- There is no listing of local services in the GP system.
- No method of auto referral, it’s “not at the touch of a button”.
- No reporting system telling the service provider someone is on the way
- Not even a referral letter that can be printed or emailed
- No Payment method for the service provider.
- No system to make sure the final payment is only taken on the delivery of the service.
- No Copayment system should the patient want to do more or add services
- No way of innovating new ideas such as:
- A reward split, GP pays £20 for service,
- £1 goes to GP to encourage use of non-pharma
- £15 goes to the provider for the service
- £4 goes to the patient for completing the course (it can be seen as covering transport costs or the like if you don’t like the “bribe” aspect of this)
- A reward split, GP pays £20 for service,
What should CEOs and boards understand:
- Protection of key information assets is critical
- How confident is the Board that the hospital’s most important information is being properly managed and is safe from cyber threats?
- Are you clear that the Board members are likely to be key targets?
- Does the Board have a full and accurate picture of:
- The impact on the Hospitals reputation, if the existence of sensitive internal or patient information held by the Hospital were to be lost or stolen?
- The impact on operational services if our online services were disrupted for a short or sustained period?
Exploring who might compromise information and why
- Does the Board receive regular intelligence from the Chief Information Officer/Head of Security on who may be targeting hospital information and IT, their methods and their motivations?
- Do the Board encourage the technical staff to enter into information-sharing exchanges with other organisations in the sector and across the economy to benchmark, learn from others and help identify emerging threats?
Pro-active management of the cyber risk at Board level is critical
- The cyber security risk impacts public confidence, reputation, culture, staff, information, process control, brand, technology, and finance. Is the Board confident that:
- They have identified the key information assets and thoroughly assessed their vulnerability to attack?
- Responsibility for the cyber risk has been allocated appropriately?
- Is it on the risk register?
- Does the Board have a written information security policy in place, which is championed by the Board and supported through regular staff training?
- Is the Board confident the entire workforce understands and follows it?
This week we will be focussing on understanding in more detail what our customers actually want. Too many startups build stuff that no one wants. It usually happens for one simple reason – they don’t get out of the office enough and speak to customers. You can help us by filling out this short questionnaire. And there is a chance of winning an Amazon voucher.
There are two important hypotheses that startups need to test:
- Their Growth Hypothesis-how are we going to attract customers and partners?
- Their Value Hypothesis – does what we build meet the minimum needs of our customer?
Last week we had the opportunity to talk to the CEO of AgeUK Lambeth, as an important partner of BriteLives we felt we needed to understand their challenges. But we also wanted to discover if they can help us find local services for the BriteLives platform. In doing so we were able of capture a little more understanding of the data to support our Growth Hypothesis.
We spent the last 24 hours Prototyping the BriteLives app with Marvel. It’s such a great tool and you can quickly get a feel from users what works and what fails. We went from paper to a Prototype on a phone in less than 3 hours.
How many assumptions do we make when setting out a plan to change or build something? It’s OK to make assumptions but it not OK if we don’t check that they’re correct. Looking back on my time in NHS England I can now see that very few of the assumptions made were ever checked. Here are some questions you might think about asking before you set out to do anything. This one checks some assumptions about searching for such services.
This set checks some assumptions we might make about people searching for services.
Do you look for local services?
- How often do you look for local services?
- Where do you look?
- Why do you bother?
- When did you last look for a service?
- What service did you find?
- Where did you find that service?
- When you found a relevant service did you book or use it?
- When did you last book a service?
- What are the implications to you personally of not finding services?
- When was the last time you failed or ran out of time to find a service
- Where or what else have you used to find services?
- Who else shall I talk to and is there anything else I should have asked?
What to avoid
- Talking about your idea and getting compliments about it
- Don’t get caught up in their ideas for your product/service or change idea
- Generic Claims, “I always/never…
- Future Claims – “I could/would…
- Hypothetical feedback – “I might/could…
The bottom line of this one, if people aren’t looking for services don’t build a service that provides a look-up service.
So, three things for any Senior Responsible Officer (SRO) in the NHS to do before a Project kicked off:
- Make sure the assumptions of the Project are identified.
- Test those assumptions with a number of audiences, users old and young, organisations and specialists etc.
- Make sure you have validated any learning from tests you make.
If you can’t do these three things; then don’t start.
Quick thought: Did anyone test the assumptions made before the Electronic Prescription Service was built?
Hello, we’ve had an idea that may change the way older people access local services. It stems from the challenges I faced caring for my Mother, but I guess you may have spotted that. We have been at it for eight weeks now and we have learnt a thing or two.
Lesson 1: Read The Lean Startup and once you have done that, read it again. It’s not about Startups it’s about constant innovation. It will save you time and more importantly money.
Lesson 2: Work out, as concisely as possible, how to describe your idea.
We started with:
“The leading marketplace to make the provision of personal, household and community services easier and more accessible, helping older people and their families live happier and more connected lives“.
We are now:
“BriteLives.com is the place where you can find and review local and personal services for older people.“
Cutting out those words was a great deal harder than writing them in the first place.
Pitch it to friends and to yourself. Make sure you do it slowly, accent the name of the Business. Something like:
“BriteLives.com (pause) is the place where you can find and review (pause) local and personal services (pause) for older people.“
Lesson 3: Join an innovation accelerator. You may be sceptical about the value, don’t be. You can’t think of everything, so let someone else force you to think about the relevant things and set some deadlines for you. It will accelerate the development of the idea more than you could imagine. We are part of BGV and wow what a difference they have made already.
Quick Test: Can you guess what BriteLives.com does?
In the fifth blog, I look at the role health and social care services played in the last nine months of my Mum’s life. I have already discussed the role of decision making and what to expect. So I will try not to repeat that here.
The support we received from the NHS was pretty good, a couple of times my Mum was discharged from hospital without medication, this caused a great deal of work for our GP. I would say the NHS did what it could, I would not say that my Mum’s care was world class, staff tried their best but they seemed distracted and unsupported most of the time. The NHS is clearly under pressure, but I did not get the feeling that more money would solve its problems. It was mainly poor process and lack of communication that caused most of the issues. Sadly I don’t think the Royal Surrey County Hospital in Guildford is a good hospital.
Such a short time
The NHS and Social Services are under so much pressure don’t expect to have much engagement unless it’s in their interests to do so. I seemed to me that everything they do is part of some fine financial judgement. At best I could expect health professionals to visit Mum less than 1 hour per week in any programmatic way. Yes, the GP came to the house, if requested, but community nurses will only come out if the NHS saw it as a way of stopping the use of a more expensive form of provision. In my Mum’s case, she realised that calling 999 was the only way of guaranteeing health service support. As a result, the local community team put a regular visit in place to help my Mother stay at home and not call 999. Surrey Social Services never visited my Mother.
This Community support was vital because it enabled me to have regular contact with my Mother’s care team and of course it gave my Mum the confidence she needed.
Filling out the endless Forms
You will find that you will need to fill out numerous forms, Blue Badge forms, support and attendance payments, access to services and complaints and feedback. All of them are long, complex and ambiguous. I would say that most of them are designed to make it impossible to complete them without specialist help. The worst of them is the National Reporting and Learning System (NRLS). Multiple pages of detail that you need to complete if you think you have witnessed unsafe care in an NHS establishment. (Note the name is pretty obscure, it’s probably meant to be.)
My top tip with Forms is to get the health and social care professionals to fill them out for you. And the only way to do that is the next top tip. If the Hospital wants you to do something, ask them to do something for you. So when it became apparent that my mum needed support at home, I asked social services and the discharge team in the hospital to complete the Attendance Allowance form for my Mum. Guess what, they did, and it was approved, and I took Mum home. The whole thing took less than 2 hours. We had spent some months trying to apply ourselves for the allowance with no success.
No sharing of information
I have mentioned in a previous blog the lack of sharing of information. Health and Social Care don’t share any significant information. So you will have to act as the coordination hub. Your phone camera is a great way of recording forms and general information.
The NHS doesn’t do email with patients and family
I found if hard to communicate with healthcare professionals, they don’t want to use Email as a channel. The best I could do was SMS, and even then some would not accept attachments such as photos of meds and reports. It seemed like a policy decision because everyone appears to have the same response.
It struck me that the Community team just needed a Customer/Patient Relationship Management system to stay efficiently connected to their workload.
My Top Tips
- Get help from healthcare professionals to fill out forms
- Collect the mobile phone numbers of people who are involved in care; you can then SMS them.
- Make it clear when it’s in the interests of the NHS to do or try something different. You may be able to change their support response and improve outcomes for everyone.
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
When will we hear an effective public and patient voice in the NHS? I am not sure we can wait much longer. Have a look at http://www.ted.com/talks/jeremy_heimans_what_new_power_looks_like
A number of people have asked me what is the promise of the NHS Constitution – here is my short summary:
1. The NHS provides a comprehensive service, available to all
2. Access to NHS services is based on clinical need, not an individual’s ability to pay
3. The NHS aspires to the highest standards of excellence and professionalism
4. The NHS aspires to put patients at the heart of everything it does
5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population
6. The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources
7. The NHS is accountable to the public, communities and patients that it serves