Thursday, 1 November 2012


Now I'm not doing a George Bernard Shaw, arriving back from Moscow and declaring "I have seen the future and it works!" but I have seen how Circle run Bath and Hinchinbrooke hospitals and it's working there. The ways of working and the innovations at these hospitals have lessons for the NHS. Competition does have a role in driving more choice and replication of good practice.

Hinchingbrooke hospital is an interesting experiment in how things could be run. The hospital is still part of the NHS; its assets are still state assets and its staff NHS employees. But Circle have been able to make dramatic changes in the running to give control to doctors and nurses and to put patients first in delivery.

I was shown round by the eneregtic and inspirational Massoud Faroudi, himself a Consultant and partner of the effervescent Ali Parsa.

At lunch in the now greatly improved restaurant (they believe good quality food is part of the healing process- goodness how you want the NHS to learn that!) I met a group of the leading Consultants. I aked them what was the major change for them since Circle took over the running.

One said it was the staff empowerment and the raised morale. They have put a lot of time into re-engineering systems and processes by getting teams of doctors, nurses, staff and patients together.

One said it was about their ability to better manage risk; which is now a more collegial affair rather than top down instruction.

Just to give you a striking example of how the NHS can learn; the majority of people in hospital beds are over 60. We know that many old people end up in hospital and stay too long , with often serious consequences for their overall health and well being. So effective early discharge is crucial. Yet in most hospitals they only have 2 consultant led ward rounds a week. Sometimes less at bank holidays. Junior doctors rarely discharge patients. So they are to introduce 7 day ward rounds. So a simple measure to cut unnecessary legth of stay. A person not fit to be discharged on Thursday may wait till Tuesday to get home even though they and their condition would enable that.

There are other parts of the NHS working on this. It's an important nut to crack.

I suggested they also need to have a much stronger link with third sector bodies because older people need to have more support at home and with council budget cuts to social care this is increasingly a problem.

Another simple but highly effective initiative was to cut night time noise. One of the most frequent criticisms of hospitals (apart from food) is the inability to sleep at night with all the noise that goes on. They got together a team of patients, staff and managers to look at the causes, like waste bins with squeaky lids, and have made changes.

They also face serious financial challenges. They faced bigger problems than they anticipated and so their financial projections are of course. So time will tell if they can make it work on a financially sustainable model. 

For me the most important change has been in the clinical leadership of decision making and the patient centred approach. It is not because there are not superb examples in the NHS but the culture is a top down, centrally driven one. A huge organisation like the NHS inevitably becomes over bureaucratised and so staff involvement can be hard to achieve.

So a good day, though as a strong Episcopalean with Roman leanings I did not enjoy seeing the place of birth of one king killer and kill joy Oliver Cromwell ( Hinchingbrooke House ).

I topped this off by a visit to Addenbrooke's in Cambridge . I have to admit to finding the health service fascinating. Talking to doctors and consultants about their experiences and their expertise is hugely rewarding. I'm acquiring all sorts of extraneous medical knowledge with which I regale assorted staff and members. Usually about disease and death. Anyway it's the weekend for me. I'm having a day off to visit a stately home and eat well. Though in a healthy way obviously.


Roy Norris said...

Might not be a bad idea to check mortality rates for various procedures. All the great ambience and good food isn't much good if the quality of care or procedures adopted are poor.

richard.blogger said...

"Yet in most hospitals they only have 2 consultant led ward rounds a week."

Can you give a link to where you got this from? 5 day ward rounds seem the norm, not 2 day. Of course, illness is 7 days a week, so consultant rounds should also be 7 days a week. I suspect that the constraining issue is allowing consultants to do their lucrative private practice. If we stop consultants moonlighting in the private sector (something that is not allowed in *any* other sector) then they will be able to work more flexibly as part of 7 day working.

Sir Stephen Bubb said...

You are right Roy. Always crucial to check out who will be cutting you up! And good surgeons trump good food anyway. But I'd like to think you can have both!