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Billy Boland: The power of “systems” in healthcare

11 Jun, 14 | by BMJ

billy_bolandI looked down at my name badge. Although it said chief executive officer, I felt like an impostor. Across the table sat a suitably intimidating panel. The members of the Health Overview and Scrutiny Committee (HOSC) wanted me to justify why we were keeping open a crumbling hospital with poor outcomes, while the community was crying out for more resources. Expectant faces were staring at me, waiting for my presentation. A presentation? No one told me about that. I looked down at my notepad searching for something to say. It was blank.

This scenario was all part of a simulation, and one of the many training experiences I’ve undertaken at the NHS Leadership Academy.* The truth was, two days earlier, I’d never heard of the HOSC. Yet in this particular exercise, our trust board had come up with an options appraisal to tackle its ailing services and financial problems. Now it had to convince all and sundry, including this committee of councillors, that they were doing the right thing. The HOSC is an operation of the council in England and Wales, and has a role in independently reviewing and holding health services to account.

Such experiences are gravely familiar at the NHS Leadership Academy, which I am a part of. I have grown used to being dropped into difficult situations, and having to rely on my burgeoning skill set to figure out what to do. more…

Chris Hopson: You get what you pay for—a different approach to the 2015/16 NHS tariff is crucial

10 Jun, 14 | by BMJ

chris_hopsonIf you get what you pay for, then 2015/16 risks being a very difficult year for the NHS, as the system affordability challenge, according to Monitor, jumps from 3.1% to 6.6%. This is driven by increasing demand and costs, a flat NHS budget, changes to NHS pension arrangements, and the *Better Care Fund.

NHS providers are also contending with pressure on NHS England’s specialist commissioning budget, which was overspent by more than £800 million last year (of which over £400 million was covered by the use of non recurrent and contingency reserves), but which is a key source of income for many trusts. And, on top of this, NHS providers are also faced with unfunded demands for mandatory service improvements, such as seven day services and increased staffing ratios. more…

Ceinwen Giles: Patient leaders at the NHS Confederation Conference

10 Jun, 14 | by BMJ

ceinwen_gilesAs readers of The BMJ will know, leadership is a widely discussed and hotly debated topic across the NHS at the moment. It’s also a theme that permeated the NHS Confederation Conference in Liverpool last week. Of particular interest to me was the issue of patient leadership, as I was asked to speak at a plenary session called “Patients in the Driving Seat” on the last day of the conference.

As I walked around the conference, I heard much talk of the need to involve patients and work with them—some of it tokenistic, but much of it well meaning. Various sessions highlighted the value of working with patients in different ways, and provided examples of patients who had managed to bring about new services, or shape old services in a new way. more…

Azeem Majeed: Are federations the way forward for general practices in England?

9 Jun, 14 | by BMJ

Azeem_majeedAs general practices in England come under increasing workload, funding, and contractual pressures, a new type of primary care organisation—the GP Federation—is becoming more common. The RCGP defines GP federations as practices “working together to share resources, expertise, and services.” In their simplest form, federations allow the general practices in one locality to share some administrative functions, and work together to bid collectively for NHS contracts.

However, as GP federations are not statutory organisations, they vary widely in both their structure and the activities they undertake. Some of the more advanced federations have established themselves as independent legal entities, and have already begun to compete for contracts against NHS hospital and community trusts. more…

David Zigmond: Is it time to renationalise the NHS?

30 May, 14 | by BMJ

david_zigmond2Recently the media has told us that the Labour Party is considering a long journeyed return: back to the nationalisation of rail services. Some claim that this will offer better long term value, efficiency, and safety.

Many would welcome this, but there is a puzzling anomaly: why do we not, instead, start with the NHS? For surely, the contentious market principles of competitive commissioning are better suited to human transport than human healthcare. This is an important distinction, and our failure to recognise the difference between the mechanical and the human has led to a new tranche of serious NHS problems. more…

Michael West: Collective leadership—fundamental to creating the cultures we need in the NHS

28 May, 14 | by BMJ

michael-westPositivity, compassion, respect, dignity, engagement, and high quality care are key to creating the cultures we need in the NHS. And, just as importantly, we must deal decisively, consistently, and quickly with behaviours that are inconsistent with these values—regardless of the seniority of people exhibiting them.

Yet in the King’s Fund’s most recent survey of NHS staff, two fifths of those surveyed felt that negative behaviours—typically incivility, aggression, discrimination, carelessness, brusqueness, and poor performance—were not being dealt with in a timely or effective fashion in their organisation. How then can we ensure that positive NHS cultures (with a focus on patient care) are encouraged, and inappropriate behaviours and performance are reduced? more…

Azeem Majeed: Three obstacles to increasing the use of statins for the primary prevention of cardiovascular disease

20 May, 14 | by BMJ

Azeem_majeedStatistics from the OECD show that the per person use of statins in the UK is the highest in Europe and the second highest among all OECD countries. There are a number of reasons for the very high use of statins in the UK, which include the emphasis on evidence based medicine in the training of UK doctors; the 2004 GP contract, which introduced financial incentives for the management of long term conditions such as coronary heart disease and diabetes; and the NHS Health Check programme, which aims (among its objectives) to increase the use of statins for the primary prevention of cardiovascular disease (CVD) in England in people with a 20% or more 10 year risk of CVD. more…

Mary E Black: Look at me

19 May, 14 | by BMJ

maryeblack copyI was a bit of a star in my early 30s at Harvard’s School of Public Health. On a fully funded and prestigious Harkness Fellowship (so a treasured person in the Harvard lexicon), I was bubbly, thin, well dressed, elected to student government, volunteering for just about everything, and winner of the competition to represent graduate students at graduation. The clever, golden girl with boundless energy, no family commitments, and junior enough not to be a threat. They loved me. I loved myself.

Fast forward six years—I return to Harvard as a student’s spouse with a baby in tow. Same place, same person, five more years experience at a much more senior level including in the UN, WHO, a war zone, and heading next to a professorship in Australia. I was just about invisible, pushing an inexpensive buggy across Harvard front square. Everyone looked at the cute baby. No one sought my eye. My IQ dropped 30 points. My degrees were not assumed. I tried sucking my baggy tummy in—to no effect. A designer buggy might have helped, but our cash had gone on living expenses. Harvard looked a bit pompous when I was no longer a full member of the club. more…

David Maher and David Pencheon: Adding wider social value when commissioning

14 May, 14 | by BMJ

Increasingly, we are being asked to do more with less. The Public Services (Social Value) Act 2012, a private member’s bill, became law in January 2012. It requires all commissioners of public services to consider economic, social, and environmental value—not just price—when buying goods and services. Social value is about how well scarce resources are allocated and used; it reflects a more balanced approach in assessing outcomes, taking into account the wider benefits to the patient and their community.

For clinical commissioning groups (CCGs), who are faced with increasing pressure to deliver more and better services under tighter budget constraints, social value is not just about squeezing suppliers or applying cost reduction schemes. It is about thinking creatively on how things could be done differently to ensure that the local community, as a whole, gets additional benefit through commissioning activity. more…

Mary E Black: Essential reading for new NHS Executives

12 May, 14 | by BMJ

maryeblack copyI have just joined the NHS Executive fast track programme. There will be 51 of us in total—36 clinicians from within the NHS and 15 application from outside the NHS. We will need to get up to speed fast on understanding the NHS in England. Here is my starter list of ten key sources of information that might be especially useful to NHS newbies. All feedback and suggestions for additions are welcome. more…

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