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Health Service Journal

View all stories from this issue.

  • Do we expect higher moral standards from our leaders?

    Should we be bothered by what public sector leaders do outside of work?
  • NHS news blog: Government names swine flu 'tsar'

    BBC: Government names swine flu ‘tsar’
  • Why the public sector shouldn't use head hunters

    Recruitment consultants will identify the right person for the post but this is not necessarily the best person, which is why the publci sector should not use them.
  • Your 18 week waits: November 2012 data

    The local picture on 18 week and one-year waiting times, for every English provider and commissioner, updated with the latest (November 2012) data.
  • "Alright Duck"

    Friendly or over familiar care is it a matter of class?
  • ‘Look beyond the supermarket model for health services’

    NHS commissioners should heed the experiences of other parts of the public sector to develop a health and social care model of commissioning
  • 12 v 6

    Which do you think would work best imposing longer shifts of reducing the working day? No prizes for guessing which way NHS is going.
  • 18 week waits still holding

    The NHS held steady on 18 weeks with an increase in admissions, despite signs of increased pressure on waiting times.
  • 18-week performance slips in England

    18-weeks performance slipped back slightly in England, on the latest (June) figures. Probably just a blip.
  • 18-week waits still improving

    18-week waits continued to improve, but large reductions in long-waiters were offset by some relaxation in services that are already achieving the target.
  • '18-weeks' penalties change again: this time it's good

    At last: instead of punishing hospitals for treating their long-waiters, the latest NHS Contract prevents long-wait backlogs from building up in the first place.
  • 5 per cent increase?!?

    Where did Darling get his 5 per cent figure from?
  • 50 Shades of management

    What is a management restructuring but a way of gently but firmly forcing you to adopt a new position, testing your flexibility and willingness to please?
  • A change is as good as an arrest

    Do you need frontline experience to lead an organisation?
  • A chicken and horse situation

    Whenever there’s a big policy announcement, End Game always gets deluged with preposterous responses from PRs keen to get a mention on these pages.This week the honours go to the union Unite, for the superb mixed metaphors contained in its verdict on the government’s response to the Francis inquiry.Head of health Rachael Maskell said: “While the NHS descends into the mire of privatisation, the health environment has become unsafe, as [Jeremy] Hunt continues to fiddle and dither.
  • A commercial catch 22

    Behind every good business deal is a catch.
  • A death in a hostel

    A personal account of managing a home for “difficult” elderly male patients.
  • A decade of austerity should spur on fundamental care reform

    CCGs have the opportunity to reform patterns of service provision and ways of working.A decade of austerity could spur on some long overdue changes to our health and care system..
  • A gift fit for a Queen

    In times of austerity, few things glisten in HSJ email inboxes as much as press releases announcing £30m donations to hospitals.This is especially true when the organisation’s chairman announces it will grow by a quarter, with additional operating theatres, wards and consulting rooms being built.So which trust would be the beneficiary of this exceptional generosity?None alas. The beneficiary is London’s Edward VII Hospital, the hospital of choice of the royal fam
  • A guide to the NHS Commissioning Board’s Everyone Counts

    A review by the King’s Fund policy director Anna Dixon of the planning guidance for CCGs the board released in December.
  • A leadership balancing act

    It seems that successful senior managers who give interviews fall into two types: the ‘people people’ and the macho managers; neither are helpful role models.
  • A mandate for bad waiting list management

    The draft NHS Mandate will drive up waiting times, undermine the NHS Constitution, and be unfair to patients. Not what was intended, obviously.
  • 'A mysterious outbreak led to three nurses becoming infected'

    On 27 August 1977, the BMJ published an editorial on an outbreak of a severe haemorrhagic infectious disease.
  • A new boss to navigate us through the next few years

    NHS England chief executive Simon Stevens must be prepared to change direction should he find himself going the wrong way
  • A new lobbying scandal?

    No one can doubt Tory MP, health committee member and former GP Sarah Wollaston’s seriousness.It might not even be too far say she is the parliamentarian most respected by the NHS.No-one would doubt the seriousness of her stance on plain packaging for tobacco, a policy put on a backburner last week.“A day of shame for this government, the only winners big tobacco, big alcohol” was her statement on Twitter. These industries do have powerful lobbies.But there was a t
  • A new look for NHS leaders in 2013

    Will the appearance of NHS managers follow trends from the Middle East in the coming year?
  • A picture is worth 1,000 hours of consultation

    End Game is fully supportive of the creative arts, and loves it when complex health policy is expressed in simple, visually appealing forms.So in theory we full approve of the whimsical cartoons that the Healthier Together reconfiguration programme’s Twitter account uses for its background.The programme is reviewing hospital services across Bedfordshire, Luton, Northamptonshire, and Milton Keynes.There’s a pair of handshaking hands, and a jolly looking chap with a magnify
  • A pinch of QIPP

    Having a strategy isn’t that helpful if people then forget to communicate the strategy. Nor will adding the word QIPP to everything we do ensure we deliver. We are at risk of ticking the box but missing the point.
  • 'A raft of scandals surfaced in hospitals for the elderly'

    On 24 November 1965 Lord Strabogli wrote to The Times. Public concern about the treatment of the elderly in hospitals had been growing, though apparently the government saw no problems.
  • A rich historical legacy

    First Richard III’s body was found under a council car park, now Hull and East Yorkshire Hospitals Trust has made a sensational discovery of equally historic proportions.End Game was astonished to receive a trust press release explaining how an £8m renovation project at Hull Royal Infirmary led to “a piece of history which has been hidden for the last 50 years” coming to light.“Contractors working on the exterior of the Hull Royal Infirmary tower block have discovered an old fil
  • A right royal day to bury bad news

    Of all days, the biggest royal wedding for 30 years must have seemed a ripe moment during which to sweep bad news under the carpet.
  • A rising management star crashes and burns

    Are managers being given too much credit for success and too much blame for failure?
  • A royal pain in the bahooka!

    I was going to write something witty and Christmassy in this blog but due to a temporary loss of wit on Monday this hasn’t been possible
  • A salty bullet

    Forget about pay restraint, referral management and primary care prescribing, there’s a new show in QIPP town apparently – bath salts.Reports have reached End Game, via fashion and beauty bible Cosmopolitan, that these “age old health boosters” could also save the NHS £14.5 billion annually.Yes, just under a seventh of the entire NHS budget is currently being squandered
  • A Shakespearian story at the top of the NHS

    Sir David Nicholson will no doubt be wondering who his friends are and who he can trust as the press clamours for his resignation.
  • A shocking indictment of corporate management culture

    A documentary on Gatwick Airport produced an eyebrow-raising insight into private secotor management culture.
  • A short course in leadership

    What is leadership all about, and how can you learn to be a better leader. Do you need to go on a course, read a book, or what?
  • 'A shortage of doctors was producing “a pretty ghastly awful picture”'

    It has always been wise to avoid involvement in medical manpower planning.
  • A spur to recovery

    End Game salutes Spurs striker Jermain Defoe for demonstrating how hand sanitising gel should be used when on a visit to the North Middlesex University Hospital Trust.The trust sent this amazing picture taken on a Christmas visit in which children on the Rainbow ward and orthopaedic patients were given presents by Tottenham st
  • A state of emergency for mental healthcare

    Police cells are used 9,000 times each year as ‘places of safety’ for people detained under Section 136 of the Mental Health Act
  • A touching message

    It is gratifying to discover that the NHS in Warrington continues to nurture bold and experimental approaches to the English language.Regular readers may recall that the commissioning support unit for Cheshire, Warrington and Wirral last year won one of the Plain English Campaign’s Golden Bull awards – given for the “best examples of gobbledygook” – for a piece of writing that included the poetic phrase: “Building in equality and risk impact assessments the options are taken through a
  • A week in the life of Harvard Business School

    What top teaching tips can we learn from Harvard Business School and what exactly do we mean by value in health care anyway?
  • A&E needs a sticking plaster as well as an overhaul

    A&E services a struggling to keep up with growing demand. Chris Hopson offers some possible solutions
  • Absolute gibberish

    End Game will normally rush to defend ministers against accusations that they inhabit a mad parallel universe, but we did have to concede the carpers might have a point when we read a recent Department of Health diary of forthcoming press events.There were the usual speeches at worthy events, but one of Norman Lamb’s forthcoming engagements was more puzzling.He was lined up to visit Durham Hospital and Tees, Esk and Ware [sic] Trust, followed by a trip to “Botton Village and Inv
  • Absurdism and the CSU project

    End Game will not hear it said that the new NHS commissioning system is exactly the same as the old one, except with less money and a few doctors getting in the way for the first year or so.Commissioning support units, for example, are nothing like anything that existed in the earlier age of primary care trusts and strategic health authorities.Ample evidence of this is provided by NHS South CSU, whose new website features an exciting use of absurdist principles on its “meet the
  • Abuse and negelect: what 2011 will be remembered for

    The year started badly with ombudsman Ann Abraham’s damning report into elderly person’s care; then the Winterbourne View abuse case made things a lot worse. 2011 never really recovered as the image of neglect in the NHS sharpened. Will 2012 be any better?
  • Accountable care organisations: revolution or business as usual?

    The Supreme Court ruling on the Affordable Care Act in the US could have wide ranging implications for the future of healthcare. Or could it?
  • Achieving high quality care at manageable costs: a lesson for GP consortia

    Lessons from the States are often relegated to the ‘too different to be useful’ box, but on closer inspection there are many similarities between American medical groups and the proposed GP consortia – as Paul Zollinger-Read learned on a recent visit to Boston.
  • Achieving 'one buttock' performance ..

    A conductor is a good example of leadership but I am not so sure it is as covert as some might think
  • Acquisitions are not just a business process

    Acquisitions won’t work unless attention is paid to issues other than just the business process of one organisation acquiring another.
  • 'Adams was convicted for prescription fraud'

    John Bodkin Adams was responsible for a new concept in medical management - “doing a Bodkin”.
  • After the transition, the anticlimax

    The transition is complete – primary care trusts and strategic health authorities are dead, making way for a clinically led insurgency that will sweep through the NHS like a wildfire of transparency, patient-centredness and integrated working.So get ready! Or, if you live in Wigan, don’t.The town’s new commissioning group tweeted this week: “It’s the second day of the new NHS and it’s already business as
  • 'Alcohol misuse is the most daunting of public health challenges'

    The cost of alcohol misuse is some £23bn, more than £3bn of which is borne by the NHS.
  • All fall down

    Heartiest End Game congratulations go to Greater Manchester Commissioning Support Unit, whose stand was named best in the exhibition at the Commissioning Show.One of the best things about the GM CSU’s stand was a game of giant Jenga. The bricks were marked with corporate branding and descriptions of their various service lines, which neatly offset the added excitement of the game being bigger than normal.End Game agreed not to be snarky about it, which means we are not allowed m
  • All stand together

    There is probably a book to be written about the naming of operations by public bodies.One of those books you see on the counter of a book shop by the till, the kind you think “that will make a temporarily amusing gift for a relative to whose Christmas present I haven’t given much thought to”.End Game was pleased to discover that, unlike the Americans, whose nomenclature leans towards the thunderously patriotic likes of “Operation Soaring Eagle”, the NHS equivalent has a whiff o
  • 'Ambrose made history by carrying out the first computed tomography scan'

    On 1 October 1971 Jamie Ambrose, a consultant radiologist at Atkinson Morley’s Hospital in Wimbledon, made medical history by carrying out the first computed tomography scan on a live patient, revealing a detailed image of a brain tumour. 
  • An apple a day

    Vitality is an attribute normally associated with eating a leading brand of dog food – so End Game has long wondered what possessed a string of GP practices in Birmingham to call themselves “Vitality Partnership”.There are no dogs to be found on their website though. Overall that’s probably for the best, although we were quite baffled by the imagery they did choose: a guffawing apparently naked young woman thrust
  • An ear to the ground

    Regular readers may remember that End Game got the willies a few weeks ago when something called @DHMonitoring started following a couple of HSJ’s more high profile tweeters.After all, the name was a bit creepy, and it did feel a bit like someone had brazenly parked a van with a massive satellite dish on top outside our home.Still, nothing to hide, nothing to fear.Perhaps concerned
  • An NHS love story

    In which the NHS is the woman, a man with the trousers on his head is the private sector and government policy is the magic spell designed to open up the NHS.
  • And so it begins: the decline of 18 week waits

    The waiting list usually shrinks from August to December. Not this time. The waiting list now looks set to pass the 3 million mark around Easter, and there is a risk of England-wide 18 week breaches this year.
  • And there goes £2.3bn....

    The Department of Health has been asked to contribute £2.3bn to the Treasury’s £5bn of public spending cuts in 2010-11.
  • Another record-breaking performance on 18 weeks

    All three 18-week targets were met again, with massive reductions in patients still waiting 18 weeks after referral.
  • Any sudden death

    Public sector agencies are being encouraged to work closer together.
  • Anyone who had a heart

    Jeremy Hunt continues to have a lovely time criss-crossing the nation visiting hospitals and seeing all the wonderful things that are going on.The latest trust to have the honour was Sheffield Teaching Hospitals. Tweeteth Jeremy: “Thanks to staff @SheffieldHosp for a great afternoon seeing surgical teams at the cutting edge. Saw my first heart beating…”End Game has no idea where Mr Hunt got his second heart, why he needed it, or why it was deemed appropriate to carve open the re
  • Apple of the eye? Why leaders should never be seen as indispensible

    The announcement last month that Steve Jobs was stepping down as chief executive of Apple prompted discussion about whether it is good for a company to be so identified with one individual.
  • Arbinger Institute's Self Deception

    What if you had a problem, but you didn't know that you had a problem? Do you see people as people or as objects? Are you carrying around boxes that prevent you making the right choices in what you do?
  • Are hospital chairs overreaching their role?

    Powerful hospital chairs and non-executive directors can make chief executives redundant
  • Are inspections fair?

    Is it fair? No. But that's not the fault of the inspectors.
  • Are leaders a product of their environment, or is it the other way round?

    The People Manager compares a recent report on NHS Top Leaders being “over confident” with an interview given by a chief executive this week.
  • Are managers too busy to manage?

    NHS managers are too busy to address staff health at work, according to this headline in HSJ. The report on the launch of the Healthcare Management unit code of conduct provided the opportunity for Dame Carol Black to express her disappointment and frustration at the lack of buy by the NHS. Of the 370 organisations signed up to date only eight are from the NHS. Dame C
  • Are online patients empowered patients?

    Liberating health data can stimulate innovation and get patients involved in their own health, according to one speaker at a US event. Pamela Garside blogs about whether this approach could take off in the UK as well.
  • Are the best leaders the "special ones"?

    How do you convince staff to do things “your way”?
  • Are there any leaders who don't do U-turns?

    Leaders clearly need a steady hand to take the wheel - but that doesn’t mean the road is always a straight one.
  • Are we expecting too much of the CQC?

    It has been open season on the Care Quality Commission for some time now.
  • Are we ready for the million-pound GP?

    While debate rages over whether GPs might double their salaries as a result of GP commissioning, a new type of service provider taking on a risk-sharing contract could see those in charge stand to make much, much more, writes Nick Goodwin.
  • Are we wasting money on care that patients don’t want?

    Getting patients invovled in the choosing of their services could produce big efficiencies and help the NHS provide services patients really need.
  • 'Arthroplasty of the hip transformed the treatment of hip osteoarthritis'

    On 27th May 1961 the Lancet published an article by John Charnley on Arthroplasty of the hip - a new operation.
  • 'Asking people to lead is one thing, actually leading is another'

    In the last few years, rather than address what are clearly structural failings, the NHS has had money ploughed into it.   I suspect the true level of the funding gap has been under egged and £15 – 20 billion is possibly a conservative estimate. 
  • At last: transparency on NHS IT

    David Cameron in October promised to free nurses from endless form-filling by giving them all iPads - £100m of iPads to be exact, which (bearing in mind the government’s success in previous health IT procurements) ought to buy at least 10.The PM’s involvement inevitably raised the interest of journalists who demanded to answers to questions such as: Would the money be well spent in a hurry? Does the NHS have a noble history of IT procurement at pace?End Game has seen a Q&A s
  • Awash with waiting times measures

    Monitoring only the RTT waiting times standards can land you in trouble. Here’s how to stay on track.
  • Back in the saddle

    Far be it from me to tell Babs and Cynth how to run their new gaff, but if there’s one baby they don’t want to throw out with the HCC/CSCI merger bathwater it’s that CSCI website.
  • Basildon babe

    Basildon and Thurrock University Hospitals Foundation Trust correctly identified the national media’s buttock clenchingly embarrassing over-coverage of the royal birth was a public relations open goal par excellence.Pretty much any old tosh parped out by hospital spinners including the words “royal” and “baby” was guaranteed to be handed to an unfortunate unpaid intern to regurgitate and present as a genuine news story.In Basildon’s case, it turned out that a baby was b
  • Be honest

    Every one of us can name at least one individual who is not performing or where we are not getting value for money. I don’t mean just administrators and managers, I mean all staff. I bet we could all name at least one individual. Be honest.
  • Beat the heat with eaty treat

    Take it from End Game, there’s nothing more frustrating for a journalist than getting an interesting story with an insufficient level of detail, requiring numerous follow up calls to request extra information.So we heartily thank North Middlesex University Hospital for supplying us with all the facts in a recent press release.“Beat the heat with an ice lolly at North Middlesex University Hospital”, ran the headline.The next 464 words explained exactly how that worked.
  • Bed pans and dangerous dogs

    Loose talk on FT and SoS freedoms
  • Beds too hard, food too cold, nothing just right

    A folk talk from the private sector
  • Being Bold

    In the current economic climate, cutting training budgets is an easy way to make savings, but is it really false economy?
  • Being free at the point of need is one of the NHS's greatest strengths

    Comparing the NHS to the US health system, and making a plea to retain the best of what the NHS offers at a time when “all change” may be seen as the holy grail
  • Beneath blue suburban skies

    If John Winston Lennon and Paul James McCartney had written Penny Lane today instead of back in the sixties they may have replaced their fond reference to the barbers shop with a hospital.And not just any hospital. Private healthcare firm Spire has announced the building at Number One Penny Lane is being turned into a state-of-the art medical facility by Spire Liverpool Hospital.Building contractors Lindrick Construction have begun the refurbishment of the Victorian bui
  • Better a poor service than no service

    We’ve moved for “take it or leave it” care to “like it or lump it”
  • Better to seek forgiveness than ask permission

    Have you a management philosophy? Mine is if its not explicitly against the rules then I can probably get away with it.As a senior manager I told a large gathering of managers that they should not be asking HR or finance for permission to do what they wanted to do they should ask for advice and then accept or reject it. This caused a bit of a stir around the room especially as the HR and finance directors were sitting next to me on the conference platform!Just to ram home the po
  • 'Beyond samosas and reggae' - or, developing services with equal opportunities

    A short note recognising the equality campaigning by Nasa Begum.
  • Big Apple with the Big Heart

    How US healthcare isn't all Wall Street ...
  • Big Brother is Monitoring you

    Now that the NHS has been wrested from the cold dark hands of Whitehall civil servants (allegedly) the Department of Health’s surveillance function appears to have turned its evil eye to social media to keep track of what is going on out there.A few startled members of the NHS Twitteratti last week including HSJ’s very own Alastair McLellan and Shaun Lintern found themselves followed by a new and mysterious Twitter account called @DHMonitoring. Its description informs users its siniste
  • Big data should inform commissioning decisions

    More data is available to the NHS than ever, so we should use it when making commissioning decisions.
  • Big hairy audacious cliche

    End Game was chuffed to see Ara Darzi was returning to health policy world as chair of the London Health Commission, and sincerely hopes that his high quality thoughts actually get listened to this time.Thumbing through the commission’s recently published evidence summary, we also noted another blast from the recent past, in the form of former chief medical officer Liam Dona
  • Bill announcement sparks web comments frenzy

    It isn’t every month that Health Service Journal gets to cover a newly announced Health and Social Care Bill.
  • Blackberry Cumberlege

    End Game was a little bit bemused to discover that Baroness Cumberlege – the former Tory health minister who holds paid positions at the King’s Fund, KPMG and PWC – prefers blackberries to Black History Month.Bear with us, we realise that reads oddly. We were not aware that you had to make a choice between the two until we read her tweet: “October is blackberry month. Hedges full to bursting. Forget black histo
  • Boardroom battles take place in the shadows

    It’s not the person having a row with you that you need to worry about, the plotters and schemers tend to do their work behind closed doors
  • Boards, micromanagement and failure

    ‘I think people who fail, fail because they’re not involved enough’. So said Sir Martin Sorrel of communications group WPP last month when discussing micromanagement. It’s an interesting dichotomy isn’t it?
  • Booking in the consultants

    A novel combining the flowing prose of a master wordsmith and a poignant critique of the social issues of the day is something of a holy grail for End Game.So when Alex Knight’s Pride and Joy – which appears to tackle the issues faced by the NHS via a riveting fictional format – landed on our desks, we salivated in anticipation.That was, until we read the accompanying PR blurb.“The author Alex Knight is the founding partner of QFI and has been responsible for 20
  • Born on the 25th of July

    The world’s first “test tube baby”, Louise Brown, was born shortly before midnight in Oldham and District General Hospital on 25 July 1978.
  • Bottomley's legacy

    End Game has recently returned from the Labour Party conference in Brighton, where Andy Burnham wasn’t the only former health secretary exercising the comrades.Virginia Bottomley, who served as John Major’s health secretary during the 1990s, got a number of mentions. Current Richmond House incumbent Jeremy Hunt was variously described by angry delegates as the cousin, nephew and even son of Baroness Bottomley of Nettlestone. Well, which is it?Labour MP Keith Vaz, who was chairin
  • 'Bourne agreed to perform an abortion and was prosecuted'

    On 27 October 1967 a private member’s bill, introduced by David Steel but backed by the government, was, after a heated debate and a free vote, passed. When the act came into effect, it made abortion legal in Great Britain.
  • BP, the NHS and Failure

    The NHS could learn from BP’s decision to establish a new safety division with sweeping powers to oversee and audit the company’s operations.
  • Bridging the financial gap

    The challenge of reducing spend continues and managers are looking ever more creatively at how to reduce the bottom line. I think I may have found a solution!
  • Bring back awards to reward quality care

    As scandals undermine confidence in the hospitals and care homes, it is time to bring back quality awards to recognise the work of the providers and teams doing an exceptional job
  • Britnellmania

    It’s Mark I’m talking about. Our Mark. Our Mark who has crossed to the dark side and is with us no more.
  • Brown bags Blue Hills as Coakley chokes

    The US’s flirtation with liberalism lasted precisely one year, the time it took to go from staring doe-eyed at the newly inaugurated Barack Obama to sucking the face off model republican Scott Brown.
  • Bullfighter takes on the NHS

    Who speaks more bull, commissioners or trusts?
  • Bunga-blunder

    Twitter has provided a little nugget of proof that the old order of strategic health authorities – among other things – is now disintegrating in real time before our eyes.Tweeting from a Reform event on “healthy innovation”, Robert Harris said he had asked the chief executive of private provider and Hinchingbrooke franchisee Circle, “why does everyone hate you” given the firm’s claims on improving outcomes.“Wouldn’t answer”, reported
  • Burnham's views on centralism

    National newspaper articles citing health secretary Andy Burnham and Monitor executive chair Bill Moyes raise intriguing questions about the government’sattitude to foundation trusts.
  • Businesspeople with medical degrees

    One of the biggest ongoing changes in the transformation of the NHS is the role of the GP.
  • By the rivers of Babylon, or what Ali Parsa did next

    Babylon! The Mesopotamian city-state, whose hanging gardens were considered the one of the wonders of the world.Babylon! Founded two millennia before Christ, whose ruins could be seen from the window of one of Saddam Hussein’s palaces.Babylon! Site of the mythic tower of Babel, that enduring allegory for man’s hubris!Babylon! Seat of the warlike King Nebuchadnezzar, who ransacked Jerusalem and held the Jews captive.Babylon! A symbol of every kind of evil in the Boo
  • C is for Culture - not Control

    The new Secretary of State for Health, Jeremy Hunt, should follow his decentralising instincts.
  • Cameron steals New Labour's clothes

    The Tories unveil their health manifesto
  • Campaigning journalism

    End Game is delighted to trumpet an unequivocal campaigning journalism win!Last week we welcomed Incisive Health into health policy world. The new organisation, spun out of MHP Health Mandate, is led by three well known health policy luminaries including Health and Social Care Bill, aka Bill Morgan, End Game’s favourite ex-Lansley special advisor.We asked that Inc
  • Can a leader be too good at their job?

    Sometimes a leader comes into an organisation and has instant impact, but a convoy can only go as fast as the slowest ship
  • Can clinicians make good managers?

    In the new NHS, having the necessary management skills is more relevant than your professional background
  • Can local authorities step up as good providers of care?

    Change must come as the public sector’s dominance and budget cuts in local authorities mean there is no way for the majority of the population to get, or afford, quality care.
  • Can social marketing campaigns lead a local public health revolution?

    With the government’s reforms aiming to put decision making power into the local community, the onus is on social marketing campaigns to drive a proper, positive shift in public health attitudes.
  • Can we still afford equality for women?

    The CBI wants all companies to disclose their targets for promoting women and then report on their progress.
  • Candy coated cartels, fear and loathing - is there a better way forward?

    How might policymakers, regulators and healthcare leaders work constructively to produce an informed and proportionate competition regime applied to the NHS?
  • Career advice: be opinionated, abrasive and intolerant

    Seven tips for reaching the top of the tree in your profession
  • Career coaching

    Why are we so backward in coming forward? Writing a list of our achievements doesn't come easily to most people - and now is the time to learn.
  • Castles in the air

    On 20 October 1975, in the middle of an economic crisis, a white paper, Better Services for the Mentally Ill, was published by Barbara Castle.
  • Celebrating our glorious NHS

    Getting the NHS to its 65th birthday without killing it completely would be a cause of celebration for any government, and joining in with the festivities is surely an easy public relations win for ministers.So End Game was delighted to read the response to a parliamentary question asking what exactly ministers did to mark the happy occasion.Minister Dan Poulter rep
  • Challenge the myth of integrated care

    Integrated care is not immune from the problems that affect the existing health and social care system.
  • Challenging Mediocrity

    How do we know what makes a good leader? If we are to make a difference, then we have to be more than “good enough”.
  • Champagne deception

    Ministers’ celebrations to mark the NHS’s 65th birthday earlier this year reflected the tough financial times and were suitably free of razzmatazz. They unveiled some proposals to improve patient care and visited some provider trusts.However, private hospitals are less self-conscious about making a dent in the events budget.End Game was
  • Change agents for quality and productivity

    If we look globally at those healthcare systems that deliver outstanding performance in cost and quality, a common characteristic is a systematic approach to capability building for improvement. How do we build this in the NHS?
  • Change Fatigue

    The causes,symptoms and treatment of change fatigue.
  • Change management, and changing definitions

    What does being a manager mean nowadays?
  • Change the 'delay, deny, defend' complaints culture

    A new report following the failings of Mid Staffs should force NHS organisations to confront patient complaints
  • Change tracking with Andy Burnham

    A slip up at the Department of Health reminds us of the Microsoft Word “track changes” function - and reveals a last-minute omission from the health secretary’s swine flu speech.
  • Change, altruism and emotions

    There is always an expectation of government at times of change that altruism will prevail and managers will wait until the end of the change before determining their own future. This is naive.
  • Changing behaviour needs more than a 'nudge'

    Politicians and leadership like “nudge theory” - the idea that a “nudge” in the right direction can inspire behaviour change at a large level. But does it work?
  • Charismatic leadership isn't all it's cracked up to be

    He delivers great speeches. He paints a great vision. He motivates. But now he’s in power he’s said to be cautious, allowing others to take control of big discussions and struggling to enforce the difficult decisions he faces.
  • Charm might not be on the job description, but you won't get far without it

    An unspoken requirement for an increasingly familiar style of management in the public sector is being able to relate to and charm the colleagues below, above and alongside you.
  • Charting public health

    Can some graphs shed light on debate about NHS spending on prevention?
  • Chickens come home to roost

    Finally those of us tired of the tedious, high level, generic, tick box exercises that are averaged out into star ratings are vindicated. 
  • Chief executives don't have tattoos or do they ?

    The average tenure for a chief executive in the NHS is 18 months! What's the motivation?
  • Chirpy man

    It seems the NHS has been freed from central control to such an extent that it now occupies a mythical realm beyond the constraints of rational thought.It is only natural, post liberation, that we all think carefully about what everyone’s job actually is these days.But health secretary Jeremy Hunt’s deliberations appear to have taken him through the looking glass.On his role as secretary of state, Mr Hunt gnomically told the Times: “I have to be the canary whispering in t
  • Circularity: the seventh C

    The first two elements on NHS England’s list of essential elements of compassionate care, featured on a press release commemorating the service’s 65th birthday, bowled End Game over.They are (wait for it!): care and compassion.“Care, Compassion, Competence, Communication, Courage and Commitment, are values essential to compassionate care,” says the document.End Game demands similar clarification of other elements of the health service.“NHS England is England’s NHS,
  • 'Clark received the first total replacement of an artificial heart'

    On 1 December 1982, a snowy night in Salt Lake City, Utah, Dr Barney Clark’s heart was giving out and he was moved up the operating list to receive the first total replacement of an artificial heart in an emergency all night operation.   
  • Clearing up confusion on commissioning

    Clearing up some confusion about commissioning, and a cautionary tale about public sector cooperation with the private sector.
  • Clinician involvement is key - but keep an eye on the cost

    It is vital that clinicials are involved in setting new organisation structures and plans, writes Dr Jonathan Fielden, but they must be committed to the cause.
  • Cliquey, self-absorbed and weak? Hardly.

    It’s hard when your commissioners say you’re cliquey, self-absorbed and weak in partnerships.
  • Cluster development

    What are people doing to support staff who will be working in clusters? What are the "must do" activities, and how can clusters share best practice?
  • coaching scmoching

    Let’s regulate coaching. Let’s make them pass exams and get certificates or ban them from practising. What the hell, let’s go the whole hog and give them a Royal College.
  • Collaboration with the private sector: a necessary evil?

    These days, being the chief executive of a public sector organisation means collaborating with the private sector.
  • Collateral damage

    Amid the cut and thrust of health policy debate on the internet, spare a thought for those who get caught in the middle. Foremost among the innocent victims must be long suffering Twitter user Mr Benjamin M. A’Lee.Why? Well, with the best will in the world, Mr A’Lee used his initials to create his Twitter handle, and so goes by the name of @bma.It means this unassuming “Marxist socialist; feminist; Unix sysadmin; part-time history student at Birkbeck; volunteer first-aide
  • Collective failures can hinder social care

    Hate crimes need to be treated more seriously by public sector services if tragedies like the one back in the spotlight this week are to be avoided.
  • Commissioning board changes '18-week wait' penalties

    The NHS Commissioning Board has made a small, but significant and welcome, change to the penalties for breaching 18-week waits.
  • Commissioning board fumbles on waiting times

    The draft NHS contract penalises hospitals who treat their long-waiters, but not if they keep them waiting. Why?
  • Commissioning board must safeguard the future of secure care services

    The Commissioning Board takes over responsibility for specialised services in April 2013 and needs to focus on designing a system without the blockage problems of today if it is to commissioning secure care successfully.
  • Committee pity

    A recent health committee select hearing provided a fine example of our greatest political minds offering their learned insights into the health system.Sir Bruce Keogh was summoned to discuss a wide ranging agenda focused on his review of accident and emergency services, but also rambling into broader topics such as the thorny issue of what NHS England actually is, and how it isn’t the same as the Department of Health.The highest standard of parliamentary oratory was on display,
  • Common denominator politics

    So was that just the Conservative Party’s Bank of England moment?
  • Community organising, leading change and shifting power: why the NHS needs to build weak ties NOW

    This piece aims to introduce some fresh perspectives on NHS change from civic campaigners and community organisers. Much of the conventional wisdom of NHS improvement is based on “strong ties”, peer to peer spread of ideas for change through “people like us”. However, history suggest that we might get the best chance to deliver the scale of quality and cost improvements we seek if we also focus on “weak ties”.
  • 'Compassion doesn’t cost money'

    How would we like to be treated as a patient? Would we like to be kept waiting without being updated? Would we like to hear people talking about us but not to us? Would we like to be cared for by someone not making any eye contact?
  • Competence or expertise – you choose, if you have a choice

    Workforce planning is an ambiguous art made yet more ambiguous when set on a national scale with its unconnected, conflicting and changing priorities – still, we try.
  • Competence, trust and the making of leaders

    Interesting news from the private sector. A recent study by Booz & Company stated that nearly half (46%) of all senior managers surveyed doubted their chief executive’s capacity to navigate their organisation through the current economic crisis.
  • 'Complaining about the NHS shouldn't be futile'

    The independent inquiry into the high level of deaths at Mid Staffs found evidence of appalling patient care resulting from a preoccupation with cost cutting.
  • Concern that black staff are more likely to be disciplined

    In the NHS and other public sector organisations, black staff are involved in a disproportionate number of disciplinary cases
  • Confessions of an ex-amorphous blob

    In a couple of days, Helen Bevan will be leaving for Kangerlassauq in the Arctic Circle to take part in the Polar Circle Marathon, one of the toughest marathon races in the world. She reflects on her journey over the past six months from unhealthy “amorphous blob” to extreme marathon runner.
  • Contract planning, or last minute scramble?

    Last minute deals, plans that nobody believes in… does the annual contracting round have to be like this?
  • Cooperatives: easier said than done

    The proposal to introduce staff cooperatives to run services will work only if government remains focused on the vision and principle, and does not become distracted by the discussion of the detailed consequences.
  • Copying failure and hoping it works

    Governments have a history of imposing what hasn’t quiet worked in one area of the public sector on to another
  • Could the 'Rooney rule' work in the public sector?

    A look at how attitudes to race have changed in public sector recrutiment.
  • Courage vs 'the easy life'

    Where courage stops is where leadership stops
  • CQC loses its footing

    Two senior individuals involved in the Care Quality Commission’s new hospital inspection regime have been spotted clunking around in orthopaedic boots – the sign of a nasty foot injury.An uncanny coincidence. Have they been giving some hapless trust a kicking? Or are hospitals under inspection feeling the pressure and fighting back? Perhaps the CQC’s new method for detecting “high risk” hospitals is just scarily accurate.End Game made enquiries and can confirm the injuries are u
  • CQC to improve referral to treatment monitoring

    The CQC are improving their 18-weeks monitoring. It still isn’t perfect, but that may not be entirely their fault.
  • Creating diversion will improve mental health screening throughout the judicial system

    New evidence has shown that rates of mental ill health among offenders connected with probation services are worryingly high. An investment into diversion services can help provide these individuals with vital support services at the earliest opportunity, says Sean Duggan.
  • Crime doesn't pay... but it might get you free healthcare

    It sounds like a joke or a wind-up, but losing private healthcare is no laughing matter.
  • Crisis management, disequilibrium and thermostats

    ‘Keep your hand on the thermostat. If the heat is too low people won’t make difficult decisions. If it’s too high, they might panic.’
  • Culture is as intangible as the air we breathe

    Senior managers are fond of saying we need to change the culture of the organisation.They are saying it now in response to the introduction of commissioning and greater use of the private sector in the NHS. It has been repeatedly stated in local authorities as part of efficiency initiatives and outsourcing services. Now I hear it said in relation to the culling of posts and the focus on competence in the civil service.Commentators have expressed concern about the macho managemen
  • Customer added value

    Word reaches End Game of a happy example of NHS leaders recognising that the wider public is a valuable source of information.An NHS England case officer had received a somewhat baffling request for information from a member of the public about whether retired GPs are able to work in private nursing homes. Despite their best efforts, they had not succeeded in locating a definitive answer.Displaying an encouraging amount of lateral thinking, and recognising the great untapped res
  • Customer care is such a drag

    Take a new approach to engaging with staff
  • Customer knows best ... ?

    Keeping the customer happy is important in US healthcare - but at what cost?
  • Cut down on stress, be nice to each other

    Today I interviewed master of spin Alastair Campbell, who was speaking at the NHS Confederation conference in Liverpool.
  • Cut the Newspeak out of redundancy announcements

    Managers and politicians should be upfront and clear when announcing bad news, not hiding behind jargon.
  • Cut waiting times, breach the target

    How government targets deter hospitals from cutting waiting times, and how they could change for the better.
  • Cutting season

    All the parties have plans to cut NHS costs.
  • Daft or just too unpopular to contemplate?

    Last time I checked people were still becoming unwell seven days a week.
  • Dancing with the devil? Exorcism in the NHS

    A blog about the revelation that the NHS uses exorcism as an alternative form of treatment for some mental health patients.
  • Darzi's resignation

    Lord Darzi’s resignation brings to an end a bold experiment in reconnecting the health service with staff and the public.
  • Daughters of fortune

    The world of finance is more commonly associated with mammon and the love of money, aka the root of all evil, than with holiness and the simple life of devotion to the Lord.So imagine our surprise when we learned that a group of nuns called the Congregation of the Daughters of the Cross of Liège were getting involved in a spot of M&A activity.The congregation – a charity set up by Belgian nuns in the 19th century – has just sold one of its hospitals to private firm Spire Hea
  • Death in Swaziland

    Death is a funny thing. In almost four years as a performance manager and information manager in the NHS, I never really experienced death.
  • Debunking some myths about disruptive innovation in the NHS

    As the focus on innovation grows inside the NHS, some leaders have suggested that the really radical “disruptive” innovations that the NHS needs can only come from external sources. But where do the most radical, disruptive innovations come from?
  • December's waiting times data - the local picture

    Resources for analysing local waiting times pressures by trust, PCT and specialty.
  • Defining university hospital status

    In a previous post I talked about the need for the district general hospital to reinvent itself. And the same is true of the university hospital. Although the real prize is for ‘university’ status it should only be granted for FTs linked to biomedical research-based institutions.
  • Déjà vu

    To my surprise and somewhat consternation I find myself once again chief executive of a hospital 17 years after last running one and five years after stepping down as a chief executive. So what's it like?
  • Demystifying the I in QIPP

    We regard innovation as a critical part of the QIPP equation for delivering NHS quality and cost improvement goals. Yet in NHS reports and in the wider academic literature, the term gets used in a thousand different ways, with different meanings. In this blog, I describe a framework for making sense of innovation in an era of quality and cost improvement.
  • Department of dogs

    End Game hears many reports of hairy beasts roaming the corridors of Richmond House but rarely are they serving any purpose which could be deemed therapeutic for anyone apart from perhaps themselves.So it was heartwarming to hear that the department’s policy teams were visited by three flat coated retriever dogs (a bit
  • DES mess

    I’m a GP in England, so I really am surprised to find myself sympathising with the hard-pressed frontline administrators in my PCT.
  • Devaluing social work with adults will cause huge problems

    The NHS stands to lose big if local authorities begin cutting the number of social workers helping older patients and people with disabilities.
  • Developing integrated care at scale and pace: time to make it happen

    There is not one best way to develop integrated care. Politicians, NHS leaders and frontline staff should join together to test different approaches, writes the King’s Fund chief executive Chris Ham.
  • Developing the Healthcare Workforce

    Consultations come thick and fast, a bit like the current weather.
  • DH sweeps long-waits under the carpet

    Surely the deputy chief executive of the NHS in England cannot be encouraging Trusts to sweep their long-waiters under the carpet and ignore them?
  • Diary of an intrepid arctic marathon runner

    However meticulously you plan for big events, there are some things you just can’t plan for. Last weekend, Helen Bevan was due to compete in an extreme marathon in sub-zero temperatures in the Arctic Circle, something that she had prepared and planned for intensively for the last six months. Three days before the event, she came down with a severe cold. Read on to find out the outcome.
  • Did she jump or was she pushed?

    There have been a number of women resign from the Civil Service recently.
  • Differences in waiting times in Scotland and England

    England’s waiting time guarantees are more inclusive than Scotland’s. Why?
  • Dirty work

    NHS England chair Sir Malcolm Grant possesses many of the characteristics which allowed former BBC presenter Des Lynam to be widely viewed as the suavest man in public life for a good couple of decades.He’s well groomed, sports a dashing ‘tache and always shows a good half an inch of cuff.But his ice-cool credentials were given a stern test at the Health Efficiency Through Technology Expo 2013 event in London on Tuesday.With minister for chest hair Dr Dan Poulter running
  • Disarray on waiting times targets

    By keeping the old, distorting waiting times targets in the new NHS Contract, the government has undermined its stated intention to tackle excessive waits.
  • Disestablishmentarianism in the NHS

    NHS trust documents are awash crimes against the English language – but rarely does health service nonsense jargon conjure religious imagery.
  • Disney and the NHS

    Should the NHS emulate the Disney Corporation? Can we learn from the giants in the service industries in how we deliver services, and is there a holy grail in getting it right?
  • Dispatches from the other side

    “I’m available”. With those two lonely, listless words, Sir David Nicholson summed up the tragedy of retirement.It will be no surprise to readers that End Game saw the utterance on Twitter, where Sir David continues to display the symptoms of a keen mind in search of something, anything, to do. His latest dispatches from retirement include regular comments on toddler TV shows and a picture of a slug that he thought had followed him up a hill in Yorkshire.So it was unsurprising t
  • Dive! Dive! Dive!

    A feat for fans of convoluted or plain worrying metaphors at this year’s Foundation Trust Network conference.Jeremy Hunt urged people to join the boards of troubled NHS organisations by citing the advert the explorer Shackleton is supposed to have placed in The Times.You know, the one with reference to danger, disablement and death with the reward being glory. The message seemed to be “become a NED, lose the feeling in your feet”.The speech of KPMG’s intergalacti
  • Do extroverts perform better at interview or do they just think they do?

    The interview process seems designed to favour the extrovert
  • Do the CQC and Monitor understand 18 week waits?

    The regualtors are applying the target in ways that deter hospitals from treating long waiting patients. Let’s hear the reasons why.
  • Do you think you 'deserve sex'?

    The vetting and barring panel could strike you off  
  • Doctor Bruce

    The NHS and Doctor Who have much in common, as long-running national institutions committed to decent moral values.  Both have seen much-loved figures struggle to cope with budget cuts and wonky backdrops over the decades, and both were revived by massive injections of cash in the noughties.So End Game was thrilled to see these two titans of public life collide in the studios of BBC’s ultra-soft “current affairs” programme, The One Show.A recent broadcas
  • Doctor Wars

    Word reaches End Game that some American funsters have come up with a game based on the premise that medics can be a bit competitive.We don’t know where they got that idea. Anyway, “Doctor Wars” is apparently a game in which “chance and strategy are the prescription for fun”.“When doctors compete for patients the game is on!” says the blurb, suggesting that NHS bosses have missed a trick in restricting competition to the provider
  • Doctors do it best

    Word reaches End Game of an opulent evening out hosted by the Royal College of Physicians.The “Harveian Oration and dinner” is an annual feast to celebrate the memory of the college’s 17th century benefactor Dr William Harvey. Guests are treated to a look inside the RCP’s cubist-influenced headquarters, and a lecture from someone clever about something important.Star attraction though was the five-course menu, which read like a Nigel Slater dish reimagined by Edgar Al
  • Does cutting long-waits cause a jump in demand?

    Long-waits were sharply reduced under the last Labour Government. Did GP referrals spike as a result? Maybe.
  • Does the NHS need management consultants?

    As NHS management expenditure tightens, management consultancy costs are in the spotlight. Over the past period, the NHS has been big business for the consultancy industry. Whilst management consultants have made a significant contribution to NHS transformation, there have been many situations where the NHS investment in consultancy has not led to the outcomes we seek. Is there a future role for management consultancy in the NHS? How might we work more effectively with consultants in the futu
  • Dogged display from Peedell poodle

    The National Health Action Party, set up in response to last year’s Health Act, is going from strength to strength, End Game is pleased to report.First came their stunning by election performance in Eastleigh in February, where they won 392 votes, way out in front of the rest of the weirdo parties such as “Beer”, “Loonies” “Elvis” and the English Democrats.Now, two of the party’s activists have completed a 35 mile run to gently mock deputy prime minister Nick Clegg.The “C
  • Don Berwick’s appointment to CMS and the politics of “If we don’t have it, you don’t need it”

    Today, Don Berwick was sworn in as the new leader of the Centers for Medicare and Medicaid. While Berwick commands the widest respect, many feared that his appointment could be delayed or hampered in congressional hearings by opponents to health reform whose goal it is to make the countless next steps of implementing reform as difficult as possible.
  • Don’t 'unnecessarily' annoy the patients

    Ryanair boss Michael O’Leary is reminder of how public sector management used to be
  • Don't believe everything you read...

    Thumbing through the Department of Health response to Francis, End Game was shocked to learn that the government had lost all confidence in the General Medical Council and was proposing to transfer the medical revalidation programme to NHS England.“We are now at the right point for transferring the programme to NHS England to take forward and lead the continued implementation across England,” it unambiguously stated.A terrible idea, but not beyond the bounds of plausibility, we
  • Don't listen at your peril

    The weekend’s media was full of the leadership lessons from last week’s parliamentary debate on Syria. Perhaps the biggest lesson is about listening.
  • Don't make me think...

    Telling people what to think and making people think are very different, and often bring different outcomes. But how do the approaches compare when it comes to disability?
  • Don't presume that racism is no longer a problem

    Racism has been top of the news agenda again in recent days thanks to the conviction of Stephen Lawrence’s murderers, but how far have things really moved on?
  • Double fantasy

    End Game has come across a rather confusing account of subversive activity on the site of Lewisham Hospital.The hospital has been the subject of intense debate this year due to plans to downgrade its facilities to help solve financial troubles at neighbouring South London Healthcare Trust.Weirdly named local paper the
  • Dr Dan's achievement map

    Since a disastrous appearance at Unite’s health visitor conference and
  • Early intervention is rightly at the heart of new mental health strategy

    The government’s new approach to mental health strategy is particularly welcome in its focus on children’s services.
  • Easy wins

    The financial services industry has come up with all sorts of “innovative” ways to make a buck or two, so what better place for think-tank Reform to host its jamboree on innovation in the NHS than at Bank of America Merrill Lynch.The investment bank took no chances on any of the hoi polloi getting into its plush Canary Wharf headquarters with burley bouncers on hand to escort delegates from the lobby to the fifth floor conference area.After chomping on a fine spread of assorted
  • Economic downturn and the opportunity for Foundation Trusts

    I suspect from recent comments on ways of handling the economic downturn that the pre-election phoney war is now beginning. Views against initiatives such as workforce reductions have started to emerge but perhaps based more on philosophical grounds rather than rigorous analysis.
  • Emergency at 170ft

    Usually, emergency treatments at nearly 200 feet in the air take place on low-flying aircraft. But not for one ambulance crew in London.
  • End Game

    When a bedpan is dropped anywhere in the NHS, End Game is sniffing around the mess. Email
  • End Game exclusive! DH gets loved-up

    End Game’s cockles were warmed on a recent visit to Richmond House when we saw that the Department of Health’s staff were being encouraged to 1) get amorous and 2) raise money for charity.Like many workplaces, the DH is running one of those Valentine’s Day schemes where you can buy a rose for a loved one and get it sent to their desk on The Day Of Lurve.According to a poster we saw in a lift, the DH scheme has two twists, however. First, they are operating a marginal tariff syst
  • Engagement matters - here's why

    “Evidence-based common sense” was how Peter Lees described the Fund’s new report on leadership in the NHS at our Summit on 23 May. The report draws on evidence demonstrating the relationship between staff engagement and organisational performance to make the case for a new style of leadership. If the NHS is to address
  • Engaging with grace

    What we spend on care at the end of life
  • English waiting list peaking just below 3 million

    The English waiting list peaks just below 3 million: the largest reported list size since April 2008. But 18 weeks performance remains steady.
  • English waiting times improve in April

    Longwaits went down in April, continuing the recovery after the winter.
  • Ensuring security for secure mental health services

    Nowhere is it more important to look critically at what we are spending now and finding ways of using money more wisely than in secure mental health services, writes Sean Duggan.
  • Enter the Tories

    The opening to the Conservatives’ conference in Manchester this morning was a strangely diffident affair.
  • Equal opportunities under the new CCGs

    The first week in October is a landmark for the NHS.This is the week when the new NHS commissioning board takes on its new responsibilities.The board has a massive budget of £60bn, most of which will be given to clinical commissioning groups for them to plan and pay for their population’s health needs.There are 212 CCGs across England made up of GPs, nurses and hospital doctors. Will they be any more successful than the primary care trusts they replace at meeting the need
  • Equipping managers for an uncertain future

    After savage budget cuts public sector organisations will look very different.They will require a very different type of manager.
  • Esio Cat

    As Roald Dahl’s regular illustrator, Quentin Blake drew snozzcumbers and Willy Wonka’s chocolate factory. But even such a colourful imagination as his can struggle to comprehend the mysteries of NHS bureaucracy.Mr Blake sketched a new logo for Whittington Health Trust in north London: a goggle-eyed but chipper looking black cat, which was rejected by the trust as it did not “adhere to strict guidelines to ensure consistency of the NHS brand”.In emails obtained by local paper the
  • Even the best teams need some star players

    Whether at the World Cup or in your office, leaders are not always good team players
  • Everybody hates a tourist

    End Game was wearied to hear of the Department of Health’s latest publicity wheeze, which this time involved coming up with a new number to do with health tourism (£2bn, except really it’s £300m max) and acting all tough and resolute about making that number smaller in the future.We were puzzled, since health tourism is undoubtedly such a financial and operational priority for the service, why NHS England had nothing to say about it.Anyway just as we had stopped worrying our pre
  • Everything you ever wanted to know about John Ashton, and quite a lot more besides

    End Game has been enjoying the Twitter account of John Ashton for some months, mainly because it allows us to answer the question “what happens when a senior figure broadcasts whatever is on his mind, without the slightest regard to his personal reputation?”Mr Ashton is president of the Faculty of Public Health and had various senior public health jobs in the NHS before the government’s Health and Social Care Act reforms took effect. He has tweeted nearly 27,000 times since early 2012,
  • Evidence, not newspaper exaggeration, should direct debates about care quality

    The Foundation Trust Network has evidence The Sunday Telegraph’s story about “dangerously low staffing levels” at NHS hospitals has been greatly exaggerated, as FTN chief executive Chris Hopson explains.
  • Exalted company

    Sir Stephen Bubb, the utterly relentless head of the Association of Chief Executives of Voluntary Organisations, found himself rubbing shoulders with God Himself when he became the subject of a Today Programme Thought for the Day slot recently.Sir Stephen announced that he was “deeply flattered”, to be featured in such an exalted slot, even though Canon Angela Tilby – who went to the same Oxford college as him, his blog helpfully informs us – only brought him up so she could c
  • Explaining why candidates didn't get the job

    “Why didn’t I get the job?” is a difficult question - but there’s an easy answer.
  • Falling foul of FoI

    The NHS is struggling to come to terms with Freedom of Information.
  • False economies and raised expectations

    The prevention agenda
  • Families shouldn't have to do a hospital's job

    A friend’s experience in a Spanish hopsital is a warning for the NHS
  • Fast, cheap and intimidating - the future of NHS services?

    Why the future of our public services is like a New York breakfast.
  • Fear not: Tories are more afraid of you than you of them

    Perhaps now is a good time to start asking what the Tories would do to the health service…
  • 'Fifty years passed before smoke-free public places were achieved'

    On 26 June 1954 the main article in the British Medical Journal was on the mortality of doctors in relation to their smoking habits.
  • FIlling the void

    Ignore the harbingers of doom; clinical leaders, by driving value and putting patients first, can not only address the challenges we face but lead healthcare towards a better future.
  • First do no harm: lessons from service reconfiguration in London

    King’s Fund chief executive Chris Ham reflects on attempts to reconfigure services in the capital
  • Fitter than a butcher's dog

    I’ve been ill again. And what did I turn to? Flat pop, that’s what. And did it work? Too right it did. 24 hours later and I’m fitter than a butcher’s dog.
  • Five Myths about the Austerity Diet

    What sort of weight loss diet involves hacking off a limb? The public sector austerity diet.
  • Flailed hedges

    It’s every NHS chief executive’s worst nightmare: becoming embroiled in a local scandal where vulnerable local residents have come to harm in an obscure bit of their organisation they probably haven’t thought about in while.Spare a thought then for the folk at Devon Partnership Trust. The Plymouth Herald reports that the local branch of the Royal Society for the Protection of Birds is “livid” with them for “destroying” the home of the endangered cirl bunting.Mark Robins
  • Florida: the future of older people's care?

    In the US, there is a bizarre lack of nursing homes
  • Focus on the fat!

    How will the budget cuts affect public services? And where should the axe really fall? Answers on a postcard please…..
  • Focus on waiting list still delivering success

    The focus on incomplete pathways continues to break new records, according to the April 2012 figures just released.
  • FOI exemptions revisited

    When not busy writing this page, End Game likes to while away the day composing fiendishly worded freedom of information requests, mainly because the ingenuity so many public organisations display as they find reasons to not respond to them is a joy to behold.So take a bow, Northamptonshire County Council, which came back to an enquiry about inpatient care with this stonker:“You refer to ‘people’ in question 1 of your request. Please can you provide clarification of this before
  • For whom the whistle blows

    There’s no doubt former United Lincolnshire Hospitals Trust chief executive Gary Walker is a controversial figure. However, End Game wonders whether we’ve not fully appreciated the scale of his achievements.Tweeting ahead of a BBC programme he featured in recently, Mr Walker pondered whether “one person’s whistleblower is another’s enemy”. He followed this observation by namechecking US whistleblowers Edward Snowden, who has been forced to seek asylum in Russia, and Bradley Manning, wh
  • 'Forty three people died from head injuries and traumatic asphyxia'

    On 28th February 1975, at 8.46 in the morning, a tube train failed to stop at Moorgate station and ploughed on into a brick wall, compacting the first three coaches into a tangle of metal.
  • Francis will likely say parts of the NHS aren’t good with people

    One of the messages from the Francis report on Wednesday will be that the NHS needs to focus more on people.
  • From flower power to Facebook

    I was surprised to read “80s kids will transform the NHS”
  • 'From our viewpoint the NHS looks like a nervous colony of ants'

    When the white paper on the reorganisation of the NHS in England appeared, the Lancet commented that it was ‘welcome and wise’.
  • Further details on GP scorecards

    Including the list of practices rated red on their PCT’s scorecard in more than a third of areas.
  • Gallic abstraction

    Few NHS England board members are better versed in the pithy soundbite than the exuberant Tim Kelsey.Getting your message across to Fleet Street means talking in simple, grandiose terms and repeating your main points in case the dozy journos are a bit hungover and slow on the uptake, as Mr Kelsey, who was previously a Sunday Times journalist, is well aware.In his address to the annual EHI Live conference, Mr Kelsey hammered home the usual stuff about a coming “social re
  • Game for a laugh

    Nothing says happy new year quite like a laboured and mirthless joke about NHS privatisation.So big End Game thanks to London Health Emergency, those funsters, for sending us a new board game to ease the January blues.The group, who are celebrating 30 years of constant panic this year, have devised “Hospital Mi££ions” (see what they did there?) to entertain and educate us all.“There’s always more profit to be made from sickness!” hectors the game’s strapline. Private fina
  • Genuine 'co-production' now needs 'coming together'

    A framework to help local organisations to deliver on the objectives of the Government’s mental health strategy for England is published this week.
  • Get a grip

    The elderly. When we were babies they cradled us, secure in the knowledge that when their hour of need arrived we would return the favour.Why don’t they just “Get a Grip”? Not our words – this is the name of an initiative from South Cheshire and Vale Royal CCGs who are keen to make things better for local elderly people. Quit moaning and pull yourselves together, oldsters!It would be remiss of End Game not to point out that this unfortunately named scheme is more likely aimed at
  • Getting the message across

    With the reforms attempting to introduce competition into almost all facets of the NHS, it’s time for marketing in the health service to get with the times.
  • Give troubled trusts the right support to improve

    When it comes to improving a trust’s performance, we must make sure we do not blur the lines of responsibility
  • Go reconfigure?

    There was no “clever form of words” to spare the SoS’s blushes in the end.
  • Go Red Sox

    Reflections as my year as a Commonwealth Fund Harkness Fellow 2010-2011 draws to a close..
  • Good to Great

    Andy Burnham’s vision for the NHS for the next 5 years - preventative, people-centred, productive. Oh, and computers….
  • 'GP commissioners will need to look beyond their community and take tough decisions'

    ‘I don’t want to see the PCT re-created for me to be then told what services I can have as opposed to the services I need for my patients.’ So said a GP commissioner I saw recently to discuss the merger of community health services with his local acute hospital trust.
  • GPs neglected, again

    In the run up to the Yuletide holiday, many hospital chiefs received what End Game considers the ultimate Christmas gift: a personal call from the secretary of state for health.Alas, there’s only so much time a cabinet minister can spend yacking on the dog and bone, but fear not, Mr Hunt had not forgotten the rest of his flock.The NHS rank and file received what End Game considers the second most awesome Christmas gift imaginable:
  • Grabbing the headlines

    It was refreshing to see the Foundation Trust Network launching a staunch defence of the Care Quality Commission, amid allegations the regulator was not fit for purpose in the wake of the “cover up” scandal.Lesser interest groups might have reached for the popcorn, sat back and watched as the quality watchdog received the kind of monstering it has, on occasion, handed out to FTN members. But the network instead issued a press statement praising its new leadership and calling for
  • Graduates need more than a degree from the university of life

    Why linking up practices and surgeries with local schools could help produce the next generation of medical graduates.
  • Greenhorn Nicholson

    The departing NHS England chief executive Sir David Nicholson has been accused of many, many things, but naivety has not been among them as far as End Game can recall.But perhaps he’s a more innocent soul than we thought.We learn that Sir David recently gave a speech to an audience of eminent folk from government and industry, in which he repeatedly made reference to the precise amount of time he had left in post.When he first revealed how much time he had left to serve,
  • 'Gypsies and Travellers are the most disadvantaged minority within our society'

    There is a unpleasant smell of hypocrisy as the French government is condemned by other European governments for its mass expulsion of Romany Gypsies.
  • Hacks are coming: get bustling

    Readers may remember a common acquisition for any rebel-without-a-cause teenager was a “comedy” T-shirt  proclaiming: “Jesus is coming: look busy”. As a teen, End Game chortled at the wit and wisdom of the slogan. As a know it all student, End Game thought it was hackneyed and naff. It was only as we entered the world of work that we realised it was not a bad piece of advice.Upon seeing Heart of England Foundation Trust’s press office website, End Game wondered if the copy write
  • Halloween is over, so stop the witch hunt

    Calls to introduce laws for prosecuting people for failing to report abuses misses the point – people in positions of authority are not being held accountable for cover-ups.
  • Hands off

    Charity Commission takes a stand on NHS charities’ accounts article in Third sector
  • Hannan's claims about managers: the unblinking truth

    The web is awash with commentary on Daniel Hannan’s incendiary comments on the NHS, thanks to the Twitter army.
  • Harassment has not gone away

    The whole Jimmy Savile scandal has made people think about sexual harassment at work.The workplace has changed since the 70s and 80s and many people assumed that even if there is still a pay gap between men and women sexual harassment was a thing of the past, but it is still a problem.Sexual harassment continues to be a subject difficult to speak out about. This is despite the fact that public sector organisations have explicit procedures for tackling complaints and – in theory
  • Harkness Fellows: can payment reform improve public health?

    Payment reform for healthcare delivery in the US could improve not only the service provided, but public health as well, writes Douglas Noble
  • Harkness Fellows: expect the unexpected

    In the first blog from the 2012-13 Harkness Fellows, Julia Murphy reflects on the first few months of her fellowship and her impressions of the US healthcare system
  • Harkness Fellowships: road trip not included

    Join the 2010-2011 Harkness Fellows as they set out on their year-long journey through the US health system
  • Harsh financial lessons for the public sector

    All local authorities are going to struggle due to the size of savings required.
  • Have your say on the NHS - 'an election in less than a year'

    The BBC news web page has a link to ‘have your say on the NHS’ this week; the NHS is back in the news as a political football.I don’t intend to add more to what has already been said by many on the BBC site.
  • He likes to boogie

    It sounds like Sir Malcolm Grant’s leaving bash, to mark his departure as University College London provost, was a night to remember.Local hacks reported that the NHS England chair spent the evening last June boogieing to Bjorn Again – the world’s premier Abba tribute band. They were supported by some opera singers and a pianist. Such a line-up doesn’t come cheap, mind. The Swedes were booked for £4,725, plus £3,500 from a private donor, while £600 was the cost of hiring the rest of th
  • He only rings when he needs a fix

    A shortage of beds and a parents dilemma
  • Headhunters, beauty parades and trial by sherry

    For all the artificial glamour of senior management recruitment processes for local government, the gritty basics are usually most important things to remember.
  • 'Health and social care' Bill

    We learn of tectonic movements in the exciting world of healthcare public affairs.Three consultants who developed and have recently left the successful MHP Health Mandate - Mike Birtwistle, Bill Morgan and Sarah Winstone – have formally launched their start-up rival, called Incisive Health.If Mr Morgan’s name rings a bell, he was previously Andrew Lansley’s political advisor, and thus pivotal to bringing about the 2012 Health Act. (Does that mean we can call him “Health and Soci
  • Health policy for young people

    The long standing complaint that the central management of the NHS is no good at talking to ordinary people can finally be banished forever, End Game is thrilled to report.Someone has invented a learning tool that turns civil servant speak into young person speak.You type a web address into and it comes out unintelligible in a different way to normal. Warning: it can be a bit sweary. To be honest we’re not really sure how it
  • Health system development plans

    In my report on Lincolnshire I recommended that health system development plans should be introduced across the NHS. This is quite deliberately a recommendation about process because when dysfunctional organisations or health systems are examined the single biggest issue is a breakdown in relationships.
  • Health twits

    Health on Twitter
  • Healthcare in flux

    A delegate at the NHS Confederation’s conference in Liverpool has been spotted drawing what appeared to be a picture of the Flux Capacitor from Back to the Future, but with the patient at the centre.For any readers who didn’t tape the 80s cinematic humdinger off the telly and watch it obsessively when they were eight,
  • Healthcare in the US election: fact, fiction and Big Bird

    While the focus of the 2008 US election was healthcare (and the colour of the candidates’ ties), the 2012 election is all about money (and the colour of the candidates’ ties).Over the past few weeks, money and jobs have typically dominated the presidential and vice presidential debates. That said, healthcare remains an extremely hot topic, with polls suggesting that it is the most important issue to voters after the economy
  • Healthy Lives, Healthy People....

    Ring fenced public health budgets may be too late for resources currently facing the axe in local government budget cuts
  • Heavy duties

    Before you judge a person you should walk a mile in their shoes, goes the famous maxim.Or to quote Billy Connolly: “Never judge a man before you have walked a mile in his shoes, then you’re a mile away, and you’ve got his shoes”.Staff at one hospital have taken the empathy-through-inconvenience model a stage further, strapping staff into a fat suit to gain an insight into the difficulties faced by their obese, bariatric surgery patients.The £1,000 suit helps the moving an
  • Helping tomorrow's healthcare innovators to thrive

    As Jeremy Hunt sets more technology targets for the NHS, it’s time for the service to both help its own and look to others for the solutions to its problems.
  • Here to help

    Working together in partnership
  • High-level anger management

    There’s nothing wrong with managers being angry about poor care, but they still need to be in control.
  • Hiring and firing at will

    I would have sacked a lot more people if I could have got away with it.
  • Holding a mirror up to the managers

    “Mirror mirror on the wall, am I a good manager after all?”
  • Honest PR

    There are so many things to love about commissioning support units that it can be difficult to know where to begin.This week, it’s their transparency and honesty that End Game loves best of all. When we were faced recently with the potentially soul destroying task of ringing round lots of clinical commissioning groups for comments on a story, it was a CSU communications lead whose assistance was the most useful of any we encountered.The PR, sympathising with our struggle, advise
  • Horror movie

    Oh good, an NHS trust has produced a video in an attempt to be funny while imparting an important but humdrum message.You may remember last year Blackpool Teaching Hospitals Foundation Trust had a hit with their flu fighters campaign video, which featured a normal bloke called Phil getting a hero’s welcome for getting his vaccination jab. Well, by “had a hit” we mean “won the approval of NHS England”, who did their own sequel with Ph
  • Hospital food is a recipe of contrary ingredients

    When heart attack patients can tuck into a fry up the morning after a bypass, the health service needs to re-examine its position on hospital food.
  • Hospital guides

    Basildon, Dr Foster and public information about the NHS.
  • Hospital inflicted virus

    University Hospital of South Manchester Foundation Trust have been so overwhelmed by the positive feedback they’ve had from patients that they felt moved to produce a video about it.“Viral video launch”, a press release proclaims. End Game humbly submits that might be a little presumptuous, since it’s not up to the producer whether or not a video goes “viral”, and to be attempting to contrive such an outcome risks looking, well… a bit contrived.
  • Hospitals and illegal drugs

    Outside the main hospital doors is not just the patients unofficial smoking area its where you score. It shouldn't be a surprise that illegal drugs are available to patients or that drug addicts have health problems but it does make their stay on the ward more of a challenge. T
  • Hospitals strike back first over social care cuts

    The NHS’s concern about cuts in social care was not an expression of support for colleagues in social services…it was a pre-emptive strike from hospital trusts.
  • Houston we have a problem, can ACOs save us?

    Dear HSJ reader, As a lover of all things health-related, I am delighted to introduce you to 2 American health care acronyms from across the pond: IHI and the ACO. I hope both will bring you joy this Christmas!
  • How can managers keep staff happy amid pay freezes and layoffs?

    Happy staff work harder and achieve more. This is probably not a big surprise to most managers, nor I suspect is the view that if staff are unhappy it affects their work.
  • How do Trust Boards monitor waiting times?

    Trust board papers are often surprisingly coy about the state of the waiting list. If you were a non-executive director, would you even know if there was a problem at your Trust?
  • How good journalism can improve NHS waiting times

    There is plenty to hold the NHS and the government to account for, once we stop focusing on the wrong waiting times figures.
  • How hard is the new 18 week target?

    The new 18 week target can be achieved. In a few places it is going to be difficult. But most of the NHS could achieve it by improving patient scheduling alone.
  • How long does it take to do 100 minutes' work?

    There are 13,259 over-one-year waiters on the English waiting list. That’s only 100 minutes’ work for the NHS. Why not put an end to excessive waiting times once and for all?
  • How PR works

    It feels like a long time since we had a horrendously opportunistic press release to marvel at.Maybe the public relations industry is getting the hang of judging the boundaries of taste, or perhaps we’re getting better at hitting “block sender”.Anyway, the drought is over. Within a couple of hours of a teenage girl getting stabbed to death on a bus in Birmingham, Hillgrove PR had an offering about a
  • How public health can help the neediest parents

    Smart working by the new public health system, the NHS and schools can tackle children’s behavioural problems effectively
  • How should the DH allocate the £500m A&E bailout?

    The Department of Health’s plan to divert £500m to A&Es is to be welcomed, now comes the difficult job of allocating it
  • How the game is played

    Experience and skill are not enough you need to know how the game is played if you want to succeed
  • How to be successful at interview

    We were in a hotel bar the night before the interview, me, the three other shortlisted candidates and the recruitment consultant.
  • How to fail without really trying

    You need three ingredients to be really unsuccessful.
  • How to find a doctor

    One of the challenges facing us all as recently arrived Harkness Fellows is trying to understand how health care is organized and delivered in the US. 
  • How to win praise and influence people

    In busy, competitive environments, praise is often in short supply for anyone who thinks simply turning up deserves a shower of superlatives. But how do hardworking staff who feel undervalued get into a managers’ good books?
  • How well do you listen?

    Listening is not about being passive, nor is it an unspoken agreement with what the other person is saying; listening makes people feel valued and respected
  • How will doctors see fit to spend their budgets?

    Doctors may have a few things on their wishlists now they are supposed to be in charge of commissioning services.
  • How will Monitor judge waiting times performance?

    Monitor is out to consultation. My response explains why its approach to 18-week waits is perverse, and how to fix it.
  • Howe's that

    The latest summary of health ministers’ meetings and hospitality – covering July to September 2012 – emerged from the Richmond House fortress last week.
  • Hunt for answers

    Following his 10 minute row with pugnacious former Care Quality Commission chair Baroness Young at a Conservative conference fringe event, End Game could have forgiven Jeremy Hunt for going back to a darkened hotel room for a large brandy and a lie down.But credit where credit’s due, the health secretary was keen to speak following his interrogation in front of 100 amaz
  • Hunt performs first u-turn

    Speaking to clinical commissioning group leaders at a recent conference in London, Jeremy Hunt admitted he had made at least one about-face since taking over the role of health secretary.It turned out that, en route to the Tottenham Court Road venue, he’d gone in the wrong door and found himself in the Trades Union Congress headquarters.That would have made him the first Conservative cabinet minister to set foot in the building for… well, a jolly long while, Mr Hunt observed wit
  • Hunt, health and airlines – half right and half wrong?

    We need a culture where staff feel empowered to act to mitigate risk and prevent avoidable harm without fear of recrimination and blame. It is time for a much more sophisticated debate, says Chris Hopson.
  • Hunt's care plan puts burden on family before state

    Jeremy Hunt’s proposals for looking after older people are all about ‘care closer to home’
  • Hyaluronic acid: A love letter

    Hyaluronic acid. Say it with End Game. Hyaluronic acid. We love the stuff! It’s easily our favourite kind of acid.Known simply as HA to its pals, hyaluronic acid is sometimes marketed as the “fountain of youth” because it is good for the joints and revitalises the skin. We’ve been a fan for 70 or 80 years, though you wouldn’t believe it to look at us.So imagine our delight when we received a press release informing us that we could win an award for indulging our passion. First p
  • I don’t need to go to hospital, I just need to go home to bed

    Sometimes the patient knows best.
  • I don’t want to be a consumer, I'm happy to be a patient

    Doctor may know best on medical decisions, but they should still treat patients as adults
  • I’m missing the Proms already

    Working together and conflict resolution in tense times
  • If bullying doesn't bother staff, why are so many absent?

    Two articles published on one on bullying, the other on absenteeism. Surely I can’t be the only one putting two and two together…
  • If the NHS is doing well, why is it changing?

    A recent Commonwealth Fund survey saw respondents praise the NHS. So are the reforms aimed at addressing the right problems?
  • If the shark doesn’t get you HR will

    Managing an employee’s sick leave and return to work is never straightforward once you look into their individual circumstances.
  • If you can, do: if you can't....

    A tidal wave of conferences, seminars, webinars and more - how valuable are they, and how much do they contribute to the debate?
  • Impatient for change

    It’s time to change for WRVS and to make personalisation a reality
  • Imperial's waiting times holiday

    Imperial is taking a “reporting break” on 18-week waiters. Bad idea.
  • Implementing localism

    A particularly bold and probing parliamentary question has caught End Game’s eye.Dominic Raab, Tory MP for Surrey’s Esher and Walton ward, exhibiting his finest scrutiny skills, queried of health minister Norman Lamb last Tuesday: “What progress his department has made on implementing local commissioning of NHS services?”Mr Lamb – ignoring what may be something of a national/local contradiction in the question itself – duly explained that 211 clinical commissioning groups had be
  • Improving comorbity care is a key challenge for mental health

    Better managment of care for people with both physical and mental health conditions would improve lives and save the NHS billions of pounds.
  • Improving the health of the poorest, fastest: why clusters of lifestyle behaviours matter

    When the coalition came to power I, like many others, was nervous about whether the government would see inequality reduction as one of its core aims.
  • Improving the world, one message at a time

    A misdirected email chain gives us insight into two of End Game’s favourite subjects: the relationship between the Department of Health and NHS England, and the everyday life of public relations professionals.The scene is a dreary Monday 6 January, millions are miserably returning to work after a holiday – among them are (seemingly) thousands of national press officers dealing with the infinite complexities of trying explain to the nation’s press what on earth their ministers are tryin
  • In NHS board games, no one is safe

    Cynthia Bower’s resignation yesterday reminds us that the casualties of NHS boardroom powerplays go all the way to the top.
  • In response to relatively popular demand

    Why does it matter if GPs can earn interest from their “hard cash”?
  • In search of Valhalla

    What’s the real agenda at all expenses paid health conferences?
  • In the boardroom: tough talks as reality sinks in

    Now that the size and implications of public sector cuts are sinking in, senior managers and board members are realising that efficiency savings will not be anywhere near enough to cover it.
  • In the drive for equality, culture eats strategy for breakfast

    Even the best laid strategies sometimes fall short of achieving their goals. With an issue like equality, cultural changes are just as important as putting official plans in place.
  • In the NHS you need political skills to survive

    The casualty rate among chief executives is rising. To survive they need to hone their political skills. But what does it mean to be politically aware and sensitive? 
  • Inadvertent integration?

    Recent reports from the US and UK suggest primary care and hospitals merging on both sides of the Atlantic. But are we missing these opportunities to understand truly integrated care in the NHS?
  • Incendiary reporting

    “SEND FIREMEN ON 999 CALLS INSTEAD OF AMBULANCES,” bellowed a Daily Mail headline.It was in reference to NHS England chief executive Sir David Nicholson’s recent Commons health select committee appearance in which he said he had given thought to the idea of the fire service “supporting paramedics”.A very boring quote came next, followed by a section in reported speech: “[Sir David] said it was unlikely that fire and ambulance services could merge but said firemen could be first
  • Innovation and the NHS: the health entrepreneurs’ view

    HSJ talks to Zahid Latif, the Technology Strategy Board's head of healthcare about how the NHS can better embrace innovation
  • Innovation Eye

    Pamela Garside is a consultant at Newhealth and co-director of the Cambridge Health Network.
  • Innovation for higher quality and lower costs

    At no other time in its history has the NHS needed innovation for service delivery as badly as it does now. But innovation won’t just happen, even if we give it a high strategic priority. We need to take a systematic approach to innovation practice, building it into every aspect of daily work.
  • Innovation in healthcare: ‘There’s a way to do it better – find it’

    Alexandra Norrish on the lessons the UK can learn from the US health system’s long tradition of innovation
  • Inspections can only hope to inspire managers into stopping abuse

    Inspectors can’t realistically hope to “catch out” staff who abuse care home residents; it’s up to the managers to ensure their employees are all delivering good care.
  • Integrated care and why the NHS needs more deviant leaders

    Local leaders are ahead of the game, writes Chris Ham.
  • Integrating mental health and substance misuse services

    While there has long been a link between mental health problems and drugs and/or alcohol abuse, providing services for this group should be better integrated if outcomes are to improve.
  • Integration must not default to a box-ticking process

    Integrated care is a hot topic again thanks to the Health Bill’s passage through the House of Lords, but the NHS and Department of Health must ensure integration is not just a buzzword that falls out of use in the long-term.
  • Interim NHS managers can relate to Rafael Benitez

    Senior NHS managers are now considered like football coaches, no one expects them to be around for very long.
  • iPath

    Ipods revolutionised, and possibly destroyed, the recording industry forever, with their convenience, user friendliness and the bewildering, strangely alienating level of choice they offer.Vinyl records, on the other hand, may be fragile and cumbersome, but are also beautiful and comforting objects that ooze history and value.So what are we to make of University Hospitals Coventry and Warwickshire Trust’s boast that “the pathology equivalent of moving from vinyl LPs to iPods is
  • Is community care, as we know it, dead?

    Reports of the death of community care have not been exaggerated.
  • 'Is cost-cutting turning managers into bullies?'

    Is the harsh financial climate in the public sector leading to a return to the bad old ways of “macho” management in the NHS?
  • Is enthusiasm the key skill to look for in public sector recruitment?

    Surely departing from tradition and qualifications and embracing enthusiasm will make for a more successful public sector.
  • Is fiddling the figures all part of the game now?

    Mark was angry, and the more he read, the angrier he got.
  • Is it harder to be an honest senior manager in today’s NHS?

    League tables, naming and shaming and austerity have put more pressure on managers in the public sector, making if difficult for some to remain honest and open.
  • Is it that good to talk?

    I’m unconvinced the government’s Schwartz rounds pilot will improve staff wellbeing or patient care
  • Is 'Just-in-time' the best way for pandemic flu planning?

    We’ve had a Pandemic Flu Plan since 2007 - and on paper are well prepared! Rhetoric and reality are different! All I can say is, many thanks for sending swine flu - instead of avian flu - this time!
  • 'Is the answer to have more black senior NHS managers?'

    Why do so few people from ethnic minorities make it into the top jobs in the public sector?
  • Is the betting off for Lansley's vision?

    David Cameron’s speech yesterday did little more than reaffirm the government’s commitment to pushing on with NHS reform. But will the prime minister show as much support to his beleaguered health secretary Andrew Lansley?
  • Is the NHS safe in the hands of the Competition Commission?

    The competition authorities must give due consideration to the interests of patients and taxpayers when considering NHS trust mergers.
  • Is the public sector running out of ideas?

    The changing role of chief executive’s requires a change in approach. But do the demands on management team leave them no room to manoeuvre?
  • Is the US ready for evidence based care?

    What does the controversy about mammography screening tell us?
  • Is there an I in success? Busting the team building myth

    A successful team of staff doesn’t mean that all of them have to be “team players”. In fact if they don’t get on with each other, they may get on better with the job in hand.
  • Is trust really the be all and end all of leading?

    You can’t be an effective leader if you don’t have the trust of your peers and the public.
  • Is your mental health policy bad for business?

    Organisations in the public and private sectors need to be prepared to support their employees
  • Is your organisation accepting the unacceptable? Challenging 'ethical fading'

    They call it “ethical fading”. You and I call it going along with something you know is wrong.
  • It takes gumption to voice your views on the NHS

    Is having an opinion a disciplinary offence?
  • 'It was the nadir for the GPs, but they also had their supporters'

    The Collings Report published in 1950 led some to feel general practice was past saving and not worth the effort.
  • 'It won’t be lack of money that does for the public sector'

    In the end it won’t be lack of money that does for the public sector. It won’t be the loss of skills or the lack of experience due to early retirements and redundancies.
  • It’s a surplus Jim, but not as we know it

    Intrigue over that £1.5bn shaved off the DH’s departmental expenditure limit for 2008-09 continues
  • It’s adapt or die for the quality improvement movement

    -The healthcare quality improvement movement needs to step up to the challenge of cost constraint. It’s an “adapt or die” situation.
  • It's a funny old game

    Comparing NHS trusts to premiership football clubs tells you just how much trouble we are in.
  • It's sometimes best not to follow the leader

    Following a success story can be difficult for leaders everywhere
  • It's the vision thing

    Joseph Chamberlain, the man who brought street lighting and paving to Birmingham, is generally considered the nation’s greatest public health visionary.But perhaps Public Health England can be seen to have similar visionary powers.A few months ago the organisation was widely mocked for producing an action plan to deal with a heatwave, as the nation shivered.“In the midst of the coldest spring in 30 years, the government offers advice on coping with days of balmy summer,”
  • It's time to talk about values

    The public sector’s values have become aligned in recent times to those of the private sector. It’s time to get back to what the public sector should stand for: doing the right thing.
  • 'I've seen how innovation makes a difference from top to bottom'

    Forcing through innovative service changes might be met with resistance, but it worked for London’s stroke services, as Pamela Garside can testify first hand.
  • James Illman's Innovation Blog

    HSJ’s technology correspondent on the latest developments in healthcare IT and innovation
  • Jazz Expo

    If NHS England had promoted with the same gusto it advertised its own Expo in Manchester this week, it may well have avoided the unwelcome jaunt-up-poo-creak-sans-paddle-come-stool-storm it’s currently, which involves the laudable but tricky task of joining up patients’ health records without breaching their privacy, was advertised by shoving a shoddy leaflet through a few letterboxes.The Expo meanwhile has been promoted by countless press releases
  • Jeremy Hunt's first hand NHS experience

    All the old cynics who dismissed ministers’ plans to spend time working on the NHS front line as a cheap and stupid publicity stunt were confounded this week by Jeremy Hunt.Reflecting on the time he spent on an accident and emergency department in Watford, the health secretary noted the “dramatic” growth in accident and emergency activity, and that non-elective services were under huge pressure.End Game wonders how long Mr Hunt must have been working in the NHS to observe and co
  • Jermey Hunt has jumped the shark

    A new prison sentence for wilful neglect is an unnecessary gimmick
  • Journalists for the Ethical Treatment of Women

    There are many joys that come from End Game’s status working on a noted health publication, but foremost among them is that we get kept abreast of what’s going on in the world of eating.That’s because many mailing list machines think that “health policy” and “mindless guff about food” are one and the same.And so it was that End Game was sent a press release from People for the Ethical Treatment of Animals urging us to go vegan.Nothing wrong with that. But the accompanying
  • Just do it! (Subject to rules and regulations)

    I’m only a couple of months into my year in the USA, but I’ve quickly picked up how things are done here.
  • 'Just enough' is far from good enough

    The vast majority of workers are not strivers or skivers but fall somewhere inbetween, so how can managers get the best from them?
  • Just like True Detective

    Some meetings can leave you asking what was that all about and yet the chair proclaims it was useful, every one appears to agree yet makes a mental not to send a sub next time.
  • Keith Floyd and leadership

    Keith Floyd was hugely entertaining albeit with personal flaws such as occasional rudeness and arrogance. Translate this to leadership and it’s the Keith Floyd-esque characters who push the boundaries, always bounce back and rarely give up.
  • Kelsey Uncut: Tweet 'n' delete

    End Game has been a fan of NHS England’s colourful national director for patients and information Tim Kelsey for some time - and his Twitter account in particular.The latest missives from what we like to think of as “Kelsey Uncut” were fired off after a privacy campaigner raised concerns around how well patient confidentiality would be protected when NHS England’s planned monster patient data compendium was up and running.Mr Kelsey shot back: “You can object and your data will n
  • Kick the hornet's nest

    An Essex trust is looking forward to welcoming a new intake of Filipino nurses, and sees no risk in the recruitment because they’re “more highly trained” than their English counterparts.
  • King's Fund 'boffin' in tabloid promotion shocker

    Fame at last for the King’s Fund’s esteemed chief economist John Appleby.The Irish Sun has run a short piece based on Professor Appleby’s findings that 40 per cent of girls born in Ireland in 2013 would live to be 100. The figure will hit 60 per cent of girls born in 2060, the paper reports.The paper’s website ran an enormous picture of Professor Appleby with “boff
  • Known unknowns

    Massive End Game appreciation goes to South Warwickshire Clinical Commissioning Group, for this beautifully worded admission of ignorance in a recent finance report: “The complexity of the issues involved, and the quality and paucity of data available mean that it is presently not possible to confidently assert that the CCG view of the world is entirely correct.”Socrates himself could not have put it better. Still, while it’s philosophically true of all sentient beings, it is not a tru
  • Lansley and Neil in the waiting times trap

    Waiting times have come to mean the opposite of waiting lists, and this has turned public debate on the NHS upside down.
  • Lansley steps up to bat

    The health debate at the Conservative conference failed to hit the process target of starting on time. Shadow health secretary Andrew Lansley came into a half full auditorium almost an hour late.
  • Lansley’s devil is in his detail

    It’s a policy: real terms cuts to NHS pay
  • Lansley's sums

    No matter how many times shadow health secretary Andrew Lansley repeats his pledge that there will be real terms growth in NHS spending under a Tory government, the NHS is not convinced.
  • Laser guided surgery

    End Game was excited to read of a clever new cancer intervention being pioneered by University Hospital Birmingham.It’s called “CyberKnife”, but less scary than that sounds because it is actually a tiny beam of radiotherapy, and not a grudge-bearing robot with a blade.According to the blurb, “it uses technology similar to that used in cruise missiles to target tumours”. Though hopefully incurring less “collateral damage” than the average “surgical strike”.
  • Latest on 18 week waits: better in December

    The December 2011 data for 18-week waits shows a continued improvement, not just in the total list size, but also in the number of long-waiters.
  • Latest on RTT waiting times - the May 2011 data is out

    RTT waiting times in England improved again in May. But you wouldn’t know it from the media. Or even the Department of Health.
  • Latest on waiting times - signs of recovery?

    Pressure on waiting times fell in March, as Trusts treated their long-waiting patients. As a result, the headline 18-week target deteriorated.
  • Latest RTT waiting time figures for England - July 2011

    It’s starting to get worse.
  • Latest RTT waiting times data - November 2011

    Data shows that waiting times improved in November.
  • Latest RTT waiting times: August 2011

    The NHS fended off its waiting time pressures in August, providing some much-needed breathing space as winter approaches.
  • Latest waiting time stats: one year waits halved in October

    One-year waiters halved in October; a spectacular success for the NHS. Otherwise, it’s steady as she goes as we head into winter.
  • Latest waiting times - a closer look

    The latest waiting times data, drilling down to Trust level; what's up and what's down
  • Latest waiting times, trust by trust

    A detailed look at the May 2011 RTT waiting times, at specialty and Trust level.
  • Lead from the front and behind the scenes

    The NHS requires leaders across the service who are influential and willing to learn from others
  • Leaders lack confidence in the changes they've been asked to make

    Transforming the public sector on the scale the government requires was always going to be difficult. The success looks more difficult still as the majority of leaders in the public sector have no confidence in the changes they’ve been asked to make.
  • Leadership and getting the right people on the bus

    If the wrong people are on the bus they should be dropped off at the next stop, they might need to catch a different bus.
  • Leadership in Mental Health

    Sean Duggan is chief executive at the Centre for Mental Health. 
  • Leadership is about taking responsibility

    Leadership isn’t just about grand visions and great strategies or inspiring staff. Often leadership is simply about taking responsibility.
  • Leadership lessons from the Thin White Duke

    The NHS is seeking to revive a familiar refrain with a return to “heroic leadership”.
  • Leadership needs to be more local than national

    The reputation of top leaders is not achieved by delivering national bottom-line outcomes. What does differentiate one top leader from another is the ability to deliver local change, innovation and transformation seen as important to local people.
  • Leadership: not as dangerous as some might make out

    The claim that “leadership is dangerous” needs some context, as the public sector doesn’t necessarily lend itself to all-guns-blazing macho men and women.
  • Learn anything new today?

    “What did you learn today?”  Well, quite a lot, actually.
  • Learning from a model medical leader

    The swift changing of the seasons in Boston accompanied an equally swift change in administrator for the Centres for Medicare and Medicaid Services.
  • Learning from Humpty Dumpty

    I don’t want to fall off the wall, I certainly don’t want to sit on the fence either. I’ve tried the fence, it’s uncomfortable and it makes my bottom hurt.
  • Learning lessons from north of the border

    The Scots have repeated England’s mistakes in setting their waiting time targets. But they still have a trick up their sleeve that England could learn from.
  • Learning lessons in mental health care from around the world

    A global call for action into mental health research has set out a list of priorities that identify the most pressing challenges to delivering improved mental health care and improving the lives of people with mental health in the UK
  • Learning the management lingo

    Ambitious managers need to learn a certain type of language to get ahead - the rest of us just need to try and work out what they’re saying.
  • Lessons for the care industry from the car industry

    The car industry and the health care industry have much in common. Both deal in body parts, and what are surgeons but mechanics, hospitals mere repair shops and people “soft” machines?
  • Lessons from Boston on integrated care

    Pamela Garside reports back from her trip to the US in winter last year to explore “value-based healthcare”.
  • Lessons from Co-op Bank: how much should the chair know?

    The criticism of former Co-operative Bank chair Paul Flowers overlooks the benefits of boards operating with a non-expert chair
  • Lessons to learn from Barclays

    Bob Diamond appears to have seen nothing, heard nothing or known nothing. So said the Treasury Select Committee. But is it possible for chief executives to know everything that is going on in their organisation? Clearly not, but they do need to know what they should know.
  • Letter from America

    A hearty End Game standing ovation goes to former British Medical Journal editor Richard Smith for bringing incredible personal flair to that most mundane of communiques – the “out of office” email.Here’s what a recent automated response said:“Gone to Chicago that city of hammers, meat, graft, bull, and pork to make a film on evidence based medicine, roast an old friend (with all the trimmings), cogitate on peer review, swim in the lake, look at the Caillebotte’s, and l
  • Letters from America: the 2010-2011 Harkness Fellows

    Established by the Commonwealth Fund and co-funded by the Nuffield Trust, Harkness Fellowships allow professionals to research health policy in the US. 
  • Life after senior management: it's not over for the over 50s

    The task of applying for a new job as a former manager may seem daunting, but the benefit of experience channelled the right way makes it very achievable.
  • Life on the front line is tough wherever you work

    Many nurses want to move jobs, but the causes of their disillusionment go far beyond their current trust.
  • Lights, camera, cliche

    Drumming up support for worthy causes is a good thing – but that doesn’t give PRs carte blanche to write complete twaddle.The press release promoting the 75th birthday of the British Polio Fellowship is a case in point.“Lights, camera, Polio, action!” parped the headline on the release which went on to detail how the fellowship had screened three documentary films about polio at its AGM last month.Plonking the word “Polio”, a highly contagious viral infection t
  • Lights, camera, inaction

    TV’s Undercover Boss is a lesson in management – for all the wrong reasons
  • Like a circle in a spiral

    First, let us be absolutely clear that End Game is a profound supporter of NHS Change Day, and applauds both its aims and the outcomes of thousands of tiny improvements to make NHS services more considerate, caring and patient centred.But however committed our cheerleading, we will always be outclassed by Helen Bevan when it comes to inspirational rhetoric. Of late, she has been more encouraging about NHS Change Day than anyone has ever previously managed to be, about anything.S
  • Lincolnshire existentialists

    Lincolnshire Community Health Services Trust hosted a fun jamboree to try and help inspire some of its resident smokers to kick the habit this month.The trust laid on a day of “1940s-themed No Smoking Day celebrations”, inviting all comers toimmerse themselves in 1940s spirit, with the retro dance demonstrators and live singing.Now, we love a good lindy hop as next much as anyone and loudly applaud the trust for trying to make quitting the fags fun. But the trust’s choice
  • Little known FoI exemptions, from CSU Cassander

    Fed up answering troublesome Freedom of Information requests? Worried that the old “commercial confidentiality” excuse is wearing a bit thin? Don’t worry - help is at hand. In this new occasional series, CSU Cassander points you towards some little known exemptions that can help you get on with your job uninhibited by the inconvenient light of scrutiny.Section 45: request written in Comic SansSection 49: response would only e
  • Little known FoI exemptions, from CSU Cassander

    End Game’s esteemed colleague CSU Cassander identifies some little known exemptions to the pesky Freedom of Information Act
  • Little known FoI exemptions, from CSU Cassander

    This is the latest installment in End Game’s occasional series, in which the ever-resourceful CSU Cassander identifies some little known exemptions to the pesky Freedom of Information Act.Section 66: Archives hauntedSection 71: Information eaten by catsSection 75: NHS will be privatised from 1 AprilSection 84: We’ve always been at war with Eastasia
  • 'Living on pizza saved my life'

    Only in America would a three-year long pizza-a-day habit put someone in hospital - for the right reasons.
  • Living with 'socialized medicine'

    Targets have reduced waiting times, but how else do they affect care in a nationally funded health care system?
  • Local picture on 18 week waits: April 2012

    Interactive maps and resources with detailed analysis of the 18-week pressures by Trust and PCT, by specialty.
  • Locating the right evidence for merger decisions

    Candace Imison asks whether potentially merging trusts’ evidence will meet the Competition and Cooperation panel’s exacting review standards, and what the challenge means for the 20 currently unviable trusts in the FT status pipeline.
  • Logan Five Arrives

    I landed in the States in the middle of the ‘NHS WOULD HAVE LET STEPHEN HAWKING DIE’ furore, and so was hardly harbouring high hopes for a rational health care debate.
  • Logging on early

    Buoyed by recent enthusiasm about personal health records, I’ve signed up for three.
  • London smog and a major advance in public health

    From 5 to 8 December 1952 smog (fog filled with smoke) of unusual density and persistence covered the Greater London area.
  • Longer life expectancy can be too much of a good thing

    An ageing society has to address ethical issues about when and how people choose to die
  • Long-waits soar in Scotland

    Scotland is achieving its main waiting times targets. Yet long-waits are soaring.
  • Look, it’s a Darzi vision – in multicolour!

    Roughly a year after the Darzi documents were published, it is time to look back. That process may be gratifying, inspiring or horrifying, but it will almost certainly be tedious.
  • Lookey-Likey on the Radio Mikey

    VaughanRoylesHere are two twinkly-eyed, football loving everyblokes.Both have a personal style combining keen intelligence with down to earth, homespun common sense.Both enjoy wholesome pursuits – though one is into cooking and the other prefers a countryside stroll.It seems t
  • Looking Out, Not Up

    How do we know if we are getting it right? Is it meeting targets? The people who really know whether our services are good or bad are the people who receive them.
  • Looky likey

    Buzz LightyearWhen HSJ naughtily put together a joke piece for April Fool’s Day, we thought we had made it implausible enough to be self-evidently a joke.Chortling to ourselves, we ran a story stating that ministers would have to tell the truth in future, as they were to be subjected to a
  • Looky unlikely

    Jon Restell: the charming chief executive of the union for HSJ readers, Managers In Partnership.Gordon Brown: author of unpopular books and noted Arctic Monkeys
  • Losing le tache

    Congratulations to NHS England chair Malcolm Grant, who was awarded a knighthood in the Queen’s birthday honours list. He will now be able to hold his own among all those extremely highly respected “Sirs” of the health world, even former strategic health authority chief executives.Anyway, rising to the occasion, End Game looked on the internet for facts about Sir Malcolm.We could not have dreamed of discovering anything as exciting as this image, which depicts the then lowly-tit
  • Love over fear in managing absenteeism

    Managers need to show they care about the wellbeing of their employees
  • Low morale: does it really matter?

    He had noticed the atmosphere in the office and knew that staff were unhappy.
  • Macho macho management

    Three quarters of the NHS workforce is female, half of GPs are women but commissioning is man’s work, according to workforce figures. Is this consciously unfair, or a simple by-product of the current climate?
  • Making savings through sackings - but who goes?

    A report published recently expresses concern that the eagerness to cut costs in the short term could seriously undermine the public sector’s ability to deliver in the long term.
  • Making sense of conflicting waiting times targets

    The NHS has been given conflicting waiting times targets this year. There is a solution, and it lies mainly in PCT clusters’ hands.
  • Making the case for a one-year limit on waiting times

    Rob Findlay and Anthony McKeever make the case for NHS trusts guaranteeing a one-year limit on referral to treatment waiting times.
  • Making time for successful management development

    Management development programmes have a vital part to play in achieving powerful organisational change - but only if they can be delivered properly, to the right people.
  • Man management is a funny old game

    Managing conflict in the team and the art of getting rid of those who just won’t play ball
  • Man of Steel

    Is it a bird? Is it a plane? Nope – somewhat surprisingly, it’s Phil Morley, chief executive of Hull and East Yorkshire Hospitals Trust.It’s fair to say Mr Morley threw himself headlong into the organisation’s Workout at Work day by appearing in a short film made especially for the event.The video, which was supposed to be for employees’ eyes only but later surfaced on YouTube, begins with an interesting insight into the l
  • Managers − always look on the bright side

    Despite cuts to their budget, social services leaders appear to be relentlessly optimistic
  • 'Managers need more than a short course to lead a diverse workforce'

    Managers in the public sector seldom have the confidence and skills to manage an increasingly diverse workforce.
  • Managers show their worth

    I was taken recently by the findings of a study of careers of NHS managers with 25 or more years experience. The findings are especially interesting because the careers of many of the managers interviewed pre-date the introduction of general management into the NHS in the 1990s.
  • Managing Change

    As the changes to the NHS continue to exercise the minds of NHS staff potentially "affected by change" what are the main themes emerging?
  • 'Many managers will be sweating on the beach over their future'

    ‘Some managers think decisions will be made in their absence about their department and their future if they go on holiday’
  • Many measures of waiting times

    Bewildered by the vast pick-and-mix of different waiting time measures? Here’s a fact checker that has them all.
  • Mapping swine flu

    As an experiment I have mapped swine flu figures for primary care trusts in the North East.
  • Mapping swine flu part two: The professionals

    Following my stunted effort a few weeks ago, the professionals have got stuck in to mapping swine flu.
  • Medicine for dummies

    “Paramedics and an air ambulance who raced to the scene of a report of a person not breathing in a locked car got the shock of their lives when they arrived,” a press release from the East of England Ambulance Service breathlessly informs us.What did they find? Presumably, the air ambulance having been marshaled, they could expect to be dealing with a life threatening situation?On arrival at Milton Road, Harwich, the reality turned out to be somewhat less dramatic.“Follow
  • 'Meeting big challenges means radically changing how people behave'

    We need to promote fairness in how we recruit people, fairness in how we select people for promotion, fairness in how we treat people at work, fairness in how we allocate scarce resources.
  • Meeting the NHS spending challenge - on a wing and a prayer

    You can own the best racing yacht money can buy. It can be the ideal weight, have the best gadgets and be the optimal structure but to win you need the right team. Unless people work together and want to win you won’t win.
  • Mental Health Diet

    The power of positive thinking – is your glass half full or half empty? You can choose your mood, and control your state of mind to improve outcomes for yourself and those around you. Is this just so much mumbo-jumbo, or is there something in it?
  • Mental health in 2011: challenges and opportunities

    After a year of political and policy change in 2010, the New Year will bring major challenges and opportunities for mental health services.
  • metamorphos-ising the metaphors

    It’s about time we moved on from the patriarchal sporting metaphors of the playing fields of Eton and got a bit more now, a bit more edgy, a bit more credit crunch.
  • Metaphor to die for

    End Game was recently reminded that sound bites can be largely catagorised into one of three broad groups:1.   The good:  “It’s the economy, stupid” - well done to Bill Clinton’s 1992 presidential campaign strategist James Carville. Jolly clever. 2.   The bad: remember Nick Clegg claiming his Liberal Democrats were on the side of “Alarm clock Britain”? Must try harder.  3.   The ugly: Gordon Brown’s borderline-unsayable clunker “the change we choose” from his 2009 Labour
  • Mid Staffs shows a foundation trust can go bust

    Is it possible for trusts provide excellent care while staying within budget?
  • Middle managers need to stir it up

    Team leaders should be the ones agitating for radical change
  • Military-style leadership doesn't suit the public sector

    Why the armed forces’ show of force leadership style is the wrong type for the NHS and local government.
  • Minimum waiting times, and hopelessness

    The Co-operation and Competition Panel report that minimum waiting times are widespread. Why are minimum waits the wrong approach? And what is realistic?
  • Minister for innuendo

    End Game was saddened – well, ruddy gutted if we’re honest – to learn of the departure of Anna Soubry from our lives.After just a year of saying whatever came into her head about public health, prime minister David Cameron was so impressed that he moved her to the even more sensitive defence beat.One Department of Health source thinks she will be just fine, imagining Ms Soubry enjoying photocalls in which she is surrounded by “hunky sailors and soldiers”.End Game believes
  • Minister for modesty

    Dan Poulter, the
  • Ministerial pedigree

    End Game was impressed to discover that Norman Lamb is a descendent of the painter Henry Lamb, who was part of Sickert’s Camden Town group of post-impressionists.Thanks to a parliamentary question, we now know that the care services minister has a few of his ancestor’s works up on the wall of his Department of Health office.And it seems his ministerial colleagues
  • Ministry of Truth

    End Game is a passionate advocate of grown up debate, so of course we welcome any a ministerial letter that begins with the words, “I am very sorry”.The penitent in question was Dan Poulter, who was appealing to shadow health minister Liz Kendall for forgiveness regarding “inaccuracies” in answers to two of her parliamentary questions.These mishaps included getting financial information wrong by a factor of a thousand, and supplying incorrect information about the NHS England wo
  • Mob-ilising for great care

    What’s in a name? End Game ponders not the name a celebrity might give their first born child – that’s way too easy. The name is selected to attract the most tabloid column inches.No, End Game is contemplating, not for the first time, the meaning of the names given to NHS initiatives, and, more specifically, how on earth commissioners in Peterborough have contrived to make a community care project sound like some sort of sinister Mafia-style collective of thugs and hit men.The p
  • Money can't buy an all-star team

    High-performing teams are rarely created but they evolve when all memebrs share responsibility, support their colleagyes and take it in turns to lead
  • Monitor on the move

    Word reaches End Game that everyone’s favourite NHS economic regulator is vacating its Westminster premises.Apparently Monitor is moving everyone out of their Matthew Parker Street headquarters and into its other central London abode in Waterloo.That leaves a prime bit of central London office space empty - but this situation will not be the case for long, we learn.No sooner has one band of male-dominated competition hawks packed their briefcases and free marketed away ac
  • Monitor's new home

    Monitor! Dynamic, inspiring and unleashing the invisible golden hand of the market into fusty old healthcare!End Game’s favourite disruptive innovators have now largely moved from boring, civil servant-ridden Westminster to energetic, mould-breaking Waterloo.Round the back of the Old Vic and opposite a soup kitchen on Webber Street, since you ask.But now the sector regulator needs an eye-catching atrium to inspire the consultants and, in particular, the doing-their-best N
  • Monitor-vember

    End Game has little interest in charity, so don’t try it on.But we were forced admit that Monitor press officer Sonya Cullington brightened up what may otherwise have risked being a turgid morning press conference about the regulator’s review of walk-in centre closures by wearing a moustache.What japes! It was in aid of “Movember” which, to explain for fellow misers, is a cultural phenomenon which seems to come round earlier every year, where people grow moustaches during Novemb
  • Moore confusion over women at the top

    Sir David Nicholson’s resignation (as exclusively revealed by HSJ - you’re very welcome) sparked a predictable frenzy of bile, praise and speculation about who will replace the big beast.While health select committee head honcho Stephen Dorrell has no jurisdiction over the selecting the new Commandant, his choice would at the very least, be an interesting addition to the debate.But if he is asked on national television to opine on the matter, let’s hope he avoids a name mix-up s
  • Moral question

    We at End Game regularly have our morals called into question, but rarely are we brazenly flirted with by interviewees.No longer: a nursing director – who on balance we have decided not to identify – signed off a an otherwise run-of-the-mill chat with the mother of all non-sequiturs, by asking End Game whether we were, in fact, a “naughty boy”.Days later, and after many hours spent in a dark room with a cold towel applied to the head, we can finally just about muster a response.
  • More lessons from the banking sector

    Once again we have another fascinating story about the near-collapse of a bank, with the lessons again providing sound leadership learning for NHS corporate bodies.
  • More management, less leadership please

    Not everyone can be a leader but many more can be managers and take greater control of organisational life around them.
  • More NHS related cakes

    After the extraordinary “Bristol stool tart”, End Game is delighted to learn that that more clinicians have decided to express their love for their jobs through the medium of cake.Members of the Royal College of Midwives have done themselves proud (and End Game a favour) by producing a breathtaking array of birthing-related cakes.Visit their Faceboo
  • More Perspiration than Inspiration

    We are entering a different phase of NHS management that to be successful will have to be characterised by a stronger emphasis on management than leadership, more process and communication, and more perspiration than inspiration.
  • More than tea and sympathy

    It’s not just tea and sympathy that’s on offer. Advocacy, empowerment, peer-to-peer support are all available at WRVS’ hospital cafés.
  • More waiting list patients frozen in time

    There is something strange about the orthopaedic waiting list in Salisbury.
  • Motivation is needed to see clinical commissioning succeed

    Many aspects of the Health and Social Care Bill have given rise to heated debate, but one of the most controversial has been the question of whether GPs should have formal statutory responsibility for commissioning.
  • MP for barnet

    Never let it be said that politicians don’t do anything during their endless summer breaks. Those attending the Liberal Democrat conference noticed that care services minister Norman Lamb has been very busy in recent weeks growing his barnet.Regular readers will doubtless remember that about a year ago End Game compared Mr Lamb’s face to the one belonging to romcom-monger Richard Curtis, because they looked quite similar, and both were topped with a choppy crop of silvery-grey hair.
  • MPs and the EU elections- could someone get serious?

    Local and EU elections are being held on the 4th of June - but where are the manifestos dealing with important health or other issues? All political life seems to be handled the same way as strategy appears to be managed in the NHS, by political soundbite.
  • Mugging for the audience

    End Game is something of an NHS England board meeting groupie, and thoroughly enjoys travelling the length and breadth of the country so we can watch our heroes being all transparent and yet eerily in agreement about everything.But apart from total consensus on issues of policy, there is another constant at these meetings, wherever they take place: Sir David Nicholson always drinks from a Nottingham Forest mug.We wondered whether that meant he had a different mug waiting at ever
  • Mutual appreciation society

    Mutualism is the latest public sector reform craze, with all three parties talking it up. Could it work in healthcare?
  • My own experience of a report 'cover up'

    I was told my report identifying serious concerns at one organisation could not be made public
  • My trusty little revenue raiser

    End Game is all for NHS hospitals diversifying as the squeeze on their traditional sources of income continues, but we’re starting to wonder just how far this is going to go.In a flurry of entrepreneurialism, Salisbury Foundation Trust has launched a line of moisturising creams, based on one used by the trust to help burns victims.“My Trusty Little Sunflower Cream” hit the market on April 12. It contains five per cent pure sunflower oil and no “parabens” – both attractive featur
  • National recognition for NHS individual - for the right reasons

    Not that many people in the NHS have gained national recognition this year for positive reasons.
  • Negative adjustments

    It looks like the Treasury are gearing up to remove funding for depreciation costs and capital charges from departmental budgets.
  • Net Health

    Dave West is HSJ’s acute care reporter.
  • Networking

    How effective are you at networking? Do you get the best out of it, and do you know what works best?
  • Never miss a minister's verbal gymnastics

    Is your life being ruined by missing health related items from the Today programme? Then I have the gadget for you.
  • New English waiting list data: view the interactive maps

    Where are the longest waits? What are waiting times like in your local NHS? How difficult is the new waiting time target? Here are some maps to help you find the answers.
  • New inflation forecasts imply NHS funding cut

    When the spending review was announced in October, the NHS budget faired reasonably well in comparison with other departments, with a real-terms increase of just under 0.1 per cent per year.
  • New record best for one-year-waiters (now let's go for zero)

    A fantastic result on one-year waiters: come on, let’s get them down to zero. Otherwise, everything on waiting times is pretty much treading water.
  • New target, new perversity

    The new RTT waiting times target is very welcome, but it brings new dangers of its own: distortion of clinical priorities, and hidden waiting lists.
  • New year, time to get a new job?

    Seeeking feedback and reacting to it is now an important aspect of senior management
  • News you can confuse

    The appointment of Simon Stevens as NHS England chief executive was greeted with near-ubiquitous ecstasy in health policy world.However the mainstream media was more circumspect, perhaps unsure as to whether to paint him as modernising visionary or private sector villain.Thank goodness then for Top News, the international English language service, who knew exactly what to do with the announcement.They proclaimed: “Sir David Nicholson to be
  • NHS and Health Management News Blog

    Health management and policy news for NHS and independent sector health managers
  • NHS chief executive PA recognised in annual awards

    You may remember a few weeks ago that Christopher Juliff, PA to the NHS chief executive, was shortlisted for Hays and The Times PA of the Year 2011.
  • NHS consolidates its position on waiting times

    The NHS consolidated its position on waiting times, following the first ever achievement of all three 18-week targets in January. The number waiting over a year improved slightly, but is still too high.
  • NHS England's self fulfilling policy

    We at End Game know you’re terribly busy and don’t always have as much time as you would like to leaf through the latest 25 page drone-fest from NHS England.So we do it for you – and we were pleasantly surprised to find a little light relief tucked away in the mothership’s corporate governance framework.Amid the usual worthy but mirthless fare was a section on policies – NHS England has some, we
  • NHS England's Twitter handle tangle

    Jubilation rang out from Quarry House in the week before Easter as the government announced (curiously, in its response to the Francis report), that the NHS Commissioning Board would be allowed to drop its yawn-inducing title and be known henceforth as NHS England.Those running the self-described “biggest quango in the sky” – or at least the more trendy among them – hope that, now the organisation’s title includes no tedious description of what its actual function is, members of the pu
  • NHS enterprise has been given a freer rein

    Absurd restrictions on FT income have at last been lifted
  • NHS History Blog

    Geoffrey Rivett is vice-chair of the governors of Homerton foundation trust and author of From Cradle to Grave: fifty years of the NHS.
  • NHS holds the line on 18 weeks

    Small improvements meant new record-bests for long-waiters in November.
  • NHS leaders of the future: more Thatcher or Nyborg?

    NHS leaders could do worse than taking notes from Borgen prime minister Birgitte Nyborg on building alliances with others and finding unlikely common causes, says Chris Ham
  • NHS management vs NHS leadership

    Management is often based on the response to yesterday’s questions and whilst some of the responses remain valid for the here and now a good many do not, they are out of date and little is achieved by walking backwards.
  • NHS news blog: Alan Johnson launches new rules on patient involvement

    Health secretary Alan Johnson has announced a series of policies to help avoid more NHS services falling to the “appalling” standards exposed at Mid Staffordshire foundation trust.Providers will have to publish the number of complaints they get and an annual statement on how they are involving patients and the public in improving services.The government outlined the measures in response to reports by national emergency care director Sir George Alber
  • NHS news blog: Baby P case 'hitting recruitment'

    BBC: Baby P case is making it harder to recruit social workers
  • NHS news blog: Baby P review reveals 'systemic failings' in NHS

    Trusts have been urged to ensure they are meeting child protection standards in a report revealing “systemic failings” in the NHS’s treatment of Baby Peter.
  • NHS news blog: Care Quality Commission completes its management team

    The Care Quality Commission has filled the remaining director posts on its senior management team. The new appointments are:David Johnstone, director of operationsKylie Kendrick, director of organisation development and human resourcesJohn Lappin, director of finance and corporate servicesDirector of operations David Johnstone has been executive director of adult and community services at Devon co
  • NHS news blog: Care Quality Commission will 'do a number' on weakest NHS performers

    The chair of the Care Quality Commission has pledged to get tough with NHS and social care organisations languishing in the bottom 10 per cent of performance tables.
  • NHS news blog: Careless disposal of confidential data is on the rise, says study

    Guardian: Careless disposal of confidential data is on the rise, says study
  • NHS news blog: Chief executives appointed at two SHAs

    Chief executives have been appointed to West Midlands and Yorkshire and Humber strategic health authorities.City of York council chief executive Bill McCarthy will lead NHS Yorkshire and Humber, while North Lancashire primary care trust chief executive Ian Cumming will head up NHS West Midlands.Mr McCarthy, a trained economist, replaces Margaret Edwards, who left in March to lead the new NHS productivity unit.He has operated at board level in
  • NHS news blog: Chief executives picked to lead integrated Welsh NHS

    Six chief executives have been appointed to lead the NHS in Wales as it takes a further stride away from the English system.They will lead local health boards, newly merged from existing primary-focused LHBs and trusts, which run acute, community and mental health services, from October.Care provision will be merged and the internal market scrapped, with services planned by NHS Wales in collaboration with the boards.The two chief executives hired from outside W
  • NHS news blog: Confed proposes peer review to avoid Mid Staffordshire repeat

    The NHS Confederation has called on hospital trusts to invite others trusts’ directors to inspect their services to help prevent failures such as those at Mid Staffordshire foundation trust and Maidstone and Tunbridge Wells trust.The confederation has proposed a series of steps that should be take voluntarily in response to the “appalling” care at Mid
  • NHS news blog: Dental surgeries could extend opening hours

    Primary care trusts are to begin a £150m procurement process which could see dental surgeries opening outside normal hours.National director for GP and dentistry access Mike Warburton said contracts for new work should focus on quality and access rather than activity and consider extended hours. PCTs would decide what hours were appropriate.He said the money would be used for “additional procurement and new services” but did not have to involve a new building as last
  • NHS news blog: DH publishes criteria for defining failure

    NHS providers with even small deficits or which get their financial forecasting wrong risk being placed “under review” through the Department of Health’s new criteria for its failure regime.The regime – published last year and now part of the Health Bill currently going through Parliament – sets out how a failing NHS organisation would be deemed “underperforming”, triggering a process which could see them taken over and potentially broken up by the DH.The criteria is
  • NHS news blog: DH refrains from standardising patient experience

    The Department of Health will not impose standards for “real time” measurement of patients’ experience, despite pressure to use results to help identify failing trusts.Guidance will be published on the use of fast-turnaround feedback, which many hospital trusts are beginning to collect, in coming weeks.But there will be no standard collection methods, questions or measures, meaning the results cannot be used for national benchmarking, performance management or patient
  • NHS news blog: Interview - David Nicholson talks leadership

    In an exclusive interview following the first meeting of the national leadership council last week, NHS chief executive David Nicholson tells HSJ what was discussed, why the council won’t become a “dustbin” for difficult issues and why all chief executives must take responsibility for leadership.
  • NHS news blog: Mid Staffs reports - new duties on NHS to prove patient involvement

    The government has announced that NHS organisations will have to publish information that proves they are involving patients to prevent a repeat of the failures at Mid Staffordshire foundation trust.A report for the Department of Health by national director for primary care David Colin-Thomé, published today, found that a significant reason that such poor care
  • NHS news blog: Mid Staffs scandal - confed says NHS must 'put its own house in order'

    The NHS Confederation has said the NHS must “put its own house in order” in response to the failures at Mid Staffordshire foundation trust.Two reports, on the trust’s progress since the highly critical Healthcare Commission investigation and lessons for the whole NHS, were published yesterday. Health secretary Alan Johnson announced a range of measures in resp
  • NHS news blog: Monitor appoints new chief and chair to 'challenged' foundation trust

    A foundation trust has been assigned a new chief executive by Monitor for the second time in eight months.The regulator has appointed Kirsty Matthews as interim chief of the Royal National Hospital for Rheumatic Diseases foundation trust, in Bath, it announced yesterday.The regulator hired Ms Matthews as interim chair of the trust in December. Stephen Cole, who was yesterday named interim chair, was hired in December as director of corporate strategy.All the ap
  • NHS news blog: NHS culture stifling innovation, Confed warns

    The NHS is stifling innovation through an organisational culture that places barriers in the way of staff with good ideas, the NHS Confederation has warned.In a report timed to coincide with the launch by Lord Darzi of a £220m fund to boost innovation in the health service, the confederation said NHS leaders must remove the hurdles that prevent innovative practices becoming mainstream.The report on leading innovation warned the payment by results tariff is seen as a b
  • NHS news blog: NHS governance 'reduced to paper chase' - Audit Commission

    Many NHS trust board members cannot be sure whether or not their hospital is operating within the law, the Audit Commission has found.
  • NHS news blog: NHS productivity on the rise

    NHS productivity has improved, with the growth in the quality and volume of treatment now exceeding the increase in NHS funding.Figures due to be published by the Office for National Statistics later this month will show that between 2003-04 to 2007-08 productivity growth was at worst static and at best grew by as much as 1.6 per cent a year. The greatest improvement was between 2004 and 2006.Report authors Professor Andrew Street and Padraic Ward attribute the improv
  • NHS news blog: PCT poll backs Alan Johnson on swine flu pandemic

    NHS organisations are backing up health secretary Alan Johnson’s assertion this week that the UK is one of the countries most prepared to deal with a flu pandemic.As cases of swine flu were confirmed in the UK, an HSJ straw poll of 15 primary care trusts this week revealed that, as required, all had plans in place to co-ordinate with councils, acute trusts and strategic health authorities, to communicate with the public and local businesses, to mobilise GPs and to distribute
  • NHS news blog: PCTs may face tests on financial competence

    A financial competence test could be reintroduced in next year’s round of world class commissioning competency assessments.Other changes on the cards include “tweaking” the definitions of tasks in the programme and moving panel assessments to April and May – traditionally a quieter time for primary care trusts.NHS Confederation PCT network director David Stout said the Department of Health was considering “introducing an actual measure of financial competence along wi
  • NHS news blog: PCTs spent £8.2m on suspended GPs in three years

    Primary care trusts have spent at least £8.2m over the last three years paying 134 GPs who were suspended pending investigations into complaints about their conduct.
  • NHS news blog: Plan to boost NHS purchasing power

    FT: Plan to boost NHS purchasing power
  • NHS news blog: Rising patient choice fails to improve NHS quality standards

    One year after the introduction of free choice, early trends suggest some patients are using choice - but it is not yet driving up standards in hospitals.HSJ and the Picker Institute analysed hospital episode statistic data supplied by the NHS Information Centre for the first three quarters of 2008-09 and for all of 2006-07 for 66 primary care trusts.Of the PCT results scrutinised, 11 had recorded a greater than 10 per cent change in the percentage of GP referrals going
  • NHS news blog: SHA chief appointed as national flu director

    North East strategic health authority chief executive Ian Dalton has been appointed to the new position of national director for NHS flu resilience.The appointment is a secondment from his position at the SHA, which will be temporarily filled by its director of finance and communications David Stout.Mr Dalton will report directly to NHS chief executive David Nicholson.
  • NHS news blog: Surge in women consuming harmful amounts of alcohol

    Guardian: Surge in women consuming harmful amounts of alcohol
  • NHS targets: from compliance to commitment

    The NHS is moving away from the “compliance” system of top-down national targets and standards. What should it be replaced with?
  • NHS underperformers: shape up or ship out

    I am not an ogre, I am not particularly harsh, I do not consider myself to be radical and I am not trying to be deliberately provocative but I do think that saying there will be no reduction in jobs is at best short sighted and at worst a lie.
  • Nick Clegg or Nigel Farage: who should NHS leaders model themselves on?

    NHS leaders need to decide whether to focus on what is in the best interests of their organisations, or be willing to share sovereignty and work with others.
  • Nightmare on Harley Street

    Unedifying news reaches End Game from Harley Street.It appears that the illustrious London thoroughfare has been the site of some rather unsavoury discoveries. The street is home to an array of medical clinics famous for charging loads of money to rich people who are unable to confront their own mortality to make them look weird and old rather than just old… er, we mean high quality private practices of international standing.Anyway, Westminster City Council reports that they ha
  • No blame − the NHS's the gain

    The Berwick reviews says the NHS should have a learning, no blame culture. But what would that look like?
  • No cause for alarm

    At last month’s NHS England board meeting chief nursing officer Jane Cummings seemed surprised by the dramatic response her talk on compassionate care received.As she settled in to her subject - the six Cs to help create a culture of compassion among nurses and midwives - a fire alarm cut her off mid-flow.Ms Cummings said this was the first time she had received such a strong response to anything she had to say.The raucous laughter following this statement did require som
  • No one can provide quality care in 15 minutes

    The increasing use of “pop in” calls by social services departments will make people who need care even more vulnerable
  • 'No other nation has had the chance to refashion its hospitals so comprehensively'

    The Hospital Plan will determine for many years to come the broad lines of development of the hospital service.
  • No U in team

    You don’t have to be a cricket fan to recognise the situation: your best player - who thinks he can do a better job of running the team - is bad mouthing you and his team mates to the opposition. Clearly this is not good for team spirit. However it is not unusual in sport - or in the office.
  • Non-geographically defined consortia: Further details

    GP practices in a significant minority of areas are forming groups with non-neighbouring practices. In some of those, data suggests one group is formed from better performing and/or less deprived practices.
  • Non-PC robots versus man

    Ever since Prometheus stole fire from the gods, the humble human was suffered at the hand of technology as much as she has benefitted from it.The most recent example of this ancient truth was unearthed in Northampton.Local paper Northampton Chronicle wins an EndGame applause for a story on how cuts to a mental health trust would hit patients.But the accompanying article entitled “The Seven Craziest Mental Diseases”? Not so much.The blame for such poor placing can b
  • Not sleeping your way to the top

    Separating fact from fiction about senior managers and their lives away from work
  • Not smelling of roses

    Quelle surprise - a political decision
  • Nuffield Trust website relaunches

    The think tank relaunches its website and adds new tools for the online audience.
  • number crunching leadership

    Leading and managing by numbers - or how to find a set of theories, skills, disciplines, habits or principles to fit whatever your burning issue is today.
  • Nursing, society and older people

    The argument about whether nursing should be a degree-based profession is merely a displacement activity. The real issue is about the link between nurse training and how society wants its older citizens to be cared for.
  • Obama's political leadership lesson

    So here we are just after a year in office and Barack Obama has pushed through a major piece of domestic policy. However, it is not solely an achievement in social domestic policy but just as importantly, a lesson in political leadership and management.
  • Off the hook on targets?

    Targets and top-down management are out, so are failing trusts now off the hook?
  • Olympic Legacy

    As Danny Boyle has higlighted, the NHS is one of our great institutions, one to be out centre stage as we open the Olympics. So much great effort and focus is going into the preparation and smooth running of the Olympics and the health response. Let us ensure that there is a lasting legacy within organisations - through great operational performance; for our staff and the public at large through the positive impact of exercise, great personal performance and the benefits of team work. The Olympi
  • On a mission to get tomorrow’s ideas today

    HSJ has joined 20 of the UK’s brightest entrepreneur-led companies on the Future Health Mission to Boston
  • On Arctic marathons and large scale change

    Training to run an Arctic marathon has made me reflect on the psychology of large scale change.
  • On being fierce

    The culture of an organisation is not nebulous. I am the culture. You are the culture.
  • On coaching and interference

    I’m part way through a coaching qualification. I’m learning a lot about others, but a whole lot more about myself! I’m not going to get into definitions of coaching, counselling and mentoring (that’s another whole blog on its own) but one of the fundamentals is that the agenda needs to be led by the coachee (the person being coached, for the uninitiated).
  • On organising to change the world: from Californian farm workers to Obama’s election campaign to NHS transformation - Part one

    The ideas of Marshall Ganz, Harvard academic, community organiser and unofficial “Mobiliser-in-Chief” for Obama’s election campaign, offer some poweful perspectives for NHS leaders.
  • On organising to change the world: from Californian farm workers to Obama’s election campaign to NHS transformation: part two

    The wisdom of Marshall Ganz, unofficial mobiliser-in-chief of Obama’s election campaign on how we can challenge the status quo, the vested interests and perverse incentives in the current NHS system that get in the way of delivering high quality, high value care for all.
  • On the road to Recovery

    The government made Recovery the mental health strategy’s defining goal in February - which gives mental health service providers to do something truly radical, says Sean Duggan.
  • One and twenty - a buttered scone and getting plenty: pension take up in bingo hall and tea bar

    Tackling povety in old age
  • One country, one surgeon

    A tiny Caribbean nation is looking for healthcare insights from the UK
  • One-word inspection judgments don't help anyone

    In-depth visits and constructive criticism would be more beneficial to service users and organisations
  • One-year waits race towards zero

    One year waits continue to fall sharply. 18 week waits, and the waiting list overall, are steady. Orthopaedic long-waits are deteriorating.
  • One-year-waiters: real patients or data errors?

    The dramatic reduction in one-year-waiters was more down to validation than treating real patients. But it’s essential nonetheless: there were still plenty of real patients there.
  • Only in America?

    A gunman with a psychiatric disorder took a school librarian hostage after his Medicaid cover an out.
  • Oomph!

    Everyone faces challenges. Every person, every career, every organisation, every family and every team have to overcome difficult periods; there are of course different levels of challenge but no one goes through life untested. We might not always be able to control events but we can control how we respond to them.
  • Ooooo I'm a leader!

    Whilst it might be possible to hide poor leadership in good times, it is less possible when times are hard. When the pressure isn’t on people can get away with a certain amount of incompetence or bumbling, when the pressure is on there should be no room for incompetence or bumbling.
  • Open sesame

    Among the few perks of being a hack is being able to stumble into various events, often late and smelling of last night’s indulgences, mumbling the word “press” and watching the doors magically open.We’re like modern day Ali Babas, but without the cave full of treasure.But the old “open sesame” trick wasn’t working at the Commissioning Show this week as End Game found itself stuck outside a talk by NHS England bigwig Tim Kelsey with the rest of the disgruntled hoi polloi.
  • Open, Honest and Transparent

    So how should managers behave in an organisation which aspires o be open ,honest and transparent
  • Orthopaedics scrapes inside waiting target for first time

    Long waits are down again, but the total number waiting is a bit higher than usual. This will become worrying, if it carries on.
  • Outpatient waits take the pain in Scotland

    Scotland does well against its two main waiting times targets. So why are outpatient waits soaring?
  • Parity of esteem

    The draft NHS Mandate will require the Commissioning Board to take steps to bring mental health on a par with physical health.
  • Parliamentary cycle

    End Game was pleased to see care and support minister Norman Lamb having such a lovely time in his constituency, modelling this weird bike/cross trainer hybrid.But we couldn’t help but notice that the machine was static. Should we take pedalling furiously and going absolutely nowhere as a visual metaphor for being in government?
  • Particularly pleasing

    The Sunday Times list of the most influential and inspiring people in healthcare, compiled in partnership with Debrett’s People of Today, made for interesting reading, we thought.There were a few notable absences from the list selected by an “expert panel”, with neither the current nor incoming chief executives of NHS England thought sufficiently influential to merit inclusion.End Game concedes such orthodox establishment choices would be far too obvious and sa
  • Partnerships - the Emperor's new clothes

    What cost partnerships? Will the Tories bite the bullet and save us a bundle?
  • Partnerships can make or break a provider

    There are no ideal partners in business.
  • Party time

    Special End Game love goes to the comms firm which got in early with our first Christmas party invitation this year. In the seasonal spirit of goodwill, we won’t name it.Their bash takes place on 26 November – for those of you who are no good at maths, that’s very nearly a full month before Christmas Day.We appreciate that by the time advent actually starts everyone is horrendously, joylessly busy, and venue hire prices go through the roof. So we salute this canny band of PR fol
  • Passion runneth over in the job search

    Employers have devalued passion as a word for describing how we feel about work.
  • Patients vs the business case

    The NHS is not subject to local democratic accountability. If you want to have more say in what happens to your local hospital maybe you should advocate a transfer to local government
  • Pausing for effect: clock pauses and waiting times targets

    Clock pauses - they don't make a massive difference to waiting times. Do they? Um, perhaps you'd better sit down...
  • PbR: A target by any other name...

    PbR as an abbreviation now lends itself to a much clearer redefinition for the providers of healthcare services in NHS England – ‘Patients bring Revenue’.
  • PCT fall guys

    PCTs are in the frame again - this time Dame Barbara Hakin warns GP consortia not to turn to them for support, highlighting other options available to them. How does this feel if you work in a PCT?
  • PCTs: forgotten forever?

    End Game firmly believes that just because primary care trusts were bloodily sacrificed on the altar of clinical commissioning that doesn’t mean they should be forgotten.So we put in a Freedom of Information request to the Department of Health asking how PCTs performed on their final year of quality, innovation productivity and prevention savings. QIPP has always been centrally reported, so we thought the department would probably have a fairly good idea of how they got on.Nope!
  • 'Pensioner crime wave challenges public sector leaders'

    Where life means life, in the USA, the problem of elderly prisoners has been around for a long time but it is a relatively new feature of British prisons.
  • Pensions propaganda?

    The government says many public sector workers will be better off under the changes to the pension scheme. How does this apply to the average NHS employee?
  • Personal health records continued

    Following my frustrated experiments with personal health records last week, a south London GP has drawn my attention to another option.
  • Personal Impact

    Self awareness and personal impact are hugely important, we must not underestimate this.
  • Pestilence and the art of public relations

    Heatherwood and Wexham Park Foundation Trust’s public relations people got in touch today to inform us that the trust “takes the issue of pest control very seriously”. Fantastic! Because so many other trusts treat pestilence as a great big giggle.“Any large organisation, including hospitals, will experience infestations on occasions, and, like every responsible organisation across the country, this trust takes an extremely active approach to pest control.”A quick Google n
  • PFI for an eye?

    It is, of course, not for HSJ to speculate why a months old PFI story appeared so prominently in the quality press yesterday.
  • Plan B - or not plan B?

    What happens if your department doesn’t make the savings?
  • Playing to the whistle?

    Are whistleblowers good people trying to do the right thing or are they persuing their own agenda, just trying to get someone else into trouble because they don’t like them or want their job?
  • PMQs and the truth about waiting times

    David Cameron and Ed Miliband traded waiting time statistics over the dispatch box today. Who was right?
  • Pointing the finger

    Pointing the finger of blame at one individual is often convenient for a lot or people, but
  • Pointing the finger of blame for A&E delays

    Waiting to be treated at A&E is no laughing matter. But there’s not much else you can do while someone gets their fingernail seen to.
  • Politicians want to slay the beast that never was

    MPs bashing the NHS is about softening up the public for the Americanisation of services
  • Politics and satisfaction with the NHS

    To say the NHS is political is to state the obvious. But are the public’s views about the NHS shaped by, or linked to, identification with political parties?
  • Politics and the English language

    End Game has been a fan of minister for laughs Anna Soubry maverick style ever since she arrived at Richmond House.She’s a street walking cheetah with a heart full of napalm and she’s peppered her latest interview with hearty profanity.Limbering up, she declared a builder’s sign to be “fucking useless” and said the minister for public health “bloody well” wasn’t the “girly option”.All pretty standard pub vulgarity so far but Soubs is a moderniser, always looking to innova
  • Politics reopens the age-old leadership question

    What a fascinating week for politics and leadership with the leaders’ debate at the centre of the age-old question whether leadership is about personality or substance.
  • Polyoaks - can Radio 4 out-absurd the current reforms?

    The NHS is to be lampooned next month in a new Radio 4 satirical comedy co-written by Dr Phil Hammond.
  • Poor elderly care is more than circumstantial

    Addressing problems in care standards starts with changing the group mentality.
  • Post-budget confidence

    Phew, that was close.
  • Power games

    End Game has learned Sir David Nicholson has been broadening his cultural horizons as his period in charge of NHS England draws to a close.In recent weeks the big beast has apparently been absorbed in Game of Thrones, the glossy American fantasy TV series.The show has been described as “The Sopranos in Middle-Earth”, and mixes swords and sorcery bombast with political intrigue and violent dynastic power struggles. On average 14 characters die per episode, and t
  • Powerpoint presentations

    “Beware of anyone who says that they're "just going to talk to some slides" - because that's exactly what they'll do - without realising that they're spending most of their time with their backs to the audience.” So says Max Atkinson, author of “Speech making and Presentations made easy”, in BBC news Magazine on 19th August.
  • Pre-Budget predictions

    It’s dangerous I know, but I’m going to stick my neck out and make my Big Budget Prediction for 2009: Alistair Darling will use the term “confidence”, oh, let’s say, at least five times. Hmm, maybe I should hedge this a bit. Alistair Darling, or someone else from government, or a prominent Labour MP, will make prolific use of the C-word.
  • Preferred provider – the saga continues

    Preferred Provider - the saga continues
  • Preparing to roar like lions

    Preparing evidence for the DH’s Co-Operation and Competition Panel
  • Pressure? Andrew 'Chopper' Lansley isn't feeling it

    Andrew Lansley might have News International to thank for a relatively pressure-free few days - he certainly didn’t appear to be unduly worried during his latest press spot.

    What does PRINCE2 mean to you?
  • Prioritising mental health commissioning is brave, but it's also sensible

    The decision to focus on mental health care, as Brighton GPs are doing, is indeed a brave one. But it is also one that makes a lot of business sense for any GP consortium, big or small, urban or rural, anywhere in England.
  • Prior's biggest fan

    End Game always loves an opportunity to interrogate the Care Quality Commission and we had a particularly nasty question waiting to lob in the direction of its chair at an improving patient care conference last month.However, following his speech on the commission’s new inspection regime David Prior made a swift exit before questions could be taken from the floor.The move clearly didn’t enamour Mr Prior to at least one other conference speaker.Sheldon Stone, a consultant
  • Private good, public bad, not for profit better

    Combine the business know-how of the private sector with the social ethos of the public sector
  • Profit and loss in the 'new' public sector

    It is very clear now that the new public sector is going to look very different to the old public sector.
  • Profound disappointment

    HSJ hacks were eagerly awaiting the final version of guidance on safe staffing levels from the chief nursing officer and the National Quality Board, despite obtaining a draft almost a week before publication.You see, the leaked version ended with a tantalising question from one anonymous editor: “Do we need to close with any profound statements/message?”Yes, as it turned out - the final version had a 200 plus word concluding paragraph bolted onto the end.So what
  • Proper tea is theft

    End Game fans will remember, perhaps with a nostalgic chuckle, that a few months ago we exclusively revealed that Sir David Nicholson takes a Nottingham Forest mug on tour with him.The famous mug, in its new home at the HSJ nationa
  • Protecting the NHS brand or devaluing it?

    Sir David Nicholson has had to defend the role of the NHS’s new “head of brand”
  • Public health inside and outside of the School

    I like taking stairs, but must admit to having had second thoughts when I heard my office was on on the 11th floor. But then, a voice inside (that I wish I hadn’t heard) reminded me that the ground floor is already counted as the 1st floor in the US. That’s one less floor to worry about.
  • Pure froth

    “Imagine a world where our health literacy matched our coffee literacy.” So tweeted Johnny Marshall, the NHS Confederation policy director and all round jolly good egg, linking to piece he’d written for the BBC.The gist of Mr Marshall’s argument was that patients should be treated more like customers and if they complain people should listen to them.In Johnny’s local cafe, if your drink isn’t perfect, the barista will make
  • Push yourself to succeed, don't wait for someone to push you

    Until you try you don’t always know what you are capable of achieving.
  • Putting on wait: English waiting list looking big

    Some waiting times figures got a bit better in December, some a bit worse. But the size of the waiting list is starting to look worryingly big.
  • Putting the trust in technology

    The health service has a reputation – though perhaps not entirely warranted – for looking fondly to the past, particularly at times of great change.
  • Questionable aroma

    Hearty End Game congratulations go to the team of volunteers who achieved a “professional relaxation qualification” via George Eliot Hospitals Trust.A graduation ceremony took place in February to recognise the team, who work on the trust’s Oasis Project, all of whom received an A grade in the diploma assessments.The project is intended to help patients relax ahead of a stressful medical or surgical procedure, through creating a “calm, tranquil environment away from the clinical
  • Real terms cuts of 2.3% a year from 2011 onwards?

    Just got back from the Institute for Fiscal Studies’ annual post-budget briefing. Scary stuff… They reckon real terms cuts of 2.3% a year are looming
  • Reconfigure It Out

    Ben Clover is an HSJ reconfiguration reporter.
  • Record breaking rise in English waiting list

    The English waiting list got much bigger again in April. There will be trouble.
  • Reforming the funding of long term care in the US

    The US is not that different from Europe in the funding of long term care but urgent reform is needed.
  • Reforms offer best chance to change managerial culture

    The Coalition's proposed reforms offer the best opportunity to change the managerial culture of the NHS but more so for providers than commissioners. Strengthening local leadership will always be limited because of the strong history of hierarchical management overlaid by political control.
  • Replacing the 'irreplaceable'

    If no one is indispensable, it is still vital an individual’s unique qualities are fully recognised to continue developing a strong staff, and an improving work ethic.
  • Resources for transformation are abundant, even in an era of austerity

    Social movement leaders typically don’t have the economic resources of conventional leaders so they have to grow their own
  • Retiring leadership

    As a senior clinician approaches retirement, colleagues arrange little or even large gatherings to mark the occasion.
  • Revolutionary measures

    NHS England last week trumpeted that it had “launched a package of revolutionary measures to ensure the voices of patients, their carers and the public are at the centre of healthcare services”.“Transforming participation in health and care,” the media release continued, “is online guidance to commissioners that aims to put people in control of their own health and care.”Note to NHS England’s over excited spinners: there are precious few circumstances when it is acceptable to ca
  • Rite of passage

    Congratulations to Julian Hartley, formerly of the NHS Improving Quality parish, on getting a real job as chief executive of Leeds Teaching Hospitals Trust, where he began work on 14 October.As if the trust’s challenges – ahem, opportunities – were not sufficient, Mr Hartley received a baptism of fire when, on the very same day, a newly engorged Care Quality Commission inspection team arrived en masse.Reports that, on being told of the inspectors’ arrival, Mr Hartley believed he
  • Running prize

    End Game was delighted to see the famous runner Clive Peedell at the recent HSJ Efficiency Awards in London.He was being honoured with a gong for devising a time-saving route from Nye Bevan’s birthplace to Jeremy Hunt’s constituency (or something). Inevitably, the co-leader of the National Health Action Party, who moonlights as a consultant oncologist, is too dynamic an individual to have shambled up to the stage to collect his gong like everyone else.So when his name was called
  • 'Safe and secure housing is critical to the wellbeing of mental health patients'

    Housing needs for patients with mental health need to be properly addressed in order to improve mental health services and individuals’ health.
  • Same circus different clowns

    Organisation Change fatigue leaves staff exhausted, burnt out, cynical and ineffective
  • Sandbags, dredging and waiting times forecasts

    What can the NHS learn from the Environment Agency’s management of flood risk?
  • Say no to 'yes' men and women

    As the Liberal Democrat conference draws to a close, opposition ministers have again targeted Nick Clegg for reneging on party policies and ‘selling out’ in forming the Tory-Lib Dem coalition. Can he ever be more than a “yes man”?
  • Scandinavian cool

    End Game was delighted to receive an email from some agency or another on the state of the technology market on the continent.“Swedish enterprises are cautiously optimistic about their ICT spending”, thundered the headline.End Game was humbled by how utterly reasonable the sentiment was, and wonders whether there might be lessons here for the NHS. We certainly can’t remember a time when anyone in our health service was “cautiously optimistic” about anything, and certainly not IC
  • Scents and sensibility

    End Game has a wide range of interests, but normally we draw the line at cosmetics, so when a perfumer sent in a press release about some new smells they’ve made, we were all about hit “delete” without further thought.But just before we did, we got a whiff of something rather more tasty.It turns out that pong-mongers Ashleigh & Burwood have managed to represent Westminster using only scent.The blurb says: “Imagine yourself amongst the historical seats of Parliament wi
  • Scotland slips on outpatient waits

    Scotland is slipping badly on its least-enforced waiting times target. It’s not looking good for the most enforced one either.
  • Scotland's backlog still growing

    Scotland is growing a waiting list backlog, despite the new RTT waiting times target. Will the new Treatment Time Guarantee solve the problem?
  • Scotland's treatment time guarantee shows results

    Scotland’s inpatient and daycase waits, which are subject to a legally binding target, improved. Outpatient waits, which aren’t, didn’t.
  • Scotland's waiting times slide again

    Scotland’s long waits are worse again, though you wouldn’t know it from the media coverage.
  • Scottish waiting times still worsening

    Waiting times are getting worse in Scotland, but you wouldn’t know it from the government’s press release.
  • Seagull strife

    To North Bristol Trust, where the move into the new £430m private finance initiative hospital has for the most part gone smoothly.However, the state of the art new building has fallen victim to one act of nature which End Game imagines did not appear on any risk register prior to the move – mating seagulls.The Bristol Post reports that male birds have
  • Securing equal mental health investment is still a big task

    The Health and Social Care Act earlier this year included a new requirement on the secretary of state for health to give equal prominence to physical and mental health. This week, a report published by the LSE has reminded us of quite how big a task this is.
  • Seddon joins the Downing Street inner Circle

    End Game’s congratulations to Nick Seddon, who has been propelled from introspective think-tankery as the deputy director of Reform, to the heady position of advisor on health and social care policy to the prime minister.Mr Seddon – a former communications director for private health provider Circle – is media savvy.We are already enjoying his work – including this rather matter of fact retort in a newspaper piece highlighting some of his past comments about the NHS (extend char
  • Self Coaching - is it possible?

    Exploring the value of self coaching and whether it is a substitute for one to one coaching, and the support of a coaching style of management
  • Senior management was ‘incompetent and reckless’

    Blair McPherson on how we should judge managers
  • Senior managers need to get 'hands on' with customers

    Organisations need to return to the days without layers of middlemen when dealing with customers if they are to ensure their services are running properly.
  • Sex, gardening and leadership

    We can all articulate what we consider to be the essential characteristics of exemplary leaders; I am sure there would be some variation but I am equally sure that the similarities would beconsiderable.
  • Shakin' Simon

    Simon Stevens’ arrival at NHS England has been marked, in what is becoming the conventional fashion, by an unfunny Twitter spoof account.Twitter fans may be aware that previous attempts to caricature Mr Stevens’ predecessor, Sir David Nicholson, rapidly ran out of puff and were nothing like as bonkers as Sir David himself.The comic conceit this time is that the soon to be NHS chief executive shares a surname with Shakin’ Stevens, the ultra-soft retro rock ‘n’ roller who wore atr
  • Sharp increase in English waiting list

    The number of patients waiting rose sharply in March, and is now higher than in recent years and may indicate waiting time pressures to come. But bed pressures over winter do not explain all the increase
  • 'She looked like she was on a big ride at Alton Towers'

    The hospital porter was pulling the wheelchair at speed from the x-ray department to the ward. The elderly patient was tipped back in the chair, gripping the arms tightly, her face frozen in fear all she could see was the ceiling lights flashing past.
  • Should Rose Gibb be forced to pay all the legal costs?

    There was one aspect of the judgement against Rose Gibb that was harsh.
  • Should we eradicate dyslexia?

    There are some highly successful and influential people who have dyslexia, and some might argue that it is this that has given them the abilities they needed to succeed. What are the positive aspects?
  • Sir David's leaving do

    Sir David Nicholson is now enough of an adopted southerner to have had his farewell drinks reception at St Thomas’s Hospital this week, and we made it onto the guest list.That means we were treated to canapés and free drinks – including some presumably ironic bottles of London Pride. We were also subjected to a stupefyingly loud performance by a jazz combo featuring NHS England’s Tim Kelsey on bass and Roger Taylor from Dr Foster on keyboards.Four of the five health secretaries
  • Six pack sensation

    Three health secretaries turned up to the farewell bash of outgoing NHS Confederation chief executive Mike Farrar just before Christmas. Jeremy Hunt was joined by Alan Milburn and Patricia Hewitt – the former two spending at least 20 minutes locked in animated private conversation.Mr Farrar’s distinguished contribution to the NHS was praised at length by NHS England chief executive Sir David Nicholson. However, he was horrified that the former SHA chief executive and DH mandarin had pa
  • Sixty per cent guff

    The important matter of Monitor’s 2013-14 report and accounts was on the agenda at the regulator’s latest board meeting.It won’t be published until July. But it’s not surprising that the wheels have to be set in motion early when its proposed length is 86 pages.We’ll be honest - End Game’s heart sunk at the thought of having to trawl through that during our summer hols.What we didn’t expect was that Monitor’s own board would share our sentiments.“The only comment t
  • Slim pickings

    Spare a kind thought for the Trust Development Authority. Oh, go on. When news of its 70 per cent budget boost broke, it must have been greeted with glee, among its officers at least. Hotel upgrades and fine dining all round! All in the name of essential networking, of course.Now that meanie old Stevens has slammed shut the NHS England treasure chest, it was at last the TDA’s time to shine, for sure.No such luck for the hopeful gaggle, according to the latest missive from TDA ch
  • So what’s wrong with wearing a dress to work?

    Ben had since adolescence felt uncomfortable in a man’s body, so after much careful thought and counselling had decided to have a sex change.
  • Some pointers for the NHS Equality and Diversity Council

    Grand sounding equal opportunities policies and recruitment targets arrangements have not led to a scaling of the NHS’s ‘snowy white peaks’
  • Sometimes the best thing to happen to a candidate is not getting the job

    “A few questions from the panel wouldn’t pose a problem to a candidate of this calibre,” I thought. But I was wrong.
  • 'Sometimes the small has a huge impact on delivering bigger goals'

    Don’t take your eye off the ball
  • Sophisticated Simon

    By now, you should be aware that the NHS’s Lord and saviour Simon Stevens launched his descent into the NHS with an appearance on his first day in the North East of England.
  • Soubry watch

    End Game is the biggest fan of public health minister Anna Soubry and was distressed to see her dragged into controversy after attempting to make a sensible point about women doctors.The minister for shooting from the hip - as her distractors unfairly label her - got herself in trouble during a Westminster Hall debate after her Conservative colleague Anne McIntosh made some remarks about the “burden” women doctors place on the NHS when they inconveniently have babies and go part time.
  • 'Special measures' are a stick to beat trusts with

    In my experience, trying to get out of special measures is the start of reducing the quality of services
  • 'Spending on the health service was to rise to the European average'

    On 16th January 2000 Tony Blair was interviewed by Sir David Frost. In what was described as the most expensive breakfast in British history, the PM announced that spending on the health service in the UK would rise, over five years, to the European average. 
  • Spending Review conspiracies

    Has the evil Treasury swiped £2.8bn from the NHS’s 2010-11 baseline?
  • SRO for fun

    Tim Kelsey, NHS England’s director for patients and information and End Game stalwart, gave the audience at the HC 2014 conference last week a peculiar insight into the health service’s appraisal system for senior managers.He told delegates at the health IT jamboree that, as part of his appraisal, he had been asked to detail “how much [he] was contributing fun to the office”.End Game dearly hopes this was someone in the HR department’s idea of a wee jape to help staff through a
  • Stairlifts on cell block H: who cares for older prisoners?

    The photograph was of a frail man in a wheelchair handcuffed to a prison officer. The article and accompanying photograph appeared in The Guardian highlighting the problem of caring for the increasing numbers of elderly and disabled prisoners.The story focused on the comments by the hospital consultant who criticised the care provide by the prison service claiming it has severely damaged the patient’s health.Concerns over the care of elderly and disable prisoners howeve
  • Stampede for the exit

    I am one of those people who says “I told you so”. The NHS Commissioning board has identified that it is struggling to find suitable people to fill its senior vacancies and there is a risk of posts remaining vacant.The NHS reforms have so far cut 18,000 senior posts. The determination to reduce the management headcount, the uncertainty about future posts and structure, the mach
  • Startling openness from NHS England

    The latest “bulletin” for clinical commissioning groups out of the Quarry House Quango In the Sky may have been a little bit too open.NHS England’s deputy chief executive Dame Barbara Hakin, writing about patient safety, writes: “Dr Don Berwick, in his advisory role as chief inspector of hospitals, spoke at a conference in London last week on how he and a panel of experts will try to offer guidance on the next steps following Mid-Staffordshire.”Although the missive stri
  • Stirring up the multicultural melting pot

    The NHS has a duty to serve all groups and communities
  • Stock punishment

    We are pleased to report that Heatherwood Hospital’s fete went brilliantly and everyone had a jolly nice time - including Heatherwood and Wexham Park Foundation Trust chief executive Philippa Slinger.This was despite her being put in the stocks and pelted with wet sponges.End Game has decided not to worry about why the hospital had a set of stocks in the first place. But we do wonder whether being a glutton for punishment was listed as an essential skill for that role, given the
  • Stock up on painkillers. The Tories are coming.

    What will a new government mean for the health service? Hmmm, let me think….
  • Stony silence

    Savings plans! Contentious stuff! What do we cut, sorry, do more efficiently?Each year HSJ asks each of the 140 general hospital trusts in England about the size and shape of their savings programme.What, then, are we to make of our interactions with one trust that will remain nameless (not really, it’s South Tyneside Foundation Trust)?Six months after the request was made, the mystery organisation (South Tyneside Foundation Trust) has still not deigned
  • Stop looking for a quick fix from the private sector

    The government puts too much emphasis on leadership and has too much admiration for private sector management
  • Strategy is the key to provider survival

    It’s tempting to assume that surviving the economic downturn and implementation of the coalition’s health policy is the key to future provider organisational survival. Not so. It is strategy that will be the defining characteristic of provider organisations during the next decade.
  • Stress, strokes and Robin Hood

    The affects of stress on managers could have a serious impact on the NHS in future.
  • Stuck in the middle

    Being in middle management often requires evasive action to avoid friendly fire from both directions.
  • Stuff happens

    Don’t worry. Be happy. Launching ‘The Worrier’s Guide to Risk’
  • Stuff the bags

    How many calico bags does it take to make a conference?
  • Summer perils

    We despaired for so long because the sun refused to appear. Now summer’s here it’s apparent that we’d forgotten the dangers of heat waves.End Game was thinking about leaving the office and heading home, and maybe taking the children for a trip around the sun-drenched garden on the ride-on mower, when our daydream was rudely interrupted by a press release from Wales’s Abertawe Bro Morgannwg University Health Board.Dean Boyce, consultant plastic surgeon at the Welsh Centre for Bur
  • Supping with a long spoon

    A new Cabinet sub-committee will lift the barriers to third sector delivery of public services. The sector will need to learn new ways of influencing that retain its independence whilst making sure users of services and patients get the right services when and where they need them.
  • Supporting failure

    The tendency to support failure: A common theme in the health service’s ritual hand wringing about why it fails to stimulate radical changes and new market entrants. It was one inevitably raised at the Healthcare Innovation Expo this week, the bonanza of idea exchanging - and product flogging - held annualy in a shed on London’s eastern fringe.And so it was at one particular Expo break-out session that it was suggested the NHS Commissioning Board (the default home for all functions) sh
  • Survival of the fittest: will social enterprises thrive in the new world?

    How will an NHS opening up to “any qualified provider” fit into the government’s Big Society vision? King’s Fund senior research fellow Rachael Addicott looks at whether social enterprises can make the impression the government hopes for in the healthcare sector.
  • Surviving another recession

    Just as trees can be aged by their rings, people can now be aged by how many recessions they have survived.
  • Swine flu but still no flu plan! Is this World Class planning?

    Swine flu has arrived in my area! I know this because two patients, contacts with swab-proven swine flu, phoned for advice. We have received flu packs but no local plan: no instructions on managing contacts or accessing Tamiflu supplies - and no information that swine flu was around locally.
  • Tackling inequality is a forgotten priority

    A current Coronation Street storyline is ideal material for addressing racism issues in organisations
  • Taking action on workplace discrimination

    Two prominent sports commentators persistently make sexist comments to colleagues and guests off air. Why didn’t someone do something?
  • Taking the fight to bullies in the workplace

    If you need to exist in a culture of bullying until you’re able to move on elsewhere, The People Manager has some survival tips.
  • Talent Management

    How can we recruit and retain the very best people for the NHS? David Nicholson said in the foreword to “Inspiring leaders; leadership for quality” that it was imperative to align work on leadership with achievement on quality. He describes it as “Leadership with a purpose”. So how to identify and grow those leaders who will be critical in the achievement of high quality care for all?
  • Talking about talking about talking

    There was so much sense talked at the NHS England Expo, and so very much of it tweeted out by NHS England’s media team, that it’s difficult to single out highlights.But a special mention goes to the SOCIAL COMMAND CENTRE – a sinister sounding piece of apparatus which in fact commanded absolutely nothing, but did produce visualisations of information gathered from Twitter.Apparently it’s a “real time listening window”. No, it cannot literally listen to anything as it doesn’t have
  • Tantalos a l’americaine, wellness incentives and (no end to?) medical underwriting

    wellness incentives can be a useful part of prevention strategies, but proposals in the current health reform bills threaten to undermine affordability of care
  • Ta-ra Farrar

    Joint ventures are soon to be all the rage, we hear.And innovation has always been important to the NHS Confederation, that pace setter in the vanguard of change.So what better occasion for the spirit of the age to be felt than at Confed chief Mike Farrar’s leaving party, which the organisation is seeking to fund using commercial sponsorship?A forwarded email arrives from Confed letting us know they will be “holding a farewell reception for Mike Farrar at The Private Room
  • Targets are here to stay

    The Tories have, inevitably, confirmed they would set central targets for health
  • Targets met, records broken: good news on waiting times

    The English NHS broke records with a superb performance on 18-week waiting times in January.
  • Taxi for none

    A patient who recently had cause to visit a West Country hospital recently regaled a tale to health chiefs about how, when told they needed to visit another trust an hour down the road, they were initially pleased to learn a taxi would be called so their records could be transferred securely.End Game applauds the efforts to share data in the interests of patient care. We also understand that, whatever they’re spending per year on taxis, the arrangement must seem saner than buying some
  • Tee tweets cockadoodledoo

    It is a little known fact about Matt Tee – the NHS Confederation’s soon to be chief operating officer – that he was once interviewed by David Frost as a child.Mr Tee, the former all-sorts-of-things in and around the NHS and current boss of something called “Reputate”, took to Twitter recently to tell all.“Saw Nixon Frost [sic] last night,” he twote.“It is a little known fact that I was interviewed by Frost when I was 4. He asked me to do some animal noises.”Mr Tee
  • TeeKay's banter cannon

    Tim Kelsey’s appetite for a good old josh on Twitter with his departing boss Sir David Nicholson appears undiminished despite recent events which hopefully won’t be remembered as Hitler-gate.The japery began when Sir David Nicholson tweeted a link to the now infamous Downfall parody video lampooning Mr Kelsey’s oversight of the car crash but also health secretary Jeremy Hunt.The rib tickler, probably w
  • The 18-week waits performance in your region

    The local picture on 18 weeks, with interactive maps showing the size of the challenge and where the long-waits are.
  • The active patient tracking list

    How active PTLs work to minimise waiting times continuously and safely for all patients.
  • The Amazon Jungle

    If it works for Amazon then using some of their management tools and with the total backing of the board why would it not work in the NHS.
  • The annual planning round (and round, and round)

    How can we structure this year's planning round, to stop it from going around in circles?
  • The appeal of diversity - in theory

    Embracing diversity in the workplace is now a common goal for every organisation. Achieving it is much trickier than the cosy theory behind it, however.
  • The art of timing

    The secret of comedy is, famously… timing.And the same is true of that lesser branch of comedy: PR.Sometimes there is nothing you can do as a flack. You have a simple brief and timing is against you. Something else breaks and your press release subject line is an object of mirth in the newsroom.So maybe the PR who sent this particular release through this week took a reasoned decision that the horsemeat scandal would have passed through the nation’s imagination tract by n
  • The benefits of employment support to mental health patients

    The change in the way people with mental health problems are supported into work highlights just how vital it is for NHS organisations to be focused on employment as an outcome.
  • The better care fund fiasco

    Taking money from hospitals and giving it to local authorities is unlikely to improve working relationships
  • The blame game

    The blame game pendulum is swinging back from managers towards clinicians.
  • The blame game won't halt elderly care failings

    I don’t blame the nurses. I don’t blame the hospital managers. I don’t even blame the budget cuts for the pain and suffering inflicted on elderly patients.
  • The blip is over: waiting times break new records

    Waiting times resumed their downward trend, breaking new records for best-ever long-waits performance.
  • The blood and guts of cuts

    How well will managers cope with a spending cut? Hardly any NHS managers have been around long enough to experience government imposed cuts like this before.
  • The blue badge test: when the director's job becomes impossible

    It can show how an organisation deals with the most basic and simple request from a customer
  • The blurred lines around who you can appoint

    The NHS is not democratically and locally accountable
  • 'The BMJ said it was demeaning for doctors to appear on the stage'

    On 11 February 1958, the BBC first televised Your Life in Their Hands, presented by Charles Fletcher from the Royal College of Physicians.
  • 'The BMJ saw dangers in a state medical service'

    The 5th of July is the most important date in the history of the NHS.
  • The Book of the Dead

    The Book of the Dead is the name of the current Egyptian exhibition at the British museum. It would have made a good alternative title for Dr Foster’s hospital guide.
  • The bottom line

    Patient involvement must not be lip service, a tick box exercise or a token gesture
  • The Bristol stool tart

    Readers who work in a clinically-focused setting will be familiar with the Bristol Stool Chart – a table which helps doctors and nurses understand digestive health by setting out seven distinct categories of human faeces.Sometimes a pictorial version can be seen on wards or in staff rooms.Well, presumably concerned that existing illustrations were not appetising enough, one innovative team has made it into a cake.
  • The buck stops with you

    We have a tendency to blame politicians, other people and systems and processes when something is difficult to deliver or perhaps when we need a reason to resist change. The cynics amongst us might suggest that it is easy to object if you just don't really like what is being suggested. I've done it. Chances are you've done it.
  • The C word

    End Game realises that, broadly speaking, it is out of order to make observations about very successful women by reference to their husbands – or to intrude into family life (Press Complaints Commission code point 3, for media regulation fans).But we do feel the need to highlight one tweet by Birmingham Children’s Hospital Foundation Trust chief executive Sarah-Jane Marsh, who is also – as is widely known – the wife of outgoing NHS chief executive Sir David Nicholson. We hope the famil
  • The casualties of workplace conflict aren't just the staff

    Anxiety over the reforms is heightening conflict in the workplace, and that conflict is threatening to spill over into the quality of care.
  • The CEO

    Born in a basement and brought up in a lift, Innate Prejudice is a CEO with a track record of failing to make sense of it all.
  • The challenge of acquisition

    Acquisition is one of the most challenging games currently at play in the NHS. Although there are a few applicable lessons from the private sector, public services demand a more considered approach. Understanding exactly why one organisation is interested in wanting to take over another is a good starting point.
  • The Charity Chief

    Charity chief Lynne Berry is transforming volunteering stalwart WRVS into an organisation that helps older people get the support they need.
  • The Clinical Leader

    Dr Jonathan Fielden is chief medical officer at Royal Berkshire Foundation Trust. 
  • 'The coalition’s distrust of managers means the usual options are closed'

    The health white paper has set out a clear direction of travel, but it is far from a done deal.
  • The Coalition's Managerial Approach

    The coalition government has set off to a good start with the mangerial approach of setting clear but ambitious priorities. By so doing they may avoid the death by policy approach of the 1997 government where there was a naïve belief in the correlation between policy volume and service improvement.
  • The Consultant

    Nadeem Moghal is a consultant paediatric nephrologist who manages and leads a tertiary regional service. He is currently pursuing an MBA.
  • The conundrum of personality driven leadership

    The media has reported that the beleaguered Trevor Phillips is to remain as head of the Equalities and Human Rights Commission after being criticised for his leadership style. This story highlights the conundrum of personality-driven leadership.
  • The corridor of power

    A recent visit to Richmond House’s fabled fourth floor corridor of power yielded some fascinating insights into the highest echelons of the Department of Health.Norman Lamb’s office is adorned with traditional depictions of the Norfolk countryside, which Alan Partridge would no doubt approve of.Anna Soubry’s office door carries a sign with little drawings of the sun in the corners. The notice says: “Come on in! The air conditioning is on!”End Game admires how her open doo
  • The cuisine quality commission

    A recent Care Quality Commission investigation has uncovered some unsettling truths about life in one north eastern town.Patients told the CQC that at Auckland Park Hospital, “They make an excellent meal here; [the] best in town”.End Game sympathies go to restaurant-goers in Bishop Auckland.
  • The culture shift required to achieve equality in the workplace

    How can you champion equal opportunities in the workplace if your staff aren’t comfortable enough to share the information?
  • The dance of innovation

    End Game learns of more evidence of innovation from a commissioning support unit.NHS South CSU has listed a set of private sector partner organisations on its website. This is in line with what policymakers had strongly suggested CSUs should do, to pull in expertise and new ways of doing things from outside the NHS.Excellent stuff – everyone knows CSUs are going to need to come up with new ways of doing things since
  • The DH's epic quest

    The government’s Care Bill “will give people peace of mind in hospital, care homes and their own homes”, trumpets the headline of a recent Department of Health press release.Excellent. End Game is all in favour of peace of mind. How are ministers going to impart it to the nation?Helpfully, a sub-headline elaborates: “Swift action following Francis report and epic changes to care laws”.End Game is reliably informed that “epic” is young person speak for “good” and, on occas
  • The difference between a board and a cabinet

    Council meetings tend to be a bit more rowdy than their NHS trust board counterparts
  • The difference between what is said, and what is meant

    Language is important to get right - there is often a difference between words said, and meaning implied. Between the lines is where the truth lies…
  • The dilemma of a tough management decision

    Managers are sometimes faced with decisions which will test their leadership skills, their willingness to act and their ability to reason over emotion
  • The dilemma of appointing senior managers

    Sir David Nicholson’s admission to the Mid Staffordshire Inquiry that in retrospect the previous chief executive was the wrong appointment highlights a common dilemma when appointing people at this level.
  • The Downfall of Tim Kelsey

    It would be charitable to describe as a communications fiasco, but anyone wondering about its impact on the status of NHS England’s national director for patients and information today received an unexpected answer.It came in the form of a Downfall parody video. Readers will surely be familiar with the genre by now, but in case you’re not, it involves taking footage from the Hitler-losing-his-marbles
  • The drama of being a whistleblower

    The potentially traumatic experience of being a public sector whistleblower, plus the dangers of NHS hospitals being “all most full”
  • The drive for equality and diversity in the NHS

    Appointing a few high profile black leaders will not change the culture within NHS trusts
  • The Editor

    Richard Vize is editor of HSJ. Follow Richard on Twitter 
  • The emotional leadership expectations of chief executives

    The White Paper changes will be more challenging for chief executives who will be expected to help manage the emotions of thousands of staff concerned about their future. This includes accepting that many staff will put themselves - rather than their organisation and perhaps the NHS - first.
  • The end of the start for personalisation in adult social care?

    With social workers critical of the idea, it looks like the government is quietly moving away from the idea of personalisation in social care before it has even been implemented.
  • The English waiting list is bigger than first thought

    After fixing a slip in my calculations, the adjusted English waiting list turns out to be bigger than first estimated.
  • The English waiting list: not growing after all?

    After adjusting for counting changes, it turns out the English waiting list might not be growing after all.
  • 'The estimated cost of the future National Health Service was £21 million'

    On 24th April 1944, before Victory in Europe, Mr Neville, of the Ministry of Health, signed on behalf of a committee of the great and the good a document outlining the demobilisation of the emergency hospital service.
  • 'The evidence of rape and the distress of the patient were clear'

    On 14th June 1938 Aleck Bourne (1886 - 1974), a prominent gynaecologist, was arrested after performing a termination of pregnancy, without fee, at St Mary’s Hospital Paddington.
  • The expenses scandal is heading your way

    The media is starting to bring expenses run up by senior NHS staff under the spotlight
  • The expert patient

    Apparently it really is true what they say about the patient being the expert.A recent Care Quality Commission report into West Cumberland Hospital quoted one patient they spoke as saying it had been “marvellous to see a holistic and multi-disciplinary team approach.”End Game firmly condemns wags on Twitter who said things like “sounds like they put the head of HR in a bed”.We equally firmly salute the people of the north Cumbrian coast, for being so spectacularly well ve
  • The Facebook metric

    It’s hard to know if health secretary Jeremy Hunt’s performance is best assessed by his level of popularity, or whether his preferred measure of success is how obscure he can remain by keeping the NHS out of the news.If the latter is best, he seems to be doing very well indeed. A recent story in the Guardian reported that Facebook, the social networking site which young people use to orga
  • The fall of the Roman Empire

    Following a humiliating defeat, those in charge blame the rank and file.
  • The Fear Factor

    Managers in all NHS organisations need to overcome fears, we need the intuition to know when to ‘go against the flow’, we need to manage and take calculated risks and set stretching goals
  • The Finance Maven

    Sally Gainsbury is a former HSJ news editor.
  • The five laws for delivering integrated care

    The listening exercise is over and the results are in; the NHS Future Forum insists integrated care must underpin how health and social care is delivered – and they are right. But do we really understand what this means, and what it implies?
  • 'The formation of the RCGP followed letters in the medical press'

    On 19 November 1952 the College of General Practitioners was established quietly at a meeting at the Worshipful Society of Apothecaries.  
  • The Foundation Trust Network: you had to be there

    The FTN’s first annual conference heard that patient centred care has to be at the heart of the FT movement.
  • The friends and family test: all Dunn in

    When Stephen Dunn, former head of policy at NHS Midlands and East (RIP), tweeted a link to a video about the “friends and family” test last week, End Game was excited.Crayon at the ready, tongue sticking out the corner of the mouth for added concentration, End Game prepared to scribble a list of arguments to unfurl next time those pesky nurses started moaning on (again) about how the test was a load of old bunkum generating a load of made up numbers with no statistical value. Th
  • The funding must be available to help achieve public health outcomes

    The recently announced Public Health Outcomes Framework sets an effective set of measurements for performance - but if the resources aren’t there to achieve them, many services will step back from this opportunity for a step change in mental healthcare.
  • The future of nursing and midwifery

    As a commission looks at what skills and competencies nurses and midwives need for the future, Martha Lane Fox tells the NHS what it was like to be on the receiving end of the NHS following a major accident. Do nurses need a degree? What makes a good nurse? And where can you find out what patients think of their local hospital?
  • The gilded bandwagon

    When the news of the royal contractions was announced, End Game joined in the celebrations.This wasn’t because we were looking forward to hours, if not days, of tedious fact-free rolling news reports, but because we knew that NHS public relations people will have spent the past few months preparing tenuous tie-in announcements, and now was their hour to shine.Quick off the mark was Frank Soodeen from the Nuffield Trust, who has tweeted:
  • The government needs to listen harder if it wants to hear patient voices

    The Future Forum should have heralded the end of an era where patients found themselves on the outside, looking in.
  • The government shouldn't cut public health loose just yet

    A government’s role in public health campaigns is not only necessary, it is desired and it works, according to speakers at the World Social Marketing conference in Dublin.
  • The GP

    Unherdable Cat is a partner in a modern group practice that has survived two new contracts and many, many re-organisations of the NHS over the past 30 odd years.
  • The great care divide

    Funding for care, particularly older person’s care, is high on the agenda, and new proposals have divided opinion.
  • The Harkness Fellows 2009-2010

    Established by the Commonwealth Fund and co-funded by the Nuffield Trust, Harkness Fellowships allow professionals to research health policy in the US.
  • The Harkness Fellows 2012-13

    Established by the Commonwealth Fund and supported by the Nuffield Trust, Harkness Fellowships allow professionals to research health policy in the US. They blog their experiences and learning for HSJ and the Nuffield Trust. The 2012-13 fellows are Joan-Costa Font, Julia Murphy, Douglas Noble and Alexandra Norrish.
  • The Harkness Fellows: 2011-2012

    Established by the Commonwealth Fund and supported by the Nuffield Trust and the National Institute for Health Research Service Delivery and Organisation Programme, Harkness Fellowships allow professionals to research health policy in the US. They blog their experiences and learning for HSJ and the Nuffield Trust.
  • 'The health secretary is publishing dodgy figures in the name of transparency'

    Two of Andrew Lansley’s big summer announcements have irked some in the NHS for a number of reasons, and they were both information publications of sorts.
  • The Health Volunteer

    Samuel Johnson has worked in NHS performance and information management. He is currently volunteering in Swaziland’s health ministry.
  • 'The hospice movement was prepared to look death squarely in the face'

    On 24th July 1967 Princess Alexandra came to St Christopher’s Hospice in Sydenham to perform the official opening ceremony.
  • The Hospital Standardised Morality Rate

    As the post-Francis funk over patient safety enters its fourth month, it seems that NHS lifers are finally beginning to point their fingers of blame directly into their own faces.In particular, at the loose morals plaguing the NHS.Evidence of this was spotted at a recent patient safety event, where a brainstorming session yielded a blackboard full of reasons why it was hard to improve patient safety.
  • The HSJ anti-bullying hotline

    Thanks to recent HSJ articles about workplace bullying in the NHS, the newsdesk has started to feel more like a Samaritans service.
  • The importance of trust

    If there’s one issue that will be the touchstone for success during 2010 it has to be trust.
  • The introverted leader's time has come

    Has the time at last arrived for the introverted leader in this brash, noisy and personality driven world? I think so. In these uncertain times we need leaders who can project calm reassurance rather than attempt to rouse us with fine oratory or hector us with their visions of what may be.
  • The issue of heterosexual discrimination

    Issues of discrimination around employees’ sexuality can be common - but can organisation leaders make heterosexual employees feel uncomfortable?
  • The King's Fund

    The King’s Fund is a health policy think tank.
  • The language of winners and losers

    Sports metaphors aren’t a useful way of describing life in the public sector
  • The Leadership Consultant

    Neil Goodwin is a director of GoodwinHannah and visiting professor of leadership studies at Manchester Business School.
  • The local detail on clock pauses

    The local detail on clock pauses, by specialty, by Trust and PCT.
  • The local picture on waiting times

    All the detail on 18 week waits: every specialty, every Trust, every PCT, all based on the latest (January 2012) data.
  • The local picture on waiting times

    Which trusts and PCTs have the biggest waiting times pressures? And how do we explain the trust whose patients are apparently frozen in time?
  • The long view on long waits

    A short history of waiting times: dramatic improvements under Labour, and a wobble followed by renewed improvement under the Coalition.
  • The long walk to the boardroom

    Are we a bunch of hard-nosed hacks who have seen too much of the cutthroat world of health policy? Yes, probably so, but even End Game’s icicle heart was warmed by a recent missive from Surrey and Borders Partnership Trust.We opened the chief executive’s report expecting the financial warnings and depressing reports about norovirus bed closures, which are the norm across the sector. Instead, a stirring tribute to the warmth of mankind greeted us.The first point under the “chief
  • The lost opportunity to review management

    While the listening panel goes about its business and Number 10 takes a closer interest in the NHS, a golden opportunity to realign NHS management has been missed. Wouldn’t it be good if management requirements anticipated the future rather than reacted to the present?
  • The mandate provides a historic opportunity for better mental healthcare

    Board and CCGs tasked with tackling disparity between physical and mental health support
  • 'The massive death rate from pneumonia forced government action'

    The massive death rate from chest disease and pneumonia were among the factors that forced the government to pass the Clean Air Act in 1956.
  • The menace of the salami slice

    The image of salami slicing has long haunted public servants as they have seen their budgets whittled down over successive years.However, last week’s HSJ Summit event was treated to a new metaphor, that of sausage making. End Game was slightly baffled at the time but we believe it to have been used in relation to the abattoir floor scrapings used in the manufacture of government forecasts for the health sector.One female attendee resorted to the wurst use of the sausage metaphor
  • The minister for charm and the NHS Valentine's ninjas

    Those incorrigible romantics at the Department of Health gave the nation £30m to get their teeth sorted as a Valentine’s gift this year.“A healthy smile and fresh breath are essential ingredients for those hoping to make a perfect impression,” a  spokesman blathered. “And with a smile being one of the first things you notice about a potential partner, it has never been more important.”Minister for charm Earl Howe even claimed better oral health was a “key priority of the governm
  • The money makers at the BMA

    The BMA campaign Look After Our NHS is a highly distorted portrayal of the health service
  • The mystery of the missing waiting list patients

    Thousands of patients are apparently missing from the English waiting list. February is 28 days long. Together, those facts help us work out what on earth might be going on.
  • The NAO report on NHS waiting times for elective care in England

    The NAO have done a good report on waiting times. This is an opportunity to simplify the targets, make better use of Choose & Book, and knuckle down to the hard job of getting the record-keeping right.
  • The never asked question: 'What if I am wrong?'

    If managers are so sure they are right, does that mean everyone else is wrong?
  • The new culture of openness in action

    End Game was delighted to discover that as part of NHS England’s ongoing commitment to transparency, one of its senior managers has apparently started her own blog.It comes from Samantha Riley, the organisation’s director of insight. Title: “Samantha Riley’s Insight Blog (Which is Hopefully Insightful!)”Yes, hopefully it is.Actually, End Game hopes the blog continues to develop the literary voice evidenced in the most recent entry, which – although not particularly recent
  • The new government and health policy

    A new government and a new dawn. But what will the future hold for health and related policy?
  • The new minister's agenda

    The new group of ministers at the Department of Health will have a lot to take in as they begin work at Richmond House.
  • The new NHS can transform mental health care

    Under the NHS mandate, new commissioners have the chance to improve mental health care throughout the NHS.
  • The new NHS CEO? Think about the challenges first

    Let’s put the guessing of David Nicholson’s successor to one side and focus on the challenges facing the next NHS England chief executive
  • The next NHS chief executive?

    The list of potential candidates for the chief executive of an independent NHS board has just got longer
  • The NHS Change Agent

    Helen Bevan is chief of service transformation at the NHS Institute for Innovation and Improvement. From 1 April 2013, she will be joining the delivery team of NHS Improving Quality. All views are personal
  • The NHS doesn't do sorry

    Whether its managers fearing legal proceedings or clinicians protecting an image of infallibility the result can be a reluctance to apologise for any mistake.
  • The NHS needs active listeners

    Active listening - it is said we are given two ears and one mouth, and should therefore listen twice as much as we speak. John Whitmore, in his book “Coaching for Performance” tells us that most people are not good at listening to others, and that it is a skill that requires both concentration and practice.
  • 'The NHS needs to recognise it is wasting talent'

    Apparently the NHS isn’t sexist. The fact that fewer than 30 per cent of consultants are women when they make up two thirds of doctors doesn’t indicate prejudice or discrimination.
  • The NHS should aim higher than "don't be evil"

    “Do no evil” seems a very modest ambition, but it’s one banks and multinationals have struggled to live up to. Surely the NHS can be better than this?
  • The NHS should resist the American way

    There are too many cultural differences for US business methods to translate into success in the UK public sector
  • The NHS: too big to fail in election year

    With a vote on the way, no any party will allow the NHS to struggle more than it has too
  • The NHS's own dead parrot sketch

    Some of the sketches of the reunited Monty Python bring the new NHS to mind
  • The Nicholson Index

    In one of his last speeches as NHS England boss, Sir David Nicholson gave his final assessment of the reformed commissioning sector, a year post-transition.Clinical commissioning groups were given a strong eight marks out of 10, and credited them for the fact that the system had not rapidly collapsed in the way everyone now admits they thought it might.Poor old NHS England only got five Nicholson performance measurement points, as did commissioning support units.The golde
  • The One Hour Challenge

    Have you physically walked a pathway from emergency or elective admission to discharge?
  • The Patient's View

    Dr Paul Hodgkin is a former GP and is CEO of NHS feedback service Patient Opinion
  • The Pearl Catcher

    Kate Hall is a Health Foundation Leadership Fellow and has specific interests in leadership and quality improvement.  
  • The People Grower

    Anne Axford is associate director for learning and development at Portsmouth PCT.
  • The People Manager

    Blair McPherson is a former local authority director and author of a number of management books, including Equipping Managers for an Uncertain Future and An Elephant in the Room. Follow him on Twitter: @blairmcpherson1
  • The perfect storm for NHS management?

    Events are bringing about a perfect storm for confidence, trust and leadership
  • The Personal Care at Home Bill

    A step in the right direction
  • The policy doctor

    Many health policy fans noticed that details of a government review recommending the banning of packed lunches for schoolchildren were published on the same day that the Department of Health decided that actually plain packaging for tobacco products was a terrible idea.End Game was among those confused as to what ministers were trying to tell us. That a free society is a good thing when it enables tobacco firms to make their products attractive to children, but not when it allows paren
  • The politics of language

    It can be hard to keep up with the evolution of acceptable language for talking about people
  • The power of an HSJ blog

    A trip to the health centre suggests local general practice staff have been reading my blog.
  • The power of the political placebo

    Are GPs prescribing placebos any more unethical than when politicians and managers talk about service closures?
  • The powers of the dynamic duo

    The role of the deputy is often underplayed, undervalued and sometimes, in the case of Nick Clegg, mocked. But this is to miss the vital part they play in partnerships, and without deputies, many leaders wouldn’t be where they are.
  • The pressing case for linking physical and mental health

    The link between physical and mental health is one all too often missed. But the example set by an acute hospital in Birmingham that has invested in high quality liaison psychiatry shows that integrating physical and mental health services has efficiency and financial benefits waiting to be discovered.
  • The problem with superficial inspections

    Some inspections of health and care providers are note much deepe than someone inspecting a second-hand car by going around and kicking the tyres.
  • The prospects for health and social care in 2013

    The pressure and demands on the NHS in 2013 will be so great it will be impossible to duck the big questions about what kind of health and care system we are willing to fund.
  • The radiology for fun tariff

    An excited press release arrives from a tech firm who are desperate for us to use their name, boasting that their equipment was used to identify the bones of deceased monarch Richard III.End Game thanks them for getting in touch, but is more interested in the fact that the work was done at University Hospitals Leicester Trust.We are, to be honest, a bit concerned that patient confidentiality might have been breached in this case – but more worried about how the trust was remuner
  • The reality of future challenges

    A recent seminar with a group of non-executive directors to discuss dysfunctional boards and corporate failure demonstrated how grounded they are about future challenges facing the NHS and their organisations.
  • The regulation game

    Learning to play the regulators is an essential part of the induction for senior managers. 
  • The Regulator

    As a regulatory worker and a sometimes-critical NHS patient, Inside Out knows the health sector, well, inside out.
  • 'The report established the principles of NHS management'

    The 1983 Griffiths review of management was the direct outcome of the chaos of industrial action.
  • 'The report had a world-wide effect on public health'

    On 10th September 1973, Marc Lalonde, the Canadian minister of national health and welfare, addressed the PanAmerican Health Organization conference in Ottawa.
  • The return of Bill Moyes

    Sir David Nicholson appeared to go into June on a relative high. He’d had a recent holiday, his retirement was decided, and as a result there had been an abating of the opprobrium from elements of the press and body politic.He could even have been described as ebullient as he went to his beloved NHS Confederation conference armed with bold announcements.So it must have seemed particularly cruel when the news dropped of the surprise return to the health service of former arch riv
  • The revolution will not be trivialised

    End Game has learned of an underground rebellion looking to sweep away the “old guard” and bring about a new order and a better NHS world for us all.This insidious group of “heretics and radicals” first caught our eye in the Twittersphere – particularly via the tweets of radical-in-chief Helen Bevan, the chief transformation officer of the NHS Horizons Group.On further investigation we learn this band of revolutionaries describe themselves as a “grassroots movement”, with no lov
  • The secret of the perfect leader

    There are three rules for creating great leaders
  • The shocking truth about anonymous comments

    You will often find on HSJ, and other professional publications, people responding to articles anonymously. Those who don’t put their names to their comments are invariably being rude, offensive or cynical.I am often shocked that professionals, or those who read professional journals, would express themselves in this way. I can’t imagine they talk like this to colleagues in the office - people just wouldn’t put up with it. Maybe they h
  • The Short-Termism of Acquisition

    The acquisition of ‘challenged’ trusts will offer a quick managerial fix but it won’t necessarily create strategically sustainable services and the operational problems that precipitated acquisition in the first place may well reoccur.
  • The sky's the limit for airport-style health services

    Ahead of the release of the Future Forum’s report into his NHS reforms, the health secretary decided to check-in to a fancy new health facility.
  • The Soubry channel

    It’s the Friday before the Oscars which can only mean one thing: another moving picture from those prolific film makers at Richmond House.Last week we were treated to a film about any qualified provider.
  • The strikes don't mean staff don't like doing their job

    Generally across the public sector, staff remain committed to providing a high standard of service to the client or end user. Keeping morale high should be a line manager’s priority in a time of organisational cuts and structure changes.
  • The surgical ninety day money back guarantee

    Geisinger promises to get surgery right first time or your money back
  • The trouble with PTLs

    When things get difficult, trusts often use PTLs to achieve their waiting time targets. But PTLs have unintended consequences.
  • The upside-down reporting of NHS waiting times

    When waiting times improve, the papers say they got worse. A closer look at the numbers shows why.
  • The vision thing's gone missing

    The Party Conference season is over
  • The Voice of Trusts

    Chris Hopson is chief executive of the Foundation Trust Network. It represents more than 200 members delivering acute, specialist, mental health, ambulance, and community services in hospitals, in the community and at home
  • The waiting list grows, but 18 week waits improve

    A narrow record-best on 18 weeks, slippage on one-year-waits, and a further worrying increase in the number waiting.
  • The Waiting Time Guru

    Rob Findlay is founder of Gooroo Ltd and a specialist in waiting time dynamics.
  • The wisdom of crowds

    The group campaigning for Stafford Hospital to remain open now have a new song to get behind, End Game learns.Titled 50,000 People Can’t Be Wrong, the song is available to listen to on YouTube or to download from Amazon.In End Game’s experience, NHS songs tend to fall into three categories: contemporary and preferably involving some rap;
  • The Workforce Watchdog

    Charlotte Santry is HSJ’s chief reporter.
  • There is now a pattern in the government's approach to competition

    The Department of Health is trying to silence the cooperation and competition panel, to stop health secretary Andy Burnham’s “preferred provider” policy being exposed as illegal.
  • There was a light...

    Shadow health secretary Andy Burnham has revealed that he used to really like The Smiths, but has gone off them a bit in recent years.In a weirdly lengthy interview with the Independent (one would think his fomulation of a new top-down reorganisation of the health and care service would be enough to keep him occupied), Mr Burnham admitted that he was once a mega fan of the
  • There was no 'golden era' to be a public sector worker

    Despite the perpetual challenges facing the public sector, young people still want to be social workers, teachers and nurses
  • There will always be staff who feel bullied by managers

    If staff are asked, “Have you been bullied?”, what is an acceptable amount of yes responses?
  • There's something fishy about all this change...

    Ambitious managers are like sharks. They need to keep moving or they die.
  • They're Goodfellas at the CQC

    I wonder what the NHS will make of Baroness Young’s announcement that the Care Quality Commission wants to “do a number” on failing organisations. It’s the kind of shadowy threat you’d expect from a Martin Scorsese g
  • Thing One and Thing Two

    Over the past few weeks the legislative spotlight has moved from the Senate to the House, and members of the lower house have been revelling in it.
  • Thinking differently about quality and cost

    "Revolution begins with a transformation of consciousness". Innovation, doing things differently, is becoming a high priority activity in the NHS. Innovation has a critical pre-requisite: thinking differently. If we are going to sustain a universal healthcare system for future generations, we need to think differently about the relationship between cost and quality.
  • Thinking the unthinkable

    End Game warmly congratulates the Conservative Party for bravely recognising the scale of the challenge the NHS faces, and daring to think outside the box in public.In this case “the box” they are thinking outside of is the principle of treatment based on clinical need.A Tory consultation paper picked up by The Independent
  • 'This was the beginning of care in the community'

    On 9th March 1961 Enoch Powell, the Minister of Health, addressed the annual conference of the National Association of Mental Health.
  • Thrive, survive and take control

    How to manage the changes that you may not have chosen and emerge positively
  • Time to acknowledge NHS managers' crucial role

    After 13 years of institutionalisation under the previous administration and now having to respond to a crisis largely not of their making, now would be a good time to acknowledge the crucial contribution of managers in leading the future changes. Changes that will have human consequences for many people including for themselves.
  • Time to change: challenging the stigma around mental health

    The latest survey on the public attitude to mental health shows some encouraging figures, but also highlights how prevalent ignorance and fear toward mental illness remains. There is, says Sean Duggan, still some way to go in tackling mental health stigma.
  • Time to topple the kings of the castle

    Borgen shows a model of leadership the opposite of NHS macho management.
  • To coach or not to coach…

    There’s many different forms of coaching, from the informal, “water cooler” conversation, through manager coaching to more formal internal or external coaching. Coaching as a style of management is now accepted as effective, but there is a growing trend towards formal coaching, because of the growing evidence of its worth.
  • To Kill a Mockingbird

    The young may need their heroes but the rest of us should be wise enough to set our expectations at competent leadership.
  • Too many chiefs

    At the excellent health policy wonkathon (TM: Dr Phil Hammond) that is the Nuffield Trust summit, talk turned to the impending arrival of a chief inspector of hospitals.As night follows day, the delegates then began debating what other areas of the service needed a chief inspector and which members of the good and great should be honoured with the various roles.“What about air ambulances, who are we going to get for that?” asked one wag.“What about Prince Harry? I believe
  • Tory press caught napping

    A special End Game hat tip goes to Jayne Morris today, for causing a media ruckus with some harmlessly irrelevant workplace tips.Both the Daily Mail and the
  • Toynbee exposes the waiting list cheats

    Polly Toynbee was right to expose waiting list cheats. But let’s fix the system, not start a witch-hunt against hospitals.
  • Transforming real waiting lists with better scheduling

    How a rules-based approach to patient scheduling can dramatically reduce waiting times.
  • Treasury tricks and accountancy acronyms

    I have a strange fascination with NHS accountancy. I don’t know whether it’s the edge it gives me over my colleagues every time we play NHS acronym bingo (their PBCs and WCCs are nothing to my IFRICs and EBITDAs) or just the opportunity to try and talk sagely about the difference between “cash” and “resource”.
  • Tredinnick's pet subject

    When the health select committee member and pro-homeopathy campaigner David Tredinnick, prefaces a question with “this may sound a little bit odd”, you know you’re in for a treat.Mr Tredinnick somehow managed steer several minutes of a recent committee evidence session, which was supposed to be about the implementation of the Health and Social Care Act, onto his favourite topic.“This may sound a little bit odd, but would you be prepared to look at the evidence of the homeopathic
  • Trick or treat ...

    The spectre of the US mid-term elections will be lingering well past Halloween. But are there any lessons in all this for how we handle our own health reforms?
  • Trouble on the road to Confed

    Travel to Confed conference from London was derailed by signalling faults.
  • True grit

    End Game invites you to join us in celebrating UnitedHealth UK’s first decade of investment in our humble health sector.The British wing of the US health giant entered the UK market in 2003, probably riding a wave of Alan Milburn-inspired optimism that the time had finally come for efficient, forward thinking innovators such as themselves to contribute to the improvement of the NHS.Well, End Game is delighted to report that since then the firm has certainly put its money where i
  • Trust chief executives have one of toughest jobs there is

    The people in the hottest seats around need more support
  • Trusts don't expect chief executives to stick around

    High flyers will always move on to the next big job, but now trusts don’t even want them to be in post for long
  • Truth is stranger than fiction

    “HR have developed a matrix to identify these negative ninjas”
  • Trying to force equality in leadership is an unbalanced approach

    The NHS breakthrough programme of putting a small number - around 60 - of black and minority ethnic managers through a leadership programme and hoping this will result in more BME senior managers isn’t working. It was a little naive to think it would.
  • Two days, 52 TFAs?

    Two working days to go until the end of September and one of the trusts HSJ reported was too small to go it alone has announced its decision.
  • 'Tylenol became a classic example of healthcare crisis management'

    12-year-old Mary Kellerman of Elk Grove Village, Illinois, woke up at dawn and went into her parents’ bedroom. She complained of having a sore throat and a runny nose. Her parents gave her one extra-strength Tylenol capsule.
  • Tyranny of When

    How many of us have thought, at some time, I'll really feel happy when (I've got the promotion, bought the new car, been on a world cruise...or whatever) and see happiness as something over the horizon - when what we already have is something to celebrate?
  • Undercover boss

    How do you know what is really going on in your organisation?
  • Undermanaged NHS needs step change in appointment process

    The King’s Fund report is right to suggest the “undermanaged” NHS is needs a new style of leadership - but the way managers are appointed needs to change first if the balance is to be successfully redressed.
  • Unexpected rise in August waiting list

    The waiting list put on a surprising growth spurt in August. Yet long-waits performance remained steady.
  • Un-learning leadership in the NHS

    The traditional view of leadership is a charismatic individual who - by sheer force of personality and will - drives through change and makes things happen; a heroic figure.
  • Update the unwritten rules of workplace behaviour

    More staff feeling they can be open about their sexuality is a measure of progress in terms of equality
  • 'Urgent action is needed to tackle mental health life expectancy inequalities'

    Stark new figures have revealed the inequality in life expectancy between people with, and people without, mental health problems.
  • US health care reform: I know it's over (and it never really began)

    US legislators finally passed health care reform. Or, at least, extensive health care tinkering.
  • Use the files - save the child

    As an increase in residential children’s homes is mooted, are we heading for a change? Inside Out argues it’s not before time.
  • Virtual public relations

    Being a web-savvy lot, End Game readers will have heard of Second Life, the online role-playing game that was big in the giddy, wasteful days before the recession.For those who were doing other things, we will explain. The game allowed players to design an outlandish character (or “avatar”) and stroll around a fantastical virtual world complete with alien landscapes and thousands of fellow players.Licensed to do entirely as they pleased, participants built palaces, foug
  • Voluntary groups shouldn't take funding for granted

    It is only natural when deciding which voluntary groups’ budgets to cut to go for the ones that have the least popular support.
  • Volunteers win support in Borders

    What can be done when our vision is shared
  • Vote of confidence

    Complaints, as we all know, are taken extremely seriously in the NHS as they are a valuable and cherished source of information from the people who matter most.So we were intrigued to read the Department of Health’s latest report on complaints it has dealt with over the past few years.In the first 10 months of 2013, Richmond House rece
  • Waiting list 'gap' is growing

    One-year-waits improved, 18-week-waits are steady, the total waiting list is looking ever larger for the time of year.
  • Waiting list grows in October for first time

    For the first time since records began, the English waiting list grew in October. Still, 18-week waits were steady. One-year waits probably got worse.
  • Waiting list grows more slowly as NHS catches up

    The waiting list grew more slowly in June, helped by higher admission rates. Even though the waiting list remains very large, 18 weeks performance held steady.
  • Waiting lists and criminal offences

    It will soon be a criminal offence to supply false or misleading waiting list data. Time to get ready.
  • Waiting times improve again in May - England RTT stats released today

    English RTT waiting times improved again in May
  • Waiting times soar as Scotland's backstop fails

    Scotland “achieves the target” while its waiting times get worse.
  • Waiting times steady in June

    A detailed analysis of the June 2011 referral-to-treatment waiting time figures.
  • Waiting times steady in September

    The position on English waiting times remained steady in September. But nearly half the country’s one year waiters were reported at just one hospital.
  • Waiting times tread water

    18-week waits didn't improve in July. Nor did they get markedly worse. It's probably still just a seasonal blip.
  • Waiting times: safe, fair, short, efficient

    The Northern Ireland Assembly asked for some advice on waiting times policy. So I had a grand day out in Belfast, and this is what I suggested.
  • Waiting times: 'strong' or 'a huge embarrassment'?

    Are waiting times up or down? It depends who you ask, but some answers are more meaningful than others.
  • Wales waits and waits

    Welsh waiting lists are soaring. Why?
  • Wanted: Business people to save the NHS

    Public sector candidates need not apply
  • War on Jargon

    This column’s protracted War on Jargon has often felt like a futile battle.But great warriors thrive in the face of adversity and evidence this week that new NHS “partner” organisations were introducing their own management piffle to our already linguistically sullied sector has only strengthened our resolve. The latest crime against the English language comes courtesy of the Technology Strategy Board, an arm’s length management organisation charged with driving innovation.
  • We cannot let the NHS slip backwards

    The NHS has come a long way in the last couple of decades - to keep gaining ground we need a national debate on the kind of NHS we want to see
  • We didn't need all those staff after all

    Efficiency drive or purge: where does outsourcing services lead us?
  • We need to celebrate best practice in tough financial times

    Should we be spending scarce resource on award ceremonies that recognise achievements and effort? I think this is money well spent.
  • We will let you know by the weekend...

    How do you prolong the torture that is ‘the interview process’?
  • We're missing the signs of alcohol abuse among older people

    The over 65 population is drinking in ever greater numbers, posing a new set of healthcare problems
  • What can civil rights leaders teach us about strategy for transformation?

    Healthcare leaders can learn greatly from civil rights and anti-apartheid leaders who typically had few economic resources, yet were able to strategise to change their worlds and enable profound change
  • What can we learn from the CQC 'cover up' story?

    Recent events at the regulator bring up many questions and a valuable lesson for senior managers
  • What causes seasonal variations in elective admissions?

    Elective admissions go up and down like a yo-yo. Why? Nearly everything is explained by the calendar.
  • What do NHS managers do?

    An article on the BBC news site this weekend asked, “What does a pope do?” The same could apply to NHS managers, says Neil Goodwin.
  • What does it feel like to be a PCT manager?

    PCTs will disappear from 2013 - what does it feel like to be a manager in one?
  • What does success look like?

    Success doesn’t necessarily mean getting to the top. What is the top anyway? Top of what?
  • What happens when chief executives are slow to pick up on patient complaints?

    The answer: patients are left believing they have cancer purely because consulting rooms are busy, as I was unfortunate enough to discover.
  • What happens when pleasing the boss goes too far?

    Managers who surround themselves with “Yes Men” are even harder to please when the answer should be “no”…
  • What is the house of care?

    There are significant benefits to focusing on patients’ goals and empowering them to take an active part in their own care, says Angela Coulter
  • What on earth is MBTI?

    “I’m ENTP – I’m guessing you are ESFJ – but what do you think J Is? ISTJ or INTP?” What on earth is this gibberish? If you’ve never been “MBTI’d” it will mean absolutely nothing. If you have – you will immediately be leaping to a set of information about me and the others, based on the Myers Briggs type Indicator.
  • What the Francis report means for mental healthcare

    The Francis report’s recommendations will have a huge impact on all parts of the NHS, not least mental health services, says Sean Duggan.
  • What went wrong at Mid Staffs?

    Yet again we have a badly under-performing hospital, resulting in the deaths of hundreds of, mainly elderly, patients.
  • What will 2012 have in store for mental health?

    Sean Duggan looks at the opportunities and challenges ahead for mental health.
  • Whatever happend to the battle against institutionalisation?

    Good care practices appear to have been forgotten in senior management’s preoccupation with budgets
  • What's so hard about saying sorry?

    Most people who complain just want an apology or explanation. They are not looking for compensation or staff to be disciplined.
  • When customer care alone is not enough

    Apparantly the saviour of public sector finances is better customer care. Is that really enough? Please hold while I connect you to an advisor.
  • When is whistleblowing not whistleblowing?

    I was recently surprised to hear an NHS board member described as a whistleblower, given their position and power.
  • When looking the part goes too far

    It’s always said that appearances can be decieving - but surely looking your best for your employer should never be frowned upon?
  • When the long-waiters are forgotten

    When patients are forgotten on waiting lists, anything can happen. Sometimes comical errors, sometimes awful tragedies.
  • 'Wherever there was social disparity, there was disparity in health'

    August 1980 will forever be remembered by public health doctors for it was then that the Department of Health published the Black report.
  • Whether it's football or the NHS, suddenly everyone's an expert

    Leaders must take responsibility for the advice they take onboard
  • Who cares what they think?

    Leaders pushing through decisions without consulting patients or even staff suggest a disregard for what people think. Is engagement just a pipedream for the NHS?
  • Who would admit to being racist?

    A survey reveals that a surprising number of people view themselves as racist
  • Why can’t health and social care services get it together?

    Everyone is talking about integration, but why haven’t we got it together yet?
  • Why did Rose Gibb lose?

    There is considerable surprise at the high court ruling against Rose Gibb in her claim for breach of contract.
  • Why do so few leaders speak out about disastrous changes?

    Not enough leaders stand their ground when bad changes are imposed on the NHS, but good leadership means having the courage to speak out, says Blair McPherson.
  • Why do we keep paying off the same senior managers?

    Making managers redundant over and over again is costing the NHS a fortune
  • Why doctors don't make good managers

    Doctors don't make good managers but it's not their fault
  • Why is changing

    The imminent move to make HSJ’s website “subscriber only” will help us expand our services.
  • Why Sherlock could never be an NHS manager

    Emotional intelligence is increasingly seen as an important skill for people in the top jobs
  • Why you should keep the 'smiling assassins' in HR on your side

    HR get a lot of criticism from staff and managers alike. But they function in the best interests of the organisation, not individuals or groups of employees, so it may be wiser to keep them onside than wage war.
  • Why you should reframe your strategy as transformational

    Leaders need to combine coercion with a sense of shared purpose to bring about real change in their organisations
  • Wicked whispers

    Which outspoken advocate of accurate data turned up late to a seminar recently because they wrote down the wrong time?End Game would love to tell you, but the event was held under solemn Chatham House rule conditions.
  • Wicked whispers

    So called “pace setting” leaders – who, according to convention, get results but leave underlings quivering and broken in their wake - have fallen out of favour in the NHS. Well, most of them are still in post but they’re all desperately unfashionable post-Francis.At the recent chief nursing officer’s summit, the outgoing NHS England south region director of nursing Liz Redfern, who previously worked at the South West Strategic Health Authority, opened up about her experience of this m
  • Wicked whispers

    End Game has been handed a set of emails showing how Department of Health flacks handled(ish) one of the more recent NHS crises.They made interesting reading, considering how divorced from each other NHS England and the Department of Health are supposed to be post-liberation of the NHS.In one, a Richmond House-based media relations man was found calling for a senior NHS England director to be “woken up” before said director’s reputation was “completely shredded” by hostile press
  • Wider lessons from Imperial's long waits

    How can we make the NHS more resilient against the risk of waiting times failures?
  • Will 2012 be the year of the accountable care organization?

    Setting aside the controversy over reform, the hot topic for 2012 will be integrated care. In the US, accountable care organizations could help drive integration - as long as they are given time to demonstrate their value.
  • Will 2014 be the year of ethical leadership?

    The public sector needs to move away from ‘greed is good’
  • Will it be happy-ever-after for the NHS?

    Stories that have stood the test of time shed light on our behaviours in business
  • Will new waiting time records be broken?

    In Thursday’s figures, will the number of long-waiting patients being admitted finally fall below the general election level? It looks like it will.
  • Will the bean counters kill PBC?

    £1.2bn reasons to wonder if they’ve done so already
  • Will the bill halt the integration of vital services outside health and social care?

    Now it looks as though the bill is - in some guise - here to stay, Sean Duggan asks how it will affect the integration of the NHS and its many partners in making a difference beyond health and social care.
  • Will the government's plans improve GP performance?

    The hope is that pressure from respected and credible peers in the form of GP consortia will help to improve performance in primary care. But will it?
  • Will the real Sir David please stand up?

    Firmly ensconced in his Quarry House office, Sir David has taken up blogging in a bid to become more open and let the people know what’s on his mind.But it seems some meanies out there don’t believe he’s been writing them himself.“This is my latest blog”, his latest blog begins, “thanks to everyone who has commented on my previous efforts so far.“However, one of the most disappointing responses has been
  • Winning charities still battling among public sector cuts

    The King’s Fund IMPACT Awards has been celebrating and rewarding outstanding health charities for 14 years. But it has never felt more important than in 2011.
  • Winning is for quitters

    The people of Lincolnshire are being encouraged to give up smoking with a prize draw for successful quitters.Lincolnshire Community Health Services Trust invited locals to “swap fags for swag in big ticket giveaway”.Sounds great! We like swag. All you have to do is kick the ciggies for four weeks.Prizes on offer include a family ticket to Pleasure Island, Cleethorpes, a family ticket to Natureland Seal Sanctuary, Skegness, and ticket to tour Lincoln on an open top sightse
  • Winter pressures, week by week

    Good planning and monitoring can reduce the risk of crises this winter. We look at a worked example of week-by-week interactive profiling for beds and waiting times.
  • Winterbourne View was shocking but hardly surprising

    Some people will be genuinely shocked at the prison sentences handed out to staff who worked at the Winterbourne View home for people with learning disabilities.
  • Word on the Web

    Tim Miller is assistant online editor for HSJ.
  • Working 9 to 5

    More evidence arrives that commissioning support units are becoming ever more businessy in their working practices.Greater Manchester CSU sent End Game an email boasting that after just four and a half months of operation they had set up a new website.The site is graced with “a modern, colourful design and has a cutting edge single page structure,” we learned.And, we were told, “the website makes full use of GMCSU’s innovative branding which pushes the boundaries of how t
  • Worskett case scenario

    End Game received an email a couple of weeks ago that filled us with admiration for the hard work and long hours put in by NHS Partners Network chief executive David Worskett, who represents the views of private providers to the NHS.It was the night of the Lords debate on a Labour motion to strike down the controversial “Section 75” regulations, which set the rules for competition in the NHS.The debate pushed on late into the evening, and it was past 10pm when peers finally vote
  • Yes to all-BME short lists for senior public sector jobs

    The aim of positive discrimination is to ensure public sector leadership represents the diverse society we live in
  • Yes, we do talk about you

    My colleague on the senior management team seemed surprised - shocked, even: “Do you mean to say you talk about me and members of my team during your meetings?” as if this was slightly improper, unprofessional and indiscrete.
  • Yesterday's man

    Sir David Nicholson – winner of End Game’s unofficial best ever person on social media award – has promised to keep tweeting about the NHS after he retires on Monday.We are sure we will continue to enjoy his weird and dangerous sense of humour for many years to come, but we have to be honest that a good part of the LOL potential comes from the fact that he’s in charge of the NHS, rather than just being another retiree banging on about football and why the Plantagenets were better than
  • Yet another opportunity to reinvent the acute hospital

    In the new world an old challenge will quickly emerge driven by implementation of the reforms. Is it time for the acute hospital to be reinvented? The answer is an unequivocal yes.
  • You can't run trusts like football clubs

    It can take years for an underperforming organisation to get out of special measures
  • You don't want to know the answer

    Managers are can choose to avoid bad news by not asking staff the right questions
  • You need more than a change in the law to improve care

    Without resources and changes in attitude things remain the same
  • Young people: Always board

    End Game was uplifted to learn NHS England has opened its doors to the nation’s young people.Recent board papers reveal that the mega quango was an enthusiastic participant in “Children’s Takeover Day”, which was all about listening, and learning, and engaging, and connecting.The write up does not confirm whether Bill McCarthy, Barbara Hakin et al were forced to deliver their message in spoken rhyming couplets, which End Game understands is the preferred medium of communication
  • Young's departure exposes cracks in the system

    The rows in the last few days over regulation, death rates and patient safety, culminating in the resignation of Care Quality Commission chair Barbara Young, are a public display of dysfunction by some of the most powerful organisations in healthcare.
  • Your 18 week waits: April 2013 data

    The local picture on one-year and 18 week waits across England, updated with the April 2013 data.
  • Your 18 week waits: August 2012 data

    Interactive maps showing where the long-waits are, and where the most clock pausing is happening, by specialty, and by NHS Trust, independent sector provider, and PCT.
  • Your 18 week waits: August 2013 data

    Interactive maps of local NHS waits around England, showing the pressures and one-year-waits, with links to all the detail by organisation and specialty.
  • Your 18 week waits: December 2013 data

    Interactive maps of local NHS waits around England, showing the pressures and one-year-waits, with links to all the detail by organisation and specialty.
  • Your 18 week waits: February 2013 data

    The local picture on one-year and 18-week waits across England, updated with the latest data.
  • Your 18 week waits: January 2013 data

    Interactive maps showing the local picture on waiting times, with click-through to detailed reports. Fully updated with the latest data for January 2013.
  • Your 18 week waits: July 2012 data

    All the local detail on 18 week waits: full specialty-level analysis by Trust and PCT, and interactive maps showing where the longest-waiters and highest levels of clock pausing are.
  • Your 18 week waits: July 2013 data

    All the local detail on 18 weeks by provider, commissioner and specialty, with interactive maps
  • Your 18 week waits: June 2012 data

    Interactive maps and resources with detailed analysis of the 18-week pressures by Trust and PCT, by specialty.
  • Your 18 week waits: June 2013 data

    All the local detail on 18 weeks by provider, commissioner and specialty, with interactive maps
  • Your 18 week waits: May 2012

    Interactive maps and resources with detailed analysis of the 18-week pressures by Trust and PCT, by specialty.
  • Your 18 week waits: May 2013 data

    The local picture on one year and 18 week waits across England, updated with the latest data.
  • Your 18 week waits: November 2013 data

    Interactive maps of local NHS waits around England, showing the pressures and one year waits, with links to all the detail by organisation and specialty.
  • Your 18 week waits: October 2012 data

    Interactive maps showing where the very-long-waiters are, how organisations fare against the “92 per cent within 18 weeks” target, and where the most clock pausing is happening. All updated with the latest October 2012 data.
  • Your 18 week waits: October 2013 data

    Interactive maps of local NHS waits around England, showing the pressures and one-year waits, with links to all the detail by organisation and specialty.
  • Your 18 week waits: September 2012 data

    Interactive maps show where the long-waits are, the waiting time pressures and where the most “clock pausing” is happening: by specialty, by trust and independent sector provider and PCT.
  • Your 18 week waits: September 2013 data

    Interactive maps of local NHS waits around England, showing the pressures and one year waits, with links to all the detail by organisation.
  • Your 18-week waits

    18 week pressures fully analysed, by Trust and PCT, and by specialty: updated with February 2012 data.
  • Your 18-week waits: December 2012 data

    Interactive maps showing where the long-wait pressures are, for NHS and independent sector providers and for commissioners.
  • Your 18-week waits: March 2013 data

    The local picture on one-year and 18-week waits across England, updated with the latest (March 2013) data.
  • Your flight has been cancelled (by your employer)

    When staff shortages mean organisations cancel their employees’ holidays, there are bound to be issues with people management.
  • your worst decision

    What's the worst decision you have ever made?
  • 'You're going home': improving the interview process

    Interview days are usually so boring, something should be done to shake up the process.

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