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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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.

Of course not. The core business of all of this debate and discussion is to relieve pain and distress through the application of the basic principles of the NHS within a limited budget. For me the reforms and the politics are an important part of that process, but they are not its purpose.

Last Thursday we had a glimpse of what this is all for when a comprehensive study of heart attacks in England was published. The outcomes of 840,000 people who had had 861,000 heart attacks between 2002 and 2010 had been studied and had found that death rates had fallen by 50% for men and 53% for women.

I remember that the 2001 Labour government had, as one of its dreaded targets, the aim to reduce the death rate from heart attacks by 50%. When I started as a special adviser in 2001 I was hoping that someone had done some detailed work on how to achieve this – and it looks like they had. Someone had carried out an analysis and shown that if best practice was applied quickly across the NHS this many lives could be saved.

The researchers found that half of the drop in death rates resulted from changes in lifestyle so that our hearts were stronger and the attacks were less severe. But 50% of the reduction is due to the much better organisation of services within the NHS.

Much of this is caused by the earlier application of thrombolytic drugs to the patient as soon as possible after they have had a heart attack.

Some of the rest is caused by angioplasty and stents having become a much more routine and safer operation and the third major reason is the much, much better rehabilitation advice and activity that makes a second heart attack less likely.

If one national intervention made the most impact upon these improvements it was the creation of the National Framework for Coronary Disease with its powerful National Director Roger Boyle. Both the Framework and its director spent most of its time out in the country arguing with medical practitioners about the way they organised their services.

The National Framework had a method which it believed was the best and it was the job of the National Director to have and win arguments with those that delivered services across the country.

Clinician to clinician argument, combined with change supplemented by extra resources, has made this enormous difference.

I grew up in the 1950s. Older men had heart attacks and died.

Many more of them now don’t – and a good part of that is down to mprovements in the NHS.


One Response to “The core business in which we are involved..”

  1. It is with much gladness that I can agree wholeheartedly with you, and I think this is one of the crowning achievements of healthcare policy under Labour. Roger Boyle deserves great credit, and so do people like you, Paul.

    Clinician to clinician argument, along with extra resources, and no political interference of note.

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