Mark Newbold's Comments
Comment on: Chief executives are running scared
Fascinating article, thanks, with many points worthy of detailed discussion. For instance, the phrase 'fear of failure' is an interesting one to reflect on. What is 'failure'? Officially, 'failure' means not achieving obligatory targets, and I have argued elsewhere that this feels like a very narrow and arbitrary definition of failure, and one that doesn't any longer chime with the views the public would have on the matter. One can hit 4hrs, or 2 weeks, or 18 weeks, but still provide disrespectful care to the elderly, or oversee poor clinical outcomes or high mortality rates - I think that is failure but it would not be defined as such currently. I'm not sure that 'fear' is the right noun either. A CEO knows for certain that they must achieve the targets, or certain regulatory consequences will follow. The Board is similarly aware. There are few choices to be made, they are 'must do's' and so it is pragmatism rather than fear which drives CEO's and Boards to prioritise these I think? I believe that ceasing the 'shouting loudly' approach will lead to more local innovation and more adventurous attempts by Boards to genuinely prioritise what is important in the communities they serve. We would see some real successes in important areas, but we would also see lesser performance in some current priorities too. Wouldn't this be a price worth paying? We are defining success and failure wrongly - access is not the priority now, care quality is. Lets change this, and recognise too that in fact it is fear of failure centrally that is holding us back. Allow local to trump national, and then we will see how innovative we can all be?
Comment on: Nicholson argues he should survive to implement Mid Staffs recommendations
Anon just above (1:39) - well said, wise words for a youngster. Whoever you are we need more of you!
Comment on: Chief executive resigns at Midlands trust
Really sorry to read this Julia. North Staffs could not have had a more committed and hard-working CEO and you have many achievements to look back on with pride. Very best wishes in the future, Mark
Comment on: Chief executives not confident on out-of-hours safety
Im not surprised by the findings re out of hours safety, because this is what the evidence tells us. All CEO's will know this. I'd be more interested to hear from those who feel their services ARE equally safe at all hours, because I haven't seen any evidence from anywhere that this is the case. We did some work unpicking our SHMI rates (which are average overall) and found many spikes and dips related to several factors, such as time of day day of week, specialty, and degree of escalation. It is complex and the issues are likely to differ between hospitals, and between specialties?
Comment on: Heart of England changes ward leaders after CQC visit
In my (original) article I was describing our own reflections as a team on why we had the issue on this ward. Our nursing staff offered the view that care of the elderly requires specialist skills that are not always found in nurses trained for other types of medical care, and we felt this might have been a contributory factor. Accordingly we have introduced some further training to try and help staff to improve the care they provide. Hope this clarifies?
Comment on: The 17 most influential health leaders on Twitter
Beth and Alyson are absolutely right. Some posters here are misunderstanding how Twitter can be used - surely they would feel communication and openness are important in health and health leaders?
Comment on: Leaders of aspiring FTs receive confidential help to improve
If Boards/CEOs find this initiative helpful then it is to be welcomed. It isn't possible to sort the problems in most chronically struggling acute Trusts by only looking inwards. Entrenched failure on 4 hrs, 18 weeks, or finance is likely to be related in large part to health economy-wide issues. After all, there is no shortage of help and advice and any 'quick fix' solutions for hospitals will have been tried, often tried many times. Both the causes, and the solutions, are systemwide, and needs leadership that recognises and addresses this. That is a challenge for some leaders, but also one for the regulatory system, because pressure to achieve targets 'today' will drive CEOs to look for quick-fix solutions. And these, as we can clearly see, simply perpetuate the problems.
Comment on: Acute trusts absent from local wellbeing boards
Hi Brian, I'm sure you are following absolutely the right strategy and it's good to hear it is working well so far. In future a successful acute Trust will need to be operating in a successful health economy, so it is important to contribute to that. Secondary care doctors will need to see their role differently too. I believe the lack of acute involvement in HWBBs is based on 'old thinking' but i'm optimistic it will change. A practical problem in large LA's like Birmingham is the sheer number of providers in the patch, but there are ways around this I'm sure.
Comment on: Acute trusts absent from local wellbeing boards
Hi Anon 2.14. My fear about keeping HWBBs at an 'epidemiological' level is that they will discover what is wrong but lack the means to fix it! And anyway, we already know what the issues are. In my Trust we have deliberately negotiated a risk-sharing contract with an agreed and fixed income level, which aligns with a system 'compact' that all parties (LA, CCG, PCT Cluster, MH, Comm Prov, Acute) have signed up to. As a large acute, we are now incentivised financially (as well as ethically) to use our expertise to keep people well and reduce hospital admissions. I think this, and a strong sense of collaboration with commissioner and LA colleagues, may allow us to succeed where we have previously failed. Anon 2.26 illustrates well the perceptual problem we have. Acute Trusts are not the problem, but they can very definitely be a significant part of the solution!
Comment on: Acute trusts absent from local wellbeing boards
The absence of proper, non-tokenistic, acute Trust representation on HWBBs, and indeed the anonymous comments above, illustrate significant issues we must address around 'silo' working and the traditional view of the role of hospitals. Discharge problems, readmission rates, overuse of A&E depts, hospital-acquired infections, SHMI rates, and many more current imperatives can only be tackled by taking a 'whole system' approach to them. The same applies to the £20bn challenge. If HWBBs develop as commissioner-side talking shops, who only interface with the acute sector via contracts and AQP, then we will be missing a huge opportunity to make real progress in the areas we have struggled with for so long.
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