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 »

What do commissioners have to buy to increase the health care value that could be created by patient co-production?

Filed Under (Creating public value, Health Improvement, Patient involvement, Self Management) by Paul on 10-05-2012

Why doesn’t it just happen anyway?

To rehearse the argument so far. Given that the percentage of GDP spent on the NHS will not rise very fast and the demand for health care will, those of us that want to save the NHS will have to help it find new sources of value to develop significantly more health care outcomes from the same resource. Read the rest of this entry »

Why self-management is only a part of the co-production of health care value.

Filed Under (Creating public value, Health Improvement, Patient involvement, Self Management) by Paul on 09-05-2012

The moral arguments in favour of greater self-care within the NHS have been around for some time. I have myself been involved in them for over 30 years. Therefore some of the counter arguments against co-produced health care have been trailed and discussed for some time. Read the rest of this entry »

From Vision to Action. Patient power fights for the future of the NHS

Filed Under (Charities, Health Improvement, Patient involvement) by Paul on 03-05-2012

I remember, in the autumn of 2010, writing about an important paper produced by 10 major patient groups and suggesting that perhaps this would prove to be a more important document than anything else that was going on at the time with regard to the wrangling about the Health and Social Care Bill. Read the rest of this entry »

Building progressive NHS practice from the rubble of the Government reform programme,

Filed Under (Clinical Commissioning Groups, Health Improvement, Public Health, Targets) by Paul on 02-05-2012

No 1 Working towards improving health care outcomes

We are now a few weeks on from the passage of the Act. The glimpses of the direction of its implementation that we have had since then are as contradictory as the Bill itself. The Secretary of State writes to the NCB saying that they must ensure that there is autonomy for CCGs and the Chair of the NCB responds by saying that it will be some time before the NHS will be liberated from its centre. Read the rest of this entry »

Over there, over there, can they all be really hopeless in health care over there?

Filed Under (Health Improvement, Reform of the NHS, USA) by Paul on 03-04-2012

Last week I spent some time in Boston as a member of a British Consulate delegation. We were there to discuss health systems with various people carrying out health care innovation in the USA.

I fell to thinking about how readers of this blog would react to that last sentence. To some it will be a red white and blue rag to a bull.

During the last year I must have been in a dozen meetings about NHS reform where most of those present would hiss at the possibility of ever learning anything from the US. Within our NHS reform debate there are groups of people who say that it would be morally wrong to learn anything at all from the US about health care – because they have such a bad system.

I’m afraid I don’t find this a very mature reaction.

In truth, in the last year I have found much of the ‘little Englander’ and ‘little NHS’ emotion which necessitates rejecting the possibility of  learning anything from the biggest economy in the world a bit sick making.

The US health system is an expensive, broken system where nearly all the incentives are moving this non-system in the wrong direction. It would be mad for any country in the world to learn anything systemic from that. The interesting thing is that every single person I have met in my three visits to the US to discuss health care over the last 4 years agrees with that. They feel that their system is an expensive generator of inefficiency and inequality, and all spend a lot of time trying to do something about it rather than accept it as a national ‘given’.

So within a very bad system there are hundreds of thousands of doctors and nurses doing very good things – and there are hundreds, if not thousands, of organisations that are developing interesting and important innovations in care.

For those that understand more about religion than I do there seems to be a sort of ‘original sin’ argument here. If you – or any of your ideas – are connected with the US health care system – then by associating with this ‘original sin’ you are irredeemably lost.

As I say, I think that sort of thinking is immature. More so it treats the NHS as if it were a fragile flower (do you remember David Cameron’s analogy of May 2011 – that it is like carrying a precious glass vase across a slippery floor?). I didn’t believe that then and I still don’t. I think it is a very, very strong institution and because of that can learn from different countries with very different traditions.

So over the next few months I will be challenging this simple anti Americanism by sharing through the blog aspects of US innovation that I think the NHS can learn from. Ideas and practices that can provide better services for patients within the principle of equal access for all, paid for out of general taxation, free at the point of delivery.

The core business in which we are involved..

Filed Under (Health Improvement, Public Health) by Paul on 30-01-2012

It’s very easy to forget what our core business is. It’s not the governance arrangements of CCGs nor is it even my quest for anyone to tell me what ‘clinical senates’ might be when they are at home. Read the rest of this entry »

So what can telehealth and telecare achieve for NHS patients?

Filed Under (Health Improvement, Telecare) by Paul on 15-12-2011

I sometimes feel that there is a conspiracy within the NHS against the implementation of step change. Those who do not want to change the way in which they work are always seeking evidence against the new. They show that the ways in which they do things are the best ways and that there is no evidence for new-fangled ways of working being any good at all. All these new ideas not only don’t save money – but are unsafe as well.

Read the rest of this entry »

Markets, business and the creation of innovative value for money health care for NHS patients.

Filed Under (Creating public value, Health Improvement, Innovation, Private Health Care) by Paul on 10-11-2011

A small story last Friday exemplified a much bigger issue. The story concerned the results of research from the University of Birmingham on how the effectiveness of different weight loss schemes. Read the rest of this entry »

Migrant Health Care

Filed Under (Health Improvement, Migrant Health Care) by Paul on 30-09-2011

Last Friday I spoke at a conference organised by the Migrant Rights Network on the subject of migrant access to health care. I was asked to run a session on the role that the new clinical commissioning groups have in improving that access.

My argument was based partly on how the Health and Social Care Bill is framed at the moment – that is a duty of the clinical commissioning group to the population covered by their geographical boundaries, and not just their registered population. In many parts of the country this duty must lead CCGs to seek out the hard to reach groups in their localities to ensure that the CCG is commissioning care for them and not just for a part of their population. Read the rest of this entry »

The hospital is dead, long live the hospital: Sustainable English NHS hospitals in the modern world

Filed Under (Health and Social Care Bill, Health Improvement, Hospitals, Reform of the NHS) by Paul on 15-09-2011

Today, September 15th, we are publishing, through the think tank Reform, a pamphlet about the necessity to convert the work of NHS hospitals into a much more sustainable set of business models. These changes will be difficult for both those inside the NHS and for those outside. However not facing up to the need for these changes will build into the NHS much greater inefficiencies, and outcomes that fail to reach the level of safety that we have come to expect. Read the rest of this entry »