My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

Read my statement in full »

“Tomorrow’s Specialist” – more clinical argument for the centralisation of NHS services from the Royal College of Obstericians and Gynaecologists.

Filed Under (Health Policy, Royal Colleges) by Paul on 28-09-2012

As I commented earlier this week a powerful consensus of clinicians and patients’ groups is emerging all arguing, for reasons of safety, for much greater centralisation of some hospital services.

The argument made by the RCOG, as with the other Royal Colleges, starts with the clinical case for safety. The case is based upon the difference in safety outcomes that occur when a specialist is in charge and when they are not. This is not to say that all births should take place through a specialist but it is to say that a service that has a specialist at hand is safer. Read the rest of this entry »

More news on consolidating hospitals from the Royal College of Physicians – and another example of why the Royal Colleges will fail to set the agenda if they can’t agree.

Filed Under (Hospitals, Royal Colleges) by Paul on 25-09-2012

Yesterday I posted on published data showing wide variations in outcomes from some surgery and the Royal College of Physicians’ consultation on the future of the NHS hospital. Blog readers have brought to my attention the article in the Guardian reporting the important views of the spokesperson of the RCP Future Hospital Commission, Tim Evans. Read the rest of this entry »

Hospitals on the edge?

Filed Under (Hospitals) by Paul on 24-09-2012

The week before last the Royal College of Physicians started a consultation on the future of hospitals with the above title. The most significant thing about the document is the front page which has a cartoon of a hospital falling off a cliff and crumbling as it does so. Read the rest of this entry »

The time of our lives – and the hard work it takes to achieve them.

Filed Under (Olympics) by Paul on 21-09-2012

For several years now Paralympians and Olympians have been getting used to having microphones pushed into their faces at that very difficult moment of completing their event – and sometimes winning a medal. In the Atlanta Olympics Team GB won only one gold and athletes there were more likely to be asked why they hadn’t won. Read the rest of this entry »

What will form the core of Labour’s NHS policy – patients or NHS organisation?

Filed Under (Health Policy, Labour Party) by Paul on 19-09-2012

Some of my friends’ lives revolve around the dates of world, national or European soccer cups. The more normal amongst them organise their time around their jobs or houses. But most of ‘me and mine’ have had their lives organised around the milestones of General Election dates. Read the rest of this entry »

More thoughts about the possible development of different party political narratives about NHS reform

Filed Under (Narrative of reform, Reform of the NHS, Secretary of State) by Paul on 17-09-2012

Last week I posted about the different way in which party political narratives about NHS reforms may develop. I expect a very different kind of debate now that the Government may have the ability to communicate some form of message about what it is trying to achieve. Read the rest of this entry »

The time of our lives

Filed Under (Olympics, Volunteers) by Paul on 14-09-2012

I am sure that in a few weeks’ time some of us will look back on the Olympics and feel a bit sad about being able to say “this was the time of our lives”. However the reality is that for a very large number of people this phrase sums up their personal experience of the event.

I am too young to remember the Festival of Britain but my parent’s generation, having survived the war and started to live fuller and slightly better off lives, often used that experience to highlight how differently they felt about their country and their lives in 1951.

A few years later the Coronation provided a similar moment in some parts of the country. But like this year’s Jubilee what was different about the Olympics is that we were – all of us – given the opportunity, and indeed the right, to celebrate not only the monarchy but the whole country.

I, along with a few hundred thousand other people, was doubly lucky.

First for having spent most of my life living in London and, from a very early age, having had strong emotional ties to the city – especially to the East End. I was born and brought up in South East London but for most of my life the East End has been the place I have walked around, occasionally had political battles over and of late enjoyed its surprising regeneration. I have often walked the Lea Valley and did not believe that anything would ever be big enough to fill the vast economic and physical hole that clearly needed regeneration.

Turning millions of tons of contaminated turf into a beautiful place with wild flowers was beyond even my optimistic list of probabilities.

Second I was lucky enough to win the opportunity to buy a set of tickets in the ballot which gave me a day at the athletics in the morning and at the basketball in the evening. So I spent a whole day in the Olympic Park and that is where I saw so many people having the time of their lives.

Much of the positive experience was about us, as individuals, linking up with us as a part of a country of which we could feel proud. That’s my historical link with the Festival of Britain. My parents were a part of a generation that had not only survived and beaten fascism, but were rebuilding their lives and the lives of the country in a new world.

Most of the last 60 years hasn’t felt like that. Many of the events that the country has celebrated haven’t been those in which I could really find much that resonated with me. But Danny Boyle’s opening ceremony not only celebrated the country as something external to me, but effortlessly placed me and my life within both the country and that celebration. The NHS, the rise of a new multicultural society, rock music, new culture and a better approach to the different ways in which we live our lives – all presented a different view of us as a country.

And when as a country we went on to win medals in both the Paralympics and the Olympics, it was this country of which I could celebrate being a part. That was the ‘time of my life’ because my life and my time felt part of something much larger – the nation as a whole.

I have two wider lessons for an NHS that was so wonderfully celebrated in the opening ceremony. The first I will discuss today and the second next Friday.

I am not alone in learning my first big lesson from the Olympic volunteers, the games makers. I know two people who were successful in being selected as volunteers and in the strangest of coincidences they were both born in Mombasa, Kenya. They both came to this country as a part of the exodus of East African Asians over 40 years ago. Both were very happy to give of themselves and their time in a celebration of internationalism in their adopted city of the past 40 years.

But it was a wider experience of the way in which the volunteers behaved that provided me with a lesson. My own experience and everyone else’s I have talked to saw and felt that these volunteers behaved entirely differently from nearly all the other volunteers we had met. In the NHS and other major institutions volunteers seem to sit on the sidelines and let everyone else get on with the main activities.

In hospitals for example it is the paid staff that run the whole experience and the volunteers sit behind a desk or make tea but they don’t push themselves into the patient experience.


At the Olympics volunteers enriched everyone’s experience of the games by being very outgoing – asking you how you were and if you were excited. They did this as a way of performing their task of getting hundreds of thousands of people from A to B. But they also made sure you were OK.

They knew they were central to the experience and they made sure we all had a good time.

How can we make volunteering in health and health care like this?

I am sure there will be some who will immediately say that volunteers simply can’t be as important in a complex, professionally led and safety conscious activity such as health care   Volunteers can never be this important when doctors, nurses, and indeed science, are so important to the NHS.

But think about the Olympics for a minute. The volunteers were very important and everyone agreed that they were essential. But no one suggested that they could run as fast as Usain Bolt or finish the marathon David Weir’s pace. The volunteers ‘made’ the games – but of course there were other specialist skills that were just as important.

Volunteers created the environment in which spectators could enjoy the hard work of the specialists.

Volunteers could make an environment in which patients have a much better experience of the NHS whilst still depending on the hard work of the specialists.

But for this to work NHS volunteers will need to be as active and outgoing as the Olympic volunteers. It was their activity rather than passivity that made them so exceptional.

Given the shift we are going to have to make in NHS care – away from the notion that health care only takes place in hospitals and clinics  when in fact it takes place in homes and communities – now is the time to rework our perception of the importance of volunteers in becoming health care ‘makers’.

The politics of Nationalisation, the NHS and the General Election of 2015

Filed Under (Narrative of reform, Reform of the NHS, Secretary of State) by Paul on 12-09-2012

Since Monday’s post appeared a number of people have asked me to clarify what I meant by the Government failing to make critics pay for constructing even the oddest arguments against their reforms.  What am I suggesting? What should Governments, or any other major institution  do when they are involved in an argument with opponents? Read the rest of this entry »

The new Secretary of State must develop a narrative to argue for the Coalition Government’s NHS reform. What might this look like? (1)

Filed Under (Narrative of reform, Secretary of State) by Paul on 10-09-2012

Many commentators have argued that the task of the new Secretary of State is a near impossible one (“his in-tray … a pyramid of hand grenades with loose pins” as Polly Toynbee put it in the Guardian on Thursday). They have argued that the fact he has been given his new job because he is a good communicator means he is bound to fail because the story he has to tell will inevitably be one of failure.

I don’t think that is necessarily true. I do think that it’s a very difficult story to develop and to tell, but being new he has a number of strong points. Read the rest of this entry »

Andrew Lansley: An epitaph

Filed Under (Health Policy, Narrative of reform, Reform of the NHS, Secretary of State) by Paul on 06-09-2012

He demonstrated every day how important it was for a Secretary of State to not only have a narrative about why there needed to be change in the National Health Service but also to have the ability to communicate that narrative to the public and the NHS.

Read the rest of this entry »