14th February 2013 

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Job done           
News and Comment from Roy Lilley
LaLite has hired the Confed-Lite to light a bonfire under 30% of the NHS' bureaucracy. I'm not sure which third? And, if Mike Farrar was honest about his task he'd say he isn't, either.


He'll cut a forlorn figure on railway stations and cab ranks, up and down the country, touring conferences, workshops and chit-chats to find out what you already know. 


It's interesting, isn't it? Ask a politician to get rid of bureaucracy and they'll invent a bureaucracy to do it. A report... urgent... ready by the Spring... then a consultation... then an implementation strategy... then implementation... then review... then we all hold hands and jump off a tall building. When you are doing something that doesn't work wouldn't it be a good idea to do something else?


The NHS is riddled with bureaucracy; none of it invented at the front-line. All of it has been dumped on the NHS by people who think they have a right to know... need to know, must know. Who knows?  


I met Janet, a nursing Sister. Forty-ish, sensible, safe hands, kids grown-up and gone, divorced, loves her work. Here's what she said to me;


"Form filling! Since Cameron decided every patient has to be spoken to every hour (like we don't) the managers have gone barmy. I'm usually responsible for eight patients in a bay. I have to tick and sign a box that I have spoken to each one of them every hour. That's 64 ticks I MUST sign for. Managers are terrified that the CQC will turn up and want us to prove we're doing it. I work six days a week, so I tick nearly 400 boxes a week. There are four other bays on the ward; that's almost 1,600 ticks a week. There's no computer; it's all on paper. By the end of the year we'll have clocked up over 80,000 ticks and destroyed a forest. If there is a cardiac arrest on the ward, or a medical emergency, the boxes get ticked at the end of the shift. I'm, sick of it....."


I wonder if Mike Farrar will tell Mary Poppins in Number 10 to stick his tick boxes. Spit-Spot, I doubt it! The Confed needs friends at the DH.


What about a gun-shot wound arriving in A&E? Have you seen what is required? It is pages and forensic because it might be used in evidence at a Court hearing. With data we might avoid another Mid-Staffs; hence the CMO looking at 14 other places.


We need data, information and statistics. Business sees it as life blood. If you have a supermarket loyalty card they'll know where you live, what you buy, how often and even which isles you walk down. They'll know what day you shop and how much you spend, the offers you like and booze you drink. What they don't have is a shop assistant following you around the store with a clip-board, ticking boxes.


Business knows the value of information and they invest to collect it. I very much doubt Farrar and friends will find one scrap of data that is presently collected that the NHS couldn't turn to good use for planning or patient satisfaction purposes, neither the info that helps to make the NHS safer.  Data Tsar Tim Kelsey knows the benefits and will want more, not less. 


It is not the data; it is the way it is collected. We can write the Confed report now; 'Data collected in the NHS is vital for the safe treatment of patients, planning, coordination of care, integration, costing and quality. Duplication makes the system overly bureaucratic but the real burden is as the result of the under investment in the technology to record and analyse it'.


The answer has been around since 1949 invented by Woodland and Silver; it's called a bar-code. Spit-Spot Mike, job done.  


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> Competition - new regulations published.  Very important stuff

>Graph and flow chart - explaining care and support funding reforms.  I must say I still don't 'get it'.  DH stuff.

>>  Rationing should not be driven by costs - I don't 'get this' either! 

>>  Observation units, savings and confusion - this is from the US but an interesting quick look.  

>>  LaLite - thinking about Francis response.  Interesting. Here is the full text of his 'Reform' speech.  

>>  Liz Kendall - speech to Reform; 'whole person care'. 

>>  Speed Dating - interesting one day conference approach for CCGs and providers




This is what I'm hearing; unless you know different. 

Tell me.

>>  The NHA Party will fight the Eastleigh by-election - details here.   

>>  King's Fund excellent 1/4ly report will say 'outlook for NHS and Social Care pessimistic as financial squeeze bites'.  Their press release was embargoed and they hadn't published a web-link by the time we compiled the news section but have a look here and you'll find it, no doubt.  It's Appleby's work so will be well worth a Hobnob and cuppa-builder's. Must read. 


>>  Confed Conference - pretty dull; Hunt, Burnham, Big-Beast, O'Lunch, Farrar and the one bright spot Baroness Manningham-Buller former boss of MI5.  Won't most people will have heard her by now?  You have to register to book?  Must be really expensive. Try the cricket instead.   

>>  The Don Berwick Fest begins - the International Forum of something or other in London is flogging tickets.  It looks like a great line-up of speakers but at �1,400 group rate for 4 days who has a budget for that?   

>>  Trusts - gets its own railway station.

>>   Mary Seacole - the woman they wanted to airbrush out of the national school curriculum.

>>  Is this the future of the NHS - old document with some revealing thinking.  

>>  Regulate managers - this is an interesting article from the HSJ.  It seems Monitor is looking to replace the jobs it wil lose to the CQC.  

>>  Accuracy of the 'traffic light' clinical decision rule for serious bacterial infections in young children with fever.

>Celebrity - smokers, oh dear!   



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