A savage trip through the heart of NHS reform with John Pinching.
My arrival at the Royal College of Physicians, for the annual Wellards Conference, was greeted by a thumping disco beat and the unmistakable brotherly harmonies of the Bee Gees. A quick scan for white polyester garments and ill-advised medallions allayed a nagging fear that I might have boogied into the wrong gig (there were one or two Barry Gibb-inspired beards, however).
I can’t lie, with the effects of three hastily consumed espressos coursing through my frontal lobes, and noticing that the walls were festooned with horrifying surgical instruments from a bygone age, the scene was becoming trippy.
When the funky grooves finally faded, charismatic master of ceremonies and resident DJ Alan Jones (ajc healthcare) explained the nostalgic intro. “We have gone for 70s music because the themes of this conference feel very retro,” he said. “Many of these subjects have done the rounds for decades!” This cat had obviously been here before – who could blame him for turning to Donna Summer for the answers? Granted, Donna is now gyrating across the great dance floor in the sky, but I felt sure that if anyone could resurrect those haunting tones, it was Alan.
Never say ‘never’ again
Among the hired guns at this first shindig was Dr Amit Bhargava, who – in his capacity as a clinical accountable officer at the Crawley Commissioning Group – provided hot gossip straight from the coal face, enthusing about some elements and speculating about others.
He insisted that “the time has come for change in the health service”.
“The structure of the NHS is like a game of Jenga and it is bound to topple eventually as a result of paying more and more for less and less,” he added.
Curious metaphor. Indeed, how interesting to note that, generally, the people who remove bricks from the lurching tower are usually hopelessly drunk. If any analogy should fall down (assuming it has), I suppose it should be one about Jenga.
He also reflected on the challenges CCGs faced when trying to improve patient experiences, with reference to the life span of residents in the Crawley area. “If you take the number 10 bus, within three miles [depending on the stop] you get a seven year age difference,” he said. “Crawley is a relatively new town; these areas don’t look deprived.”
“Look at the maps to identify the need,” Bhargava concluded, “And you’ll do all right.”
All very helpful, sure, but when – like a sniper in the thicket – I fired a slippery missile from the crowd regarding whether Hunt, in light of the Murdoch ‘affair’, was the right cat for the job, he shot me a dead-eyed stare and dodged the ol’ bullet – “I hope so, but I’ve never met him”, he choked. Ye gods, Amit, I’ve never met the Führer, but I’m telling you now, I won’t be breaking Battenberg with him anytime soon. Surely it’s essential for people with influence to hold their ‘leaders’ to account – unelected leaders at that – while forming opinions about their performances, if not their character?
As if by design Hues Corporation’s 1974 hit ‘Rock the Boat’ began playing. Freaky.
Circle of life
Circle Health’s Dr Ali Parsa’s stint at the lectern produced a captivating speech, dispensing with boring Powerpoint slides, and instead relying on the zeal of entrepreneurial spirit. It was a man and his voice, and that voice meant business (quite literally).
After lamenting his own lack of height – “Sorry if you can’t see me!” – Parsa philosophically considered the ‘micro economics’ that influence the future of every individual.
“If I was born in communist Russia or Mao’s China, I was going to do substantially worse than if I was born in the West,” he said. “Bill Gates used to say that the genius in Mumbai did fundamentally worse than the average person born in Baltimore. That world has now changed.
“I look at my children and I ask that question: what will be the micro economic trend that dictates their destiny? The answer to that lies in where Britain sits among those trends. When I first arrived thirty years ago Britain was top five in the prosperity league, it is now 28. One position ahead of Greece.”
He then pontificated about the possibility of a British resurgence, inspired by the candid investment in ‘Team GB’ throughout the years building up to the Olympic Games. He warned, however, against arrogantly assuming we could compete with the manufacturing in Germany or workforce flexibility of China.
“Why can’t Britain have global healthcare companies that sell to the world, like Tesco?” he mused.
Ali reflected on his own rise: from humble beginnings in Iran to a leading light in hospital innovation. He canvassed a firmly held belief that Britain used to be a fertile hotbed of pharmaceutical innovation and could rise once again if only it was prepared to embrace change and look at the situation through the prism of modern patient demands.
Most poignantly, Ali told a story about how he had shown guests around his first private hospital – designed by Sir Norman Foster. The surroundings were so comfortable that after a while someone had asked, “When are we going to see the hospital?” The NHS has conditioned us to assume that hospitals are grisly corridors of uncertainty. How refreshing to hear that it doesn’t have to be this way.
With much to ponder, I lunched on the chicken and apple casserole which – despite my reservations about mixing fruit and flesh – went down well.
The next port of call on my magical mystery tour was the ABPI conference and, while Wellards had provided some interesting sparring, Stephen Whitehead, ABPI’s Chief Executive, ensured the gloves were off straight away, landing some lusty blows.
He started by admitting a handwriting test had revealed he was psychotic and that he was here to explode the myth of a bright new NHS which made pharma a priority.
“Something odd is happening in the UK and I want to take this opportunity to speak out. I don’t want cry fire in a crowded room, but I was raised to tell the truth.”
At this point I sat up and brushed the remaining crumbs of pain au chocolat from my sweater. I think I was about to witness – what do they call it – ‘a happening’.
“The UK is a tough and difficult place. We [pharma] are down 16,000 jobs in four years; we have suffered closures and decline. Pressure is immense. Patients are denied choice and we have the lowest uptake of innovation in Europe,”
“We have strong new products from the likes of Shire, Novartis and Pfizer, [but] the deal we have, to discover healthcare and provide it to patients, is broken. The industry has changed from the one it was ten years ago. It used to be that the UK was the second market behind the USA: a proud place for discovery, development and launch.
“We still launch great medicines, but suffer from pathetically low levels of uptake. There have been superb breakthroughs in Hepatitis C, for example, but orders are dwindling because of agonising referrals.
“The NHS won’t invest to save longer term and its decision making is often dictated by provider interest rather than patients. Why is my dad, with crippling shingles, given Paracetamol? Why was my good friend given a cancer drug privately, but unable to get it on the NHS? Why was my mum put on a waiting list with a prolapsed bladder for six months? When I called a consultant three days later he said he would do it for £3000.
“The NHS is a religion, but we know what happens to countries that don’t revaluate their faith,” he added.
It’s been emotional
It was a passionate, robust and at times emotional response to what he considered an NHS that was failing miserably in its objectives. What defined Whitehead’s speech was a frustration that manifested itself both professionally and personally. It was terrific to hear him refer to his own personal experiences, adding a devastating cocktail of brutal honesty and spearing clarity, which surely some of the NHS’s policy-regurgitating line-toers can learn from?
All too often we are bombarded by a politically sterilised dogma that jars with reality and falls off the cerebral cortex like so many white papers off a shovel. This was in evidence when one of the NHS’s knights of the realm, Sir Ian Carruthers OBE (no less), attempted to tackle the blaze Whitehead had ignited by randomly dispatching buckets of barely legible civil service twaddle. The numbing jargon that followed was like some kind of linguistic water boarding – “innovative approaches”, “operating framework”, “technology appraisals”, “delivery uptake”, “personal incentives”. Stop, stop, stop! I can’t take it any more!
One sentence contained the word “implementation” half a dozen times. Is it possible that when these ‘honours list parasites’ pick up their prefixes and suffixes, they also agree to wander around in a clanging armour of jargon?
Again, the private sector’s clarity and verve of expression was in stark, embarrassing contrast to some of the insipid management speak on offer here.
Johnny’s final thought
Since the beginning of civilisation words have needed meaning. Organisations which grow out of all proportion to their original concept – like the NHS – often use a dribbling dialect designed to vaporise instantly, lest it should actually seep inside a human brain.
As the multi-tentacled other-worldly creature of NHS reform continues to loom over two very different cultures, it is clear that communication simply has to change – at the moment they are speaking entirely different languages.
Aclimatisation for the NHS has often been the bitterest pill to swallow but now – as Alan would no doubt agree – it’s time to change the record.