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.

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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.

Developing the Power of Nurses – US style

Filed Under (Health Improvement, Health Policy, Public Health, US opinion, USA) by Paul on 24-03-2010

One of the interesting meetings that I had whilst in Portland – the largest city in Oregon – was with nurses in one of their biggest hospitals – Providence.

I have been in the US with the excellent Helen Bevan – Director of Transformation at the NHS National Institute. One of the things we have been discussing in all our meetings is whether US hospitals would be interested in using one of the improvement tools developed in the NHS – the “productive ward”. The “productive ward” is a nurse-led project aimed at working with nursing staff on the ward to release staff to devote more time to care. It’s aimed at cutting out waste and is, in many ways, a classic time and motion study. The difference is that this study is carried out and implemented not by “men in suits” but by the nurses themselves. Some of the improved output figures are very good.
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Historic moments in the development of world health care

Filed Under (Health Improvement, Health Policy, USA) by Paul on 22-03-2010

It’s rare for one of my posts to be written through tears (although of course that doesn’t mean that many of you don’t end up reading them that way!) but by a quirk of history I am in America on the same day that President Obama’s Health Care Bill is passed.

The excitement of this comes from several sources.

Firstly and most significantly, this will extend coverage to tens of millions who have lost their health insurance through unemployment – in the US most employed people and their families are insured through their employers. When we lose our jobs in the UK it’s a big tragedy, but we still keep our health care. When someone loses their job in the US they and their family lose their health insurance. This means they often have no cover for illness at all. Given the high level of unemployment at the moment this is a big issue.
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