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Do the right thing…

I’ve had an interesting ten days.

A week ago, last Saturday, I spent an hour in conversation with Jason Helgerson. You’ll find him @policywonk1, on Twitter… and policy wonk he truly is.

He became New York’s Medicaid Director, in 2011, providing health care services to over 6.2 million New Yorkers with an annual budget over $60 billion.

He also serves as the Executive Director for New York’s Medicaid Redesign Team. He is currently focussed on reshaping the state’s Medicaid program in order to lower costs and improve health care quality.

Doesn’t that sound familiar!

We talked about his back story, US politics and his problems.

He is developing management to redesign services, has trouble recruiting staff, despite his budget, not enough money and a tidal wave of an elderly population with multi morbidities that are placing demands on the services they are struggling to meet.

If that sounds familiar, it should. We have the same problems and the problems are global problems.

Imagining we can carry on with the same management structures we have now, without redesign, is to chain us to the past.

Thinking that we are, in some way, insulated from international shortages of healthcare workers is foolish.

Thinking that any planning we do, to resolve our workforce shortages, can be achieved nationally is wrong and if we are to look beyond our borders to recruit overseas, so is New York and so is every other major city and health system, world-wide.

What are Helgerson’s solutions?

Higher standards of management, vertical integration, redesigning the workforce and a greater reliance on technologies at the interface of care.

He tells an interesting story of summer demand from care homes from elderly with COPD exacerbations. Ambulance after ambulance blocked the hospital runways, to ED. Once in hospital, they were finding it impossible to get frail people home.

Helgerson’s solution was to pay for the installation of air-conditioning units in the care homes. Admissions plummeted and the investment amortised by the fall in emergency-care-costs and delayed discharges.

I’ll leave you to ponder that one… you can only do it with a vertically integrated health and care system.

Later in the week, I was on the stage at the GIANT Healthcare show…

… in conversation with representatives from three Trusts who talked honestly and freely about how the regulatory and inspection regimes had decimated morale in their organisations and made recruitment and recovery even more difficult.

All three were prisoners of their geography, making it difficult to find staff.

All three were bound by their local health economies that were badly served by tariffs and legacy debt.

All three, victims of a history that was not of the making of current management. All of them committed to better management.

All three suffering from the New York problem; management, money, people and demand.

All three were committed to improve by sharing best practice, learning from the best.

All three were at the top of the list for sharing their successes at the Academy of Fabulous Stuff.

In my view, three exceptional organisations that deserved the awards they were given by Simon Stevens, on behalf of the Academy, for their commitment to improvement.

Finally, it was off to the House of Commons, on the quiet Thursday, before the shenanigans of the weekend.

Hosted by Lord Hunt of King’s Health, the president of the IHM, we were at the launch of the IHM’s code of practice for managers.

The Code of Practice is a response to the Kark Inquiry and to a long-over-due extent, to the Francis Report, both of which shone a light on management shortcomings and the lack of regulation for managers.

The IHM plan to make conformance with their Code a condition of membership and it comes with a disciplinary framework.

The IHM wants to avoid the panoply of regulation that mires the GMC and NMC.

Registration, regulation and compliance achieved digitally and focus on membership education, sharing best practice and development.

IHM managers, rightly, want to be recognised as professionals, just like other contributors to our-NHS.

What are we to make of all this?

People everywhere struggling with the same things, all wanting to do the right thing.

News and Comment from Roy Lilley

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Reproduced at by kind permission of Roy Lilley.