis | Dreamstime.com

Sir Richard Branson seems hopping mad…and well he might, after losing what had become his “baby”, the West Coast rail contract, after 15 years. Speaking as a Northerner who has lived with West Coast travel through the Virgin years, I can say that the service has gradually improved…the constraining factor seems to have been the track not the trains.

Sir Richard claims that the contract has been awarded on the basis of price, which he thinks will be unsustainable as happened in 2007 and in 2009 when the Department of Transport had to take back the East Coast line because the companies awarded the contract could not afford to run it.

Will this contract fail as many have in the past? I expect it will. I used to get the train into work (if I couldn’t avoid it) and remember the announcements while we were stationary at platforms where staff were trying to crush commuters onto already full trains…”we are not going anywhere until you all move up together”. FirstGroup who have won the bid said that they expect the number of passengers to rise…where do they think these passengers are going to come from?

Government purchasers never seem to realise that cheapest isn’t always best…maybe you’ve heard the old saying “you don’t get sacked for buying X – (enter the name of an international supplier at X). Procurement is mostly about risk transfer…getting the job done cheapest and with minimal risk to whoever is procuring.

A recent example is the G4S fiasco. This is probably a case of the procurement team confusing “blame” and “accountability”…they can blame G4S but they themselves will always be accountable.

Look also at the LSP contracts placed by NHS Connecting for Health…litigation and counter-litigation virtually guaranteed from the start.

SMEs are more likely to be awarded public sector contracts in Scotland than in England and as an SME I’m not surprised by that, considering the level of knowledge amongst the buying community…”big” is seen to be the safest way forward.

But then what is safe? Government have agreed mechanisms to identify suppliers who don’t deliver…which is astounding this late in the game. Most of the population knows how to pick and choose their “suppliers” based on performance…

Parents need to meddle, if we are to medal in 2016

A levels are out at last…how exciting!

Well maybe not as much as it was in my day, when everyone went back into school to see their results posted, catch up with friends, talk to teachers about the next steps…all sounds a bit Boys’ Own Paper or Jolly Hockey sticks compared with today.

I had reason to phone our local secondary schools a few weeks ago to see if I could post a notice for this year’s leavers and thought Results Day would be a good time to catch them…not happening I’m afraid. Recorded messages told me the schools won’t be manned again until September.

I’m guessing this is about keeping the results private, in the wake of our 1980s educational changes to ensure that nobody ever fails…something that I hope will be overturned if we are ever to prepare our youngsters for the real world and for working with others in a team.

That the “everyone wins” culture in state schools is bad for achievement is also supported by Bristol MP Charlotte Leslie.  She has joined the debate on why more medal winners are from private schools and whether it is the achievement-driven policy that works…she should know having had first-hand experience…and my belief is that you get what you pay for with a private education…longer hours, newer equipment, highly paid coaches, etc.

Encouragement to win is a big one and Radio 4’s Woman’s Hour had Judy Murray on today talking about how parents could handle their child’s talent for sport and there’s no doubt in my mind that it’s a bit easier if your parents are encouraging and can afford to buy you the kit.

But the Government appear to be actively discouraging sport in public sector education, still selling off playing fields despite the campaigns to stop the rot…
…while showing us that standards are improving? Yes, 98% of all marks today are passes this year.

On the subject of exam results in general, what on earth is a “CC” or a “D*D*D*” for goodness sake? How are employers like me who are a long time out of education to compare results?

Don’t get sick…just yet

Last week, alarmist headlines warned readers of an NHS ‘killing season’…a period when the average mortality rate increases in UK hospitals due to the intake of newly qualified medical graduates. To counteract this dip in the quality of patient care, the Department of Health has published details of a plan to better provide trainees with the skills they need to hit the ground running. But is it enough…after all it seems the Department of Health are happy to inflict on us medical staff who can’t speak English, so are we any worse off under inexperienced doctors?

We need more than a quick-fix solution…we need to be pre-empting both problems earlier on and providing sustained support to junior staff in the UK by better nurturing their skills and attracting, retaining and developing the very best home-grown talent from the start.

At present, it is reported that patients admitted to British hospitals in an emergency on the first Wednesday in August have, on average, a 6% higher mortality rate than those admitted on Wednesday the previous week. The Department of Health’s measures to eliminate this ”blip” look to smooth out the change-over period in August by introducing strategic, targeted training which aims to better prepare trainees for the reality of life on the wards.

The Department of Health has stressed the importance of a better transition period: “Our aim is to ensure that all junior doctors spend a minimum of four working days shadowing the job that they will be taking up and completing a Trust-based induction.” It’s this kind of exercise that will lessen the shock-to-the-system reaction which seems to be fairly common when juniors first have to face the literally life and death situations that they come up against on duty…another shock to them must be the hours they are suddenly expected to work and the exhaustion that results. Most of the working world has already worked out that by helping new starters to become more familiar with their new working environment, combined with a thorough handover of their responsibilities, they will be better prepared for flying solo.

Indeed, it’s encouraging to see that trials in Bristol of week-long shadowing and additional teaching have reduced mistakes made by new doctors by 50%. If this is truly representative of the benefits, I’d say that we’d be short-sighted to set this kind of skills development at just four days. The plans put in place so far are a great start, but more can be done both in advance and in the longer term to not only bring these statistics down, but to ensure that the very best doctors are providing the very best care in our hospitals.

To attract home-grown talent we need to be encouraging Britain’s young people into medical training, from an early stage. Over the past eight years, nearly 200 UK nationals have headed abroad to train as doctors and dentists at medical schools in the Caribbean alone. We need a system in place that can attract and retain the skills we have in the UK in a world that has become globally competitive for such talented individuals.

It’s important that we’re looking at the longer term effects of the culture too when shaping the way we go about training juniors. A recent report highlighted that during their training junior doctors do not feel valued by their superiors or the organisation as a whole: managers (83.3%), the chief executive (77.7%), the organisation (77.3%), the NHS (79.3%). These figures are not a surprise when you poll at the bottom of the heap…same in most professional sectors I would say.

So what’s in store for all of us who might fall sick next month? It’s thought that 7,000 junior doctors will voluntarily begin the new induction scheme later this month, before they start their posts in August. Compulsory from next year onwards, this personalisation of skills development is a big step towards improving patient care at this crucial time. Whilst more can be done to improve training, it is certainly a good sign that at least things are moving to bridge the massive gap between being a student and becoming a medical professional…safer too!

Change the Record

© Hurricanehank Dreamstime.com

Earlier this week Health Secretary Andrew Lansley published the Department of Health’s long awaited Information Strategy whitepaper “The Power of Information”. It details plans to take all patient records online by 2015…but haven’t we heard all this before?

Back in 2002/3 the National Programme for IT (NPfIT) was born. It promised to do much the same thing, as part of the overall revolutionary plan for NHS interoperability. We all know what happened next – at the last count the Programme had spiralled to £12.4 billion and was officially ‘axed’ in September 2011 with us being years older and no wiser.  I accept that we are a little closer than before to the goal of a standardised, electronic system for patient records across the NHS…but what needs to change to make Mr Lansley’s vision a reality this time around? Here are some pointers:

  1. Break down barriers to change – the NHS Spine has been in existence for many years…it’s not the technology that’s holding us back but the attitudes. However, things are moving and nearly 15m Summary Care Records have been created. It is interesting to note that a patient’s ability to “opt out” was a huge sticking point…to date only 1.29% have chosen to do so.
  2. Identify patients by one unique number – incredible as it may sound, a patient’s NHS Number is not always the primary identifier for an individual across all sections of the NHS. This needs to change so we move to a one patient, one record system.  This is a key message from the Information Strategy.
  3. Clean up ‘dirty’ data –in the last couple of months we’ve had news that 20,000 pregnant men and 95,000 ‘ghost patients’ remain on the NHS books. This needs sorting and much of this process can be automated.  As an example, Quicksilva’s orQestra® system is helping our customers to verify NHS Numbers…in one case resulting in a 1.1% improvement in verified records in the first month…when you’re talking about 1.3m records, that’s getting us there.
  4. Pharmacies need to be encouraged to provide electronic transmission of prescriptions using barcodes – the Electronic Prescriptions Service (EPS) shows promise, but is far from the universal standard. Greater take-up will improve the quality of the data online and remove the need for routine appointments, a significant overhead for GPs.

No one can pretend that any of this will be happening quickly. One of my main concerns is that there is no optional central guidance as to what solutions can be used to deliver on the Strategy. Mr Lansley has instead called on GP surgeries and hospitals to use “imaginative solutions”. It’s true that the top down approach of NPfIT did not work but I think more guidance is needed for those healthcare providers who cut their IT budgets leaving them with no-one to help them make important decisions which will affect their future in competition with the private sector.

NHS Data – which one are you, again?

© Matthew Collingwood Dreamstime.com

Last week’s news that the NHS has saved £6.1 million by removing about 95,000 ‘ghost patients’ from its GP lists sounds impressive, but it only exposes the tip of the iceberg.  Removing these outdated records from GP lists is a step in the right direction, but there are other pressing reasons why a concentrated clean-up of patient data is needed.

The quality of data supporting the NHS has been poorly controlled for years and now that healthcare information is beginning to be shared between care providers the true extent of the issue is set to be highlighted.   With NHS Trusts under relentless pressure to measure and publish quality outcome indicators and with the increased accountability that directly affects their budgets the need for clean, accurate and accessible data is more important than ever.

To enable health care providers to identify which patients they are actually treating the NHS maintains its Personal Demographics Service (PDS).  The PDS is where data on every recorded NHS patient is held; it’s used by hospitals and other care-providers as the most up-to-date repository of patient identity available.  However, matching the details a patient has given about who they are against the hospitals own database and then verifying with PDS is not always straight forward.

If patient A is recorded in one database as living on ‘Salisbury Road’, and on another database as living on ‘Salisbury Rd’ then to a computer you have a failed match and there is an error, whereas to a human user the records are clearly the same and perfectly usable.  However, where the flow of information is electronic, and interpretation performed by computers the situation becomes very much more polarised and a minor error can lead to the failure of the referral mechanism, resulting in a patient being unable to book treatment, or to unknowingly receive treatment under a separate identity.  Such situations are often propagated as treatment staff, having recognised registration problems, will often not have the authorisation to make the changes needed.

It is not surprising then that A&E departments find themselves treating unknown or non-NHS patients which results in the hospital not being able to claim back the cost from the Department of Health.  As part of the NHS Reforms hospitals will become reliant on their own income to fund treatment.  Without being able to verify who they are treating, hospitals will lose out to “ghost patients” and “health tourists” meaning they won’t be paid and won’t have the cash available to maintain their service levels. It is vital to address wider data quality issues now, before the Reform Bill changes the NHS beyond recognition.

What’s wrong with Special?

All the Same

© Alexey Lisovoy | Dreamstime.com

I’m at a loss to explain it…why is this government working so hard to eliminate anything that is different?  Same old, same old, seems to be their template for the future.

Once we Britons were known for our originality, if not eccentricity, and we provided the World with thousands of innovative inventions that have shaped everyone’s lives.  We’ve always celebrated “the different”… be that people or things…and these islands have always been home to the special, the unusual and the anomalous.

Now “anomaly” is spoken of as equal to wrong or unfair…something that must be wiped out or at least ignored.  It is becoming “the norm” for Government to seek out and dispose of anomalies.  As evidence I cite:

The Pasty Tax – said to remove an anomaly in the application of VAT on hot food but which puts up the price of the workers’ lunch.

The Heritage Tax – the chancellor says this will avoid the anomaly of not having VAT on repairs to old buildings, but zero tax encourages the owners of listed buildings to keep them serviceable for the Nation.

The Abolition of the 50% tax rate – the chancellor believes that everyone should have the same top rate.

I suppose these instances have highlighted the current trend to make everything the same…and the Government would probably argue, make things fairer…but then a state where everyone is the same and there is nothing worth striving for is surely the life of a drone?

This is not a new situation, though…just look at the way we run junior school sports days (no winners or losers), allocate university places (by quota) and fill jobs (by quota).  We are on the road to everything of equal value…and with it…mediocrity.