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 »

Mid Staffs: What I might have done better to improve the policy and culture of the NHS.

Filed Under (Failure regime, Francis Report) by Paul on 20-02-2013

Part 2: The failure to create a failure regime

One of the long term mistakes has been the failure of policy to clearly develop, publish and use a failure regime for the nation’s hospitals. Whatever else we learn from Mid Staffs, we must recognise that a considerable number of local people felt that this hospital was failing them. Yet I am still not clear if, several years later, Mid Staffs is labelled a falling hospital or not.

That fact it has failed is clear. Whether anyone has had to nerve to categorise it in this way is less clear.

This has been a policy area that has been fraught with political failure. Several governments, including the one for which I worked, have failed the public by failing to develop, publish and use a regime that clearly and consistently uses the label ‘failure’ to describe a hospital.

In 2000 the NHS plan made it clear, not only that there should be a simple red amber and green rating system for the nation’s hospitals, but that there should also be a regime which clearly labelled a hospital as ‘failing’ and had a policy to deal with that.

But in fact the development and application of this policy over more than a decade has been weak.

Compare this to education – where the first school was labelled as failing 20 years ago.

Let’s look at where we are today.  South London Healthcare Trust had the administrators sent in because it had failed economically. But the point made by the Public Accounts Committee was that we don’t know the criteria that determined that administrators should be sent into this hospital – and not to any of the others that can only pay their staff because money is stolen from the rest of the NHS to subsidise them.

In quality and safety terms we don’t really know what the failure regime looks like.

Two weeks ago this led the Prime Minister, in his statement in reply to Francis, to ask Monitor to develop what he described as a ‘unified’ failure regime.

We all know why there has been a decade-long failure to construct a failure regime. It is a collective failure of nerve by the political class (including me in my time in Government).

Most of the public believe that all NHS hospitals provide a similar standard of service. As far as they are concerned the NHS brand is a badge which guarantees both quality and their safety.

ALL of us in the system have long known this is not true.

But it took a catastrophe like Mid Staffs to acknowledge this.

It’s true that some Government policy helped patients at Mid Staffs. In the past they would have had to keep going to the hospital because they had no choice. Developing the policy which gave patients the choice to go to a different hospital was hugely controversial. It took row after row with the various aspects of the NHS to say that the public had the right to choose where to go.

This is one area where I don’t have to apologise because we faced down that opposition and implemented a policy of choice.

What did this mean for people at Mid Staffs?

On February 10th BBC news carried an interesting report on a Freedom of Information request. This had been published on the BBC Stoke and Staffordshire web site.  This showed that the current CEO of Stafford hospital had found that the number of patients who had chosen to go there through the ‘choose and book’ system had fallen from 15740 in 2007/8 to 6513 in 2012/13.

This is a really significant statistic. Because people could choose two third chose not to go.

It is the case that many outside the NHS may find it very odd that as many people as 6513 are choosing to go to a hospital which has been so systematically labelled as bad.

This is the first time I have seen a set of figures which so powerfully demonstrate the choice of the public not to go to a certain hospital. 2 people out of 3 are choosing not to go to Mid Staffs compared to 5 years earlier.

These choices are costing the hospital £3.7 million a year and will be one of the reasons why Monitor has had to look carefully at whether the hospital has a future.

The policy of choice enshrined in the NHS constitution gave people the right not to go to a certain hospital, but because we did not have the nerve to develop and implement a failure policy, we left it all up to the individual.

I am pleased that we gave people choice. But I am ashamed that we didn’t clearly say that failure was failure and decisively act upon it wherever and wherever it took place.

Mid Staffs: What I might have done better to improve the policy and culture of the NHS. Part 1 (Part 2 next week)

Filed Under (Culture of the NHS, Francis Report) by Paul on 13-02-2013

In the last few days several people who have commented about my blog regarding Mid Staffs have said something to the effect of “What about an apology from you for your part?” and of course, given the depth and the breadth of what happened at Mid Staffs, everybody that had a role in the NHS over those years has to look carefully at what they did and did not do.
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The Government’s response to the Francis Report

Filed Under (Francis Report, Prime Minister) by Paul on 07-02-2013

Since he became Prime Minister David Cameron has made three statements to the House of Commons in response to important reports into failures of the state. The first was the report on ‘Bloody Sunday’, the second on the Hillsborough report and the third, yesterday, was the Francis Report.

Of course all three of these reports investigated very different sorts of failures. But importantly all three of them relate to failures by government to listen to what they were being told, again and again, by the public. In all three cases the public, who were telling the truth, saw cover-ups by different parts of the state.

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An important day for the NHS to show it can stick to its principles whilst learning from mistakes.

Filed Under (Francis Report, Uncategorized) by Paul on 06-02-2013

The Francis report is published today. Nowadays even the most sensitive legal documents are heavily leaked – with the Guardian seemingly having a copy on its front page last week. However despite the leaks it’s always best to wait for publication before commenting on the actual content.

I want to make some wider points here. These have occurred to me whilst looking at the press preparing for Francis. It is already clear that a number of newspapers will construct from the findings an analysis that chimes with their fundamental hatred for the basic principles of the NHS.

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The Francis Report, transparency, and what counts as knowledge inside and outside the NHS.

Filed Under (Francis Report, National Voices, Patient involvement) by Paul on 04-02-2013

A few weeks ago Alan Milburn outlined how he saw that one of the main outcomes from the Francis Inquiry into events at Mid-Staffs should be much much greater transparency of information about the NHS for the public outside. In 2013 very few people would disagree with that. But there will be important disagreements about what this means.

Last week Liz Kendall from Labour’s Shadow Health team spoke to a National Voices’ conference about how she felt we needed to extend transparency. One of the points she made was that the public didn’t just need more numbers about what is going on inside the NHS, but that the NHS needs a form of knowledge about what is going on inside that has been partly created by patients and the general public outside. Read the rest of this entry »

Take a few steps back to understand what failing hospitals really mean for the NHS – and why we need to do something serious when they do.

Filed Under (Francis Report, Healthcare delivery, Hospital Trusts, Localities) by Paul on 28-01-2013

Last week I drew the analogy between the role of the administrator in the NHS and the fact that someone with the same name – administrator – winds up High Street retail chains like HMV. The point I was trying to make was that the announcement of an administrator for HMV was recognised as being the end of the line for the current organisation of a failed chain of stores. However when an administrator  was announced for South London Healthcare Trust it was seen as another opportunity to develop the trust with the minimal amount of change. Read the rest of this entry »

Opening up different ways of responding to the Francis Report

Filed Under (Alan Milburn, Francis Report, Regulation) by Paul on 16-01-2013

Both the Government and the NHS are gearing up to respond to the Francis Report on Mid-Staffs that will be published in the next few weeks. I am aware that some Trust Boards have already set aside dates to think through the report and their response to it. Given the importance of the way in which culture works in NHS organisations, it will be vital that they develop ways to reassure the public that they have a culture of care and safety. Culture – “the way we do things around here” – sets the parameters for the way in which staff and patients operate. Board leaders thinking through how they help set the tone for their staff is a crucial part of the response. Read the rest of this entry »

Understanding how Francis might understand the world of the NHS

Filed Under (Accountability, Francis Report, Health Improvement, Health Policy) by Paul on 17-10-2012

A few weeks ago we learnt that the publication of the Francis Report on Mid Staffs will now be put off until January. In the interim there have been some concerns shared within the NHS about how the report might understand its world.

As Paul Hodgkin from Patient Opinion said at the conference I mentioned in Monday’s post, if the answer that the Francis report comes up with is ‘more regulation’, then they are probably asking the wrong question. Read the rest of this entry »

Preparing for the Francis Report – Prepare for the next Health and Social Care Bill

Filed Under (Francis Report, Health and Social Care Bill, Secretary of State) by Paul on 21-12-2011

The car crash that is the Government’s policy-making process for NHS reform has somewhat hidden the fact that there is an entirely different policy-making process going on. Constitutionally this has no real relationship with the Government’s process. This is the Francis Report on Mid Staffs.

Make no mistake about it, though this may look like a Public Inquiry into a hospital that let down its public, it is actually an organisation writing the next round of NHS policy. Read the rest of this entry »