Three things it’s good to know now

I thought I had prepared pretty well when my Mother went into hospital for the first time after her 90th birthday.   But there were three things I quickly had to get my head around and learn how to deal with them.

Lesson 1  – Don’t be passive in any situation, I don’t care how senior they are or what specialist knowledge they have.

Right off the bat I realised I needed to be the decision maker; I felt that there were some occasions when I thought someone else was the decision maker?  This was never the case, at the bedside in a hospital ward, during some social care meeting or just choosing a hairdresser to come to the house; I realised I had to make all of the decisions. That does not mean I did not include my Mother in these decisions, but it became pretty clear all decisions would have to me made my me.

This is particularly the case in healthcare situations. During my Mother’s last stay in Hospital, which should have been a short one, I quickly realised that the ward staff were unable to make any decisions about my Mother. She was not well enough to go home without a care package and no one could decide how big that would be or who should provide it.  So we kept going round and round in circles with me asking their advice.  I found I had to guard against being passive and learnt how to challenge decisions that were or were not being taken.

Lesson 2-  When someone tells you something check both you and they understand what they are saying.

People called me out to the blue and started chatting about my Mother and her needs. This initially seemed like good news.  On at least two occasions I realised that they were not talking about my Mother, some transposition of phone numbers on a list perhaps.  So when I  got one of these calls I did the following:

  • Asked them to identify themselves
  • Got their contact details –  I always did this first. Get their general contact details to and their specific job title.
  • I recorded all of these interactions into an Evernote Notebook; you can, of course, use a paper notebook
  • I confirmed who they thought they were talking about –  I did this through active questions like; “ You wish to discuss Mavis Coulthard with me who’s on Ward XX at the Royal Surrey Hospital?  Is that correct?
  • I would then confirm who they thought they are talking to.
  • Then and only then would I have the conversation
  • Finally, I would confirm the agreed actions back to the caller.

Lesson 3 – Write it all down and keep your eyes and ears open

Don’t rely on your memory, write everything down how ever trivial it might be.  A mobile phone camera is really good at capturing complex meds and forms.   I found that I was often the only person that had all of the information.  The last hospital discharge letter, a list of the latest meds, the name of the intravenous antibiotic Mum was on.  I found that no one seemed to have the right information at the right time.  More of this in another Post.

Once my Mother was discharged from the Royal Surrey Hospital without any medication.  At the time, she was on about 13 different pills.  Fortunately, I had a photo of her medications and the schedule associated with them.  I was able to send this to a local pharmacy and they were able to sort out the mess with some help from my Mother’s GP.  Without that intervention, I guess Mum would have been back in Hospital that night.  The healthcare ombudsman has recently published a report into the discharge of older people from hospital.  It does not make good reading.

I found I needed to be aware of the conversations around me and my Mother, I read all of her medical notes, I asked open-ended questions and listened hard to the answers.  I found it easier and easier to challenge the jargon. The NHS loves jargon, three and four letter acronyms abound and I just asked what they meant.  Sometimes not even the user knew what they stood for.

In my next Post, I will look at the role of friends and family



The Death of my Mother

MumIt may seem an odd thing to Blog about the death of one’s Mother but I have learnt so much in the last two years it seems nonsensical to keep the journey to myself. We all miss Mum a great deal.  As a teacher, she knew the power of knowledge and the empowerment it brought.

Today, in London there are more than 250,000 people in the last five years of their life. In the UK, there are now 11.4 million people aged 65.   There are over 23.2 million people aged 50 years and over, over a third of the total UK population.   The number of people aged 65+ is projected to rise by over 40 per cent in the next 17 years to over 16 million. And most worrying of all, like my Mother, 3.5 million 65+ live alone.

Unless we do something, we are condemning generations of older people to a chaotic and unhappy last few of life. We can all do better!  This is not about service redesign, apps or productivity this is about happiness. So over the next few weeks, I intend to focus on some of the lessons I learnt.

My Mother died just after Christmas 2015; she was 90. She had survived three bouts of cancer, two knee replacements, World War 2 and a career as a teacher.  She was a pillar in her village community, helping the young ones, all in their 70s, access services. In the last few years of her life, she found it harder and harder to make sense of the services she needed. This was not because she was confused, it was mainly the lack of coordination between the service providers.   These providers were public sector, commercial, charity and church organisations. We had to coordinate and manage all of these services, visits and appointments.

So these are the lessons:

  • The five things you should know now
  • Engaging with friends and family
  • Finding Support
  • Allowances
  • Coordination of Services
  • Role of local NHS and Social Services
  • Hospitalisation and Blue Lights
  • Mini Mental Health Assessment
  • The chaos at the heart of the NHS
  • Access and Control

Pimp your podcast listening.

Over the last month, I have pimped by mobile phone podcast experience. Having used a fruit based product as my mobile for some years, I was happy to see the native Podcast app arrive with a recent upgrade. It has the advantage of being free (never underestimate the power of free in any marketing plan).

But I now prefer the heterogeneous world Android, so I have spent some time choosing an App. The best review I could find was on The Verge  so my choice is Shift Jelly’s Pocket Cast. If you don’t want to pay for an App then I think Stitcher is the best option. Now it’s just a matter of which casts? Here is my somewhat eclectic list:

From the BBC

  • In Our Time – has an extra bit on the end
  • Thinking Allowed
  • The Media Show
  • Front Row
  • Kermode & Mayo’s Film review – much more than just a repeat of the radio show

From The Economist

  • Editor’s Picks

From Penguin

  • Penguin Podcast with Richard E Grant

Independent –

  • The Journal by Kevin Rose
  • The Pen Addict
  • Cortex

Complaining about the NHS where will it lead?

When did the NHS decide that threats were better motivators than simple clear encouragement? I have blogged before about the NHS being a marketing-free zone. But recently the messages to the public and patients have become shriller.

Newspapers have been reporting patients barred from primary care practices for complaining. Banned for not using GP services and of course, there are the posters that state in intolerant terms the fate that anyone abusing verbally or otherwise members of staff.

When I see these posters I always wonder what must have happened to tip people over the edge that they would abuse staff, alcohol and drugs are obvious candidates, but perhaps there are other reasons like long waiting times for fearful and vulnerable people. These frustrations may trigger the fight or flight reaction in some leading to a clash. I am not saying that any of these actions by the public and patients should be tolerated against NHS staff, I merely wonder if the NHS is avoiding some issues. It is easier to blame the public then address the underlying issues.

So what do people actually complain about. When I was Director of Customer Relations for NHS England I conducted the first ever research, using the Polecat digital tools, into Feedback on NHS Choices. The results were surprising. Two main themes dominated the feedback, Communications and Professionalism, these 2 segments accounted for 80% of the feedback. The remaining 20% was a long tail of feedback on food (a British obsession), cleaning services, queuing (another obsession) and car parking.

These 2 major segments need unpacking a little:

Communications – the feedback here can refer to poor signage, complicated and repeatedly poorly written communications, late cancellations and even notification of appointments arriving after the date of the appointment

Professionalism – this seems to be a euphemism for rudeness of any type, but it can include incompetence in the eyes of the patient, cultural challenges, just being ignored and a poor bedside manner.

It is likely as Generation X and the Millennial generation show up we will see a more critical and detailed feedback. The challenge for the NHS is to embrace it rather than banning it.

NHS England Lesson 8 – Getting things done – the bias to inertia

A past CEO of the Kings Fund once described the NHS as being dynamically conservative, it shifts its shape to make resistance look like progress.

Lesson 8 – Here are 12 steps to getting something done:

  1. Know the change you want shape, don’t ask a committee to work it out for you

  2. understand the business priorities and frame your change in these terms

  3. get it into the Business Plan

  4. find academic evidence to support the change – harder than you think, but only new ideas have to have evidence, all the old ideas are just taken on trust .. bad luck!

  5. get the backing of a senior clinical leader (your choice here is important)

  6. take your case through the committees personally, don’t rely on the apparatchiks.

  7. find a supplier/delivery partner on “G-Cloud”. I advise against an internal delivery organisation.

  8. make sure you have it complete to stage 1 within 3 months

  9. Set up a cross ALB stakeholder group… otherwise someone else will

  10. Deliver incremental benefits and make sure the benefits deliver the cost savings,

  11. Market the service or change continually, get the nay sayers off your bus

  12. Make sure it remains within the business plan/5 year forward view/whatever the new name will be.. keep up the momentum.

That’s it, eight lessons from 30 months in NHS England, would I do it again, I think I will take the Redgrave oath on that one. So you can now do one of two things; pick apart my lessons, easy to do, I have kept this short, and things are never quite as bad or as good as I have suggested, and tell yourself that all of this is irrelevant, do remember that they are my lessons not yours, or, think deeply about what you are doing and see if we share any common ground. If we do then you know where to find me and perhaps we could add to the “what next” for the NHS in England.

NHS England Lesson 7 – A Marketing free zone.

Marketing is a blind spot and is misunderstood by almost everyone in NHS England. The worst excess of this lack of understanding is the “focus group of one”, the idea in the head of the senior person present becomes the received wisdom of the crowd. NHS England’s failure to engage with the needs of patient groups is the outcome of a complete lack of marketing attention to the public, patients and professionals.

Lesson 7 – make your voice heard, you will have to shout, no one is actively listening. Most likely, you are going to have to use something like 38 Degrees to crowdsource your power. We the public have far more “new power” than the NHS would like us to have. New power operates differently, like a current. It is made by many. It is open, participatory, and peer-driven. It uploads, and it distributes. Like water or electricity, it’s most forceful when it surges. The goal with new power is not to hoard it but to channel it.