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From the Archives: The NHS — From Vocational Calling to Common Purpose · UK Column Radio

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  Speaker 1: Thanks for watching!
• 0:34
  Speaker 2: Good afternoon to the UK column viewers and listeners. I've
• 0:38
  Speaker 2: come back in the studio for an interview this afternoon
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  Speaker 2: with a gentleman, Duncan White. Duncan has sent me a
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  Speaker 2: lot of very interesting information in some emails, plus an
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  Speaker 2: attached document. And he's got a fascinating background, which I'm
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  Speaker 2: going to get him to tell us a little more
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  Speaker 2: about that. But what we're going to do today is
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  Speaker 2: at least start off with having a bit of a
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  Speaker 2: discussion about the NHS and some of the problems in
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  Speaker 2: the NHS. So without any more to do, Duncan, thank
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  Speaker 2: you very much for joining us today.
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  Speaker 3: Pleasure.
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  Speaker 2: You were kind enough to email in. So I'm just
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  Speaker 2: going to ask, how did you discover the UK column
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  Speaker 2: in the first place?
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  Speaker 3: Well, some years ago, I signed up because I came
• 1:33
  Speaker 3: across it from colleagues who advised me about it. And
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  Speaker 3: then more recently, I joined a conversation group who are very,
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  Speaker 3: very keen on UK Column and its news service and
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  Speaker 3: put me in touch with one of your correspondents, Debbie.
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  Speaker 3: And we went from there. Yeah, excellent.
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  Speaker 2: OK, thank you very much for that. It's always interesting
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  Speaker 2: to hear where people find us. And there are often
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  Speaker 2: interesting stories around that little saga. But I admit that
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  Speaker 2: at lunchtime, I just walked up the road from the
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  Speaker 2: UK Column Studio where there's a really excellent little food wagon.
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  Speaker 2: And as I was waiting for my toasted sandwich, one
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  Speaker 2: of the guys in the queue said, you're Brian. And
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  Speaker 2: I said, yes. And he said, well, I'd just like
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  Speaker 2: to say that I watch the UK column news with
• 2:30
  Speaker 2: my work colleagues and all my family watch as well.
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  Speaker 2: So he was in one of the one of the companies,
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  Speaker 2: the industrial units, just a few hundred yards up the
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  Speaker 2: road from the UK column. And as I said to him,
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  Speaker 2: it's always quite a boost when people do this because
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  Speaker 2: you think, yes, we are actually getting out and achieving
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  Speaker 2: an audience. So thank you for doing the same there, Duncan. Now,
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  Speaker 2: let's have a look. You sent me some interesting stuff
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  Speaker 2: about your background. You said you were a senior technical
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  Speaker 2: advisor to the UK home care sector for nearly five years.
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  Speaker 2: And you've worked on several working groups with the Care
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  Speaker 2: Quality Commission, the National Institute of Healthcare Excellence and Skills
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  Speaker 2: for Care. You've worked on some task force projects in
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  Speaker 2: the Department of Health and Social Care. You've also got
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  Speaker 2: an involvement with a motoring organisation, which I've lost that
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  Speaker 2: one at the moment. We'll come back on to that.
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  Speaker 2: And I believe you're also involved in a charity. So
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  Speaker 2: tell us a little bit about yourself. Set the scene
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  Speaker 2: for our viewers and listeners today.
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  Speaker 3: OK, well, I started off as a registered nurse in
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  Speaker 3: both mental health and acute services. And inevitably, the career
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  Speaker 3: path takes you into management. And I worked my way
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  Speaker 3: up to executive level in both acute and psychiatry before
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  Speaker 3: joining a private enterprise rescuing bankrupt nursing homes and turning
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  Speaker 3: around failing nursing homes before I embarked on a career
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  Speaker 3: with a City of London consultancy working in.
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  Speaker 3: Healthcare systems across the 10 countries, all four jurisdictions of
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  Speaker 3: the United Kingdom, plus six overseas projects and spent a
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  Speaker 3: couple of years in the Gulf. And on returning from
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  Speaker 3: the Gulf, I wasn't quite ready for retirement. So I
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  Speaker 3: worked as an advisor in home care services to a
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  Speaker 3: trade association. And that took me into working groups with
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  Speaker 3: the Department of Health, business, enterprise innovation and skills, working
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  Speaker 3: on things like implementing the Care Act and the Modern
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  Speaker 3: Slavery Act. And I worked also with the Care Quality Commission,
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  Speaker 3: Skills for Care, and various other project groups that gave
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  Speaker 3: me a very great understanding, a very broad understanding of
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  Speaker 3: how the bureaucracy behind the healthcare system works. And then
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  Speaker 3: since retirement, I've been working with a couple of charities.
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  Speaker 2: Okay, thank you for that. And I believe that you've
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  Speaker 2: also done some time with the army, is that right?
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  Speaker 3: Yes, I was commissioned into the Royal Army Medical Corps
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  Speaker 3: as a nursing officer and spent 12 years in frontline
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  Speaker 3: roles there. I never worked in army hospitals. I was
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  Speaker 3: always working with the infantry tank regiments and frontline formations.
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  Speaker 3: So I had a very lively involvement in places like Germany, Holland, Cyprus. Okay.
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  Speaker 3: All right.
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  Speaker 2: Thank you very much for that. Well, that's quite a
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  Speaker 2: spread of experience in a range of different sectors. And
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  Speaker 2: I can see that that puts you in a very
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  Speaker 2: good place for commenting on some of the things that
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  Speaker 2: you've seen happening in those particular areas. You sent me
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  Speaker 2: a very interesting text about the NHS. which starts off
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  Speaker 2: with the bulleted headline, Demand Failures. And I read through
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  Speaker 2: this with great interest, and I'd like really to talk
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  Speaker 2: through these subjects with you for the interview today. But
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  Speaker 2: before I do, I'd just like to tell a little
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  Speaker 2: anecdotal story, which you'll understand as I get into it.
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  Speaker 2: But many years ago, what would it be now? Well,
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  Speaker 2: I'm going to say probably about 15 years ago, I
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  Speaker 2: was up in London with a lady who'd had a
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  Speaker 2: professional career in the NHS. She'd worked her way up
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  Speaker 2: from nursing on the wards to ward sister. And then
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  Speaker 2: in later years, she'd moved across into NHS management and
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  Speaker 2: A little while before I went up to London to
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  Speaker 2: see her, she said to me that she'd taken on
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  Speaker 2: a new job at one of the London teaching hospitals.
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  Speaker 2: So it was a sunny Saturday morning, if I remember correctly,
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  Speaker 2: and we were in the back garden of her house
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  Speaker 2: up in London having breakfast. And I said to her,
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  Speaker 2: how is the new job going? And there was quite
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  Speaker 2: a long pause. And then she said, well, it's sort
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  Speaker 2: of frying pan and fire. And I said, well, that's
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  Speaker 2: a little bit, sounds a little bit unfortunate. You know,
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  Speaker 2: what's happening? And she said to me, well, the problem
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  Speaker 2: is I live in a world of meetings. We have
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  Speaker 2: planning meetings. We have strategy meetings. We have preparation meetings.
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  Speaker 2: We have this meeting and that meeting. And she said
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  Speaker 2: they're very time consuming and not a lot seems to
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  Speaker 2: come out of them. But she said, sometimes it's worse
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  Speaker 2: than not much happening. Things do come out of them,
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  Speaker 2: but they're the wrong things. And I said, what do
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  Speaker 2: you mean by that? And she said, well, there's quite
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  Speaker 2: a lot of experienced people sit around the table and
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  Speaker 2: they've been at the medical profession for some years and
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  Speaker 2: an idea will be put forward. And the experienced people
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  Speaker 2: automatically know this is not a good idea. And so diplomatically,
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  Speaker 2: they tell the more senior people the reasons why the
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  Speaker 2: proposed idea is not a good idea. But she said,
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  Speaker 2: what always happens is we're told to get on with it.
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  Speaker 2: So the idea is implemented. And then sure enough, in
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  Speaker 2: a matter of days or maybe weeks, the problems start.
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  Speaker 2: And then we've got the job of sorting out the
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  Speaker 2: problems and convincing the managers that their idea was the
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  Speaker 2: cause of all the problems in the first place. She said,
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  Speaker 2: it's madness. And I said to her, what if it's
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  Speaker 2: not madness? What if it's good management? And there was
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  Speaker 2: a long pause and the lady looked at me as
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  Speaker 2: if I was slightly mad, which is probably understandable. And
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  Speaker 2: I said, just answer the question. I said, you are
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  Speaker 2: making the assumption that the managers of that hospital want
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  Speaker 2: to run an efficient and effective hospital. But what if
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  Speaker 2: they're not? And she went very quiet for several minutes.
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  Speaker 2: And then she said, oh, my goodness, that explains that.
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  Speaker 2: And it explains that. And what I'd done is just
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  Speaker 2: challenged her and pushed her slightly away from the belief
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  Speaker 2: that the ideas were being put forward in order to
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  Speaker 2: help the hospital and I just got her thinking on
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  Speaker 2: the idea that maybe the proposals were deliberate ideas in
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  Speaker 2: order to create problems in the hospital. And I can
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  Speaker 2: tell you that sometime later, things got so bad in
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  Speaker 2: that particular hospital that the lady had to leave. And
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  Speaker 2: she left on the basis that she said, I just
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  Speaker 2: couldn't accept some of the working practices that were being
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  Speaker 2: enforced on people. But worst of all was when I
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  Speaker 2: tried to use my professional knowledge and experience to put
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  Speaker 2: things right, I was eventually invited to take some time
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  Speaker 2: off to look after my mental health. And so that's
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  Speaker 2: a little anecdotal story. And I wonder what your reaction
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  Speaker 2: is to that story before we get discussing your points.
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  Speaker 3: Yes, fascinating insight you have there into the machinations of
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  Speaker 3: the NHS. And I think there's two elements to this.
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  Speaker 3: I think, firstly, there are targets which have been set,
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  Speaker 3: which bear scant resemblance to clinical need or healthcare promotion.
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  Speaker 3: So you have perverse incentives to undertake courses of action
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  Speaker 3: that intuitively for a clinician, you know, are way off target.
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  Speaker 3: And from the learned management perspective, don't actually address the
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  Speaker 3: problems that they, as managers, are trying to remedy. So
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  Speaker 3: you get this conflict, this constant conflict going on at
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  Speaker 3: pretty much every level of decision-making within the NHS. The
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  Speaker 3: second factor, though, is perhaps a little more risque in
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  Speaker 3: as far as several years ago, we were asked at
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  Speaker 3: a very, very senior level to undertake a course of action.
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  Speaker 3: And I paraphrase to an extent when I say that
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  Speaker 3: the politicians and the bureaucrats wanted this by Tuesday. And
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  Speaker 3: the answer that I gave was that if you work
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  Speaker 3: for Mercedes-Benz or Bentley or someone and you decide you
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  Speaker 3: want to do a new car, you first of all,
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  Speaker 3: you identify the niche market. You do product viability studies.
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  Speaker 3: You do marketing tests. You do engineering viability studies. And
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  Speaker 3: you go through the design paradigm of working out the
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  Speaker 3: best design, the cheapest options, the most cost effective options
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  Speaker 3: and so on and so forth. And then you do
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  Speaker 3: customer relations exercises. And that takes quite a long time.
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  Speaker 3: And if you're working for Mercedes or Bentley or whoever,
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  Speaker 3: that takes a long time and it's part and parcel
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  Speaker 3: of developing a new car. In the NHS, a bureaucrat
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  Speaker 3: decides something is a good idea and wants it by Tuesday.
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  Speaker 3: Forget anything about whether this is matched to needs, whether
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  Speaker 3: it addresses a particular health problem, or whether it is
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  Speaker 3: the latest management wheeze. And a very good example of
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  Speaker 3: that is the four-hour accident emergency waits, which have absolutely
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  Speaker 3: nothing to do with clinical priority, medical needs, or whether
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  Speaker 3: that actually addresses patient needs. I mean, it's just nonsensical.
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  Speaker 3: So I absolutely buy into your colleague's frustrations with the
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  Speaker 3: system and readily accept that after a certain amount of time,
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  Speaker 3: she had to move on for her health and wellbeing.
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  Speaker 3: And I very much reflect that because in my own experience,
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  Speaker 3: I got to a point where I could see the
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  Speaker 3: future rolling out as a chief executive of a trust
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  Speaker 3: or whatever, And when you look at these people, they've
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  Speaker 3: got gravestones in their eyes because the pressure on them
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  Speaker 3: from the political system and the politicized system is such
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  Speaker 3: that the scope of flexibility, the scope of creativity and
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  Speaker 3: entrepreneurialism to identify and address those problems is taken out
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  Speaker 3: of your hands completely. You're in the hands of a
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  Speaker 3: bureaucratic machine that dictates and very difficult. Very difficult. I
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  Speaker 3: got out as well.
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  Speaker 2: OK, now it's interesting there, Duncan, because very quickly you've
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  Speaker 2: mentioned the politicisation of organisations. And I spotted that in
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  Speaker 2: the second sentence. The first topic that you had on
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  Speaker 2: this sheet was demand failure.
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  Speaker 3: Yes.
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  Speaker 2: Perversely designed into the NHS by fault. And then you
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  Speaker 2: say the demand failure leads to the politicization of organizations.
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  Speaker 2: I think I know what you're talking about there. How
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  Speaker 2: do you come to that conclusion that when the demand
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  Speaker 2: failure is in flow, the politicization follows?
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  Speaker 3: Yes, it's a very interesting anthropological position to find yourself in.
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  Speaker 3: when you're working as a consultant in hospitals who have
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  Speaker 3: really quite desperate problems that need unraveling, that need some
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  Speaker 3: formula to get them out of this uncontrollable mess, what
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  Speaker 3: happens is that organizations that are large and dispersed and
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  Speaker 3: are very diverse in their service offering and in their
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  Speaker 3: in their presence in the community, they become very susceptible
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  Speaker 3: to turf wars. And what happens is that if you
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  Speaker 3: phone the organization up and the first person you come
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  Speaker 3: into contact with has no idea what to do or
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  Speaker 3: no idea how to respond to this request, you know
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  Speaker 3: you're in a bureaucracy. And what happens is, within the NHS,
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  Speaker 3: is that no one person has the answer to anything particularly.
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  Speaker 3: So you find yourself in a situation where you are
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  Speaker 3: confronted by this monolithic organization. And every turn you take,
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  Speaker 3: you are deferred onto someone else or another department or
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  Speaker 3: another referral pathway. And what then happens is that 80%
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  Speaker 3: of the time, the staff in the organization gets spent
• 16:57
  Speaker 3: trying to unravel this problem. And, and, When you go
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  Speaker 3: in as a consultant, you try to design what they
• 17:04
  Speaker 3: call a service line or a clinical pathway that sort
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  Speaker 3: of draws a straight line between the patient enters the
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  Speaker 3: system here and the patient exits the system there. And
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  Speaker 3: you try and draw a straight line between the two.
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  Speaker 3: The reality is that instead of having a straight line,
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  Speaker 3: you have a very convoluted line referring backwards and forwards.
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  Speaker 3: And the staff spend, in certainly many of the cases described,
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  Speaker 3: situations I was involved in as a consultant clinician, staff
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  Speaker 3: can spend 80% of their time trying to unravel these
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  Speaker 3: convolutions and distortions in service provision and the left with
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  Speaker 3: only 20% of their time actually dealing with the patient,
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  Speaker 3: which means that the lowest possible grade of staff, the
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  Speaker 3: cheapest grade of staff, get to do the vast majority
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  Speaker 3: of the work. The unqualified care assistant, the freshly qualified
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  Speaker 3: house officer, and so on and so forth. So you
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  Speaker 3: land up with this politicization of turf wars and silos
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  Speaker 3: where it's not their problem, it's someone else's problem. And
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  Speaker 3: the quicker they can refer you on to someone else
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  Speaker 3: and discharge the problem to somewhere else is how the
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  Speaker 3: system works. And as a patient going in, you find
• 18:21
  Speaker 3: yourself confronted with this monolithic organizational opaque functionality that just
• 18:28
  Speaker 3: doesn't explain itself, doesn't become apparent in terms of what's happening. Now,
• 18:35
  Speaker 3: when you're a nurse and you come in as a patient,
• 18:38
  Speaker 3: or when you've been working as a consultant overseas and
• 18:41
  Speaker 3: you come back to England as a foreigner and you
• 18:45
  Speaker 3: see what's happening through foreigners' eyes, you are awakened to
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  Speaker 3: this extraordinary silo thinking and this extraordinary amount of almost
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  Speaker 3: sort of confrontational combat between different organisations. And certainly my
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  Speaker 3: own experience was such that you fought tooth and nail
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  Speaker 3: for resources and you didn't give thought or passage to
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  Speaker 3: any other considerations. You were forced into this silo of
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  Speaker 3: thinking where you defended your own patch against all oncomers.
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  Speaker 3: And so you'd end up with medical staff fighting their
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  Speaker 3: little turf wars, You'll end up with nurses fighting for
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  Speaker 3: more resources. And of course, the patient at the bottom
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  Speaker 3: of the pile, well, conveniently gets forgotten. Yeah.
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  Speaker 2: And if we put the size of the beast to
• 19:41
  Speaker 2: the public, and you correct me if I've got this wrong,
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  Speaker 2: but I think the NHS total budget is somewhere over
• 19:48
  Speaker 2: 120 billion a year and I believe they employ over 55,000
• 19:55
  Speaker 2: that's the figure that comes into my head 55,000.
• 19:59
  Speaker 3: I think you'll find it's nearer one and a half million.
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  Speaker 2: Okay well give us more on that Where are those people? Oh,
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  Speaker 2: I suppose those are across all the, not just hospital sector,
• 20:15
  Speaker 2: those across the whole of the care sector as well.
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  Speaker 3: Well, I mean, the home care sector, care in your
• 20:23
  Speaker 3: own home is entirely different and is run separately by
• 20:27
  Speaker 3: local authorities. And there's about 1.7 million people working in
• 20:32
  Speaker 3: home care. In the NHS, we have a situation where
• 20:36
  Speaker 3: we have Last time I looked, it was about 1.4
• 20:40
  Speaker 3: million people working in the NHS. Now, that's not just
• 20:43
  Speaker 3: hospital doctors, hospital nurses, it's community staff, it's outreach staff,
• 20:50
  Speaker 3: district midwives, all that sort of entourage of people. One
• 20:55
  Speaker 3: of the most disturbing elements, I think, that has come
• 21:00
  Speaker 3: over the last decade or so is that NHS England
• 21:03
  Speaker 3: was invented. as a sort of parent body to control
• 21:07
  Speaker 3: and govern the functionality of the NHS, to smooth it out,
• 21:11
  Speaker 3: to make it more lean, to make it more responsive.
• 21:14
  Speaker 3: And here we are 10 or 11 years later, and
• 21:16
  Speaker 3: we find that NHS England, far from being that entrepreneurial, innovative,
• 21:23
  Speaker 3: developmental organization, is actually a staggering bureaucracy of 14,000 people
• 21:30
  Speaker 3: working in NHS England headquarters and its regional offices. So
• 21:34
  Speaker 3: these 1.4 million people are dispersed across the entire spectrum
• 21:38
  Speaker 3: of the NHS. And the bureaucracy, like all empires, goes
• 21:45
  Speaker 3: on breeding at will. And it's now very interesting to
• 21:49
  Speaker 3: hear that there are rumours, ugly rumours within Whitehall, that
• 21:54
  Speaker 3: they may have to take NHS England and the NHS
• 21:57
  Speaker 3: itself back under direct control of the Secretary of State
• 22:02
  Speaker 3: and to... to appoint that person as the top manager,
• 22:09
  Speaker 3: the ultimate responsibility for the NHS, which would be quite revolutionary, really.
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  Speaker 3: The bureaucracy has become a self-serving beast that just goes
• 22:23
  Speaker 3: on multiplying ad nauseum.
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  Speaker 2: And do you think that this bureaucracy has... developed of
• 22:32
  Speaker 2: its own accord, or is this something that has resulted
• 22:36
  Speaker 2: from planned and imposed policy?
• 22:41
  Speaker 3: Interesting point. What has happened on many, many occasions is
• 22:48
  Speaker 3: that a political initiative or a change in the law
• 22:51
  Speaker 3: is implemented, and the response from the NHS has been, well,
• 22:56
  Speaker 3: to implement that we need X number of additional staff.
• 23:02
  Speaker 3: So with every legislative maneuver, every ministerial diktat, stroke of
• 23:08
  Speaker 3: a minister's pen, the bureaucracy that that then creates starts
• 23:16
  Speaker 3: to burst into action, starts to breed itself. And you
• 23:21
  Speaker 3: find that whole departments start to evolve. and develop and
• 23:28
  Speaker 3: increase in their manpower, headcount. And you find that whereas
• 23:37
  Speaker 3: something in, say, one country was operating quite effectively, quite smoothly,
• 23:45
  Speaker 3: you come back to the NHS, come back to England,
• 23:48
  Speaker 3: to the NHS, and you find that it's been gold-plated,
• 23:51
  Speaker 3: that the bureaucrats have added additional features to that ministerial
• 23:56
  Speaker 3: dictate or that legislative measure. And you land up with
• 24:01
  Speaker 3: five gold stars bolted onto the side of this, what
• 24:05
  Speaker 3: the minister thinks was a very simple, very straightforward exercise
• 24:09
  Speaker 3: in smoothing out the care process, the hospital management process.
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  Speaker 3: And it just goes on replicating itself. Um, And it's
• 24:22
  Speaker 3: quite frightening to see it in action.
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  Speaker 2: OK, thank you for that. While you were talking, the
• 24:29
  Speaker 2: other point that came into my mind was the issue
• 24:33
  Speaker 2: of privatisation, because over the years, we've come into contact
• 24:37
  Speaker 2: with a number of medical professionals. Indeed, several years ago,
• 24:42
  Speaker 2: we set up an NHS conference where we had a
• 24:46
  Speaker 2: number of very good speakers talking about their experience of
• 24:50
  Speaker 2: what was happening in the NHS. And they varied from
• 24:55
  Speaker 2: clinical specialists, doctors, essentially, were talking about what was happening
• 25:02
  Speaker 2: inside the NHS in relation to care. We also had
• 25:06
  Speaker 2: one lady who had got considerable experience inside the financial
• 25:13
  Speaker 2: systems of the NHS, and she talked about everything from
• 25:18
  Speaker 2: fraud and corruption. But the theme that I'm going to
• 25:22
  Speaker 2: say most of the speakers came out with is damage
• 25:27
  Speaker 2: being done by privatisation, that although the government was constantly
• 25:33
  Speaker 2: selling the NHS as a national treasure, which was safe,
• 25:39
  Speaker 2: behind the scenes what was happening was that elements of
• 25:43
  Speaker 2: the NHS were being sold off bit by bit, step
• 25:47
  Speaker 2: by step. And this, I can remember some of these
• 25:51
  Speaker 2: speakers were saying they believed was a key problem because
• 25:56
  Speaker 2: it wasn't as if the bureaucracy was allowed to get
• 26:00
  Speaker 2: on with itself. It had also got nibbling away at it,
• 26:05
  Speaker 2: a sort of cancerous privatisation. Do you recognise any of
• 26:10
  Speaker 2: that sort of description or do you think those people
• 26:13
  Speaker 2: didn't quite see it correctly?
• 26:17
  Speaker 3: Firstly, I absolutely do see that situation. And secondly, I
• 26:21
  Speaker 3: think they've got it wholesale wrong. I think, firstly, the
• 26:26
  Speaker 3: NHS has not been privatised. What has happened in several instances,
• 26:31
  Speaker 3: and I've been involved intimately with several contracts, is that
• 26:35
  Speaker 3: certain services have been contracted out. But that contract is
• 26:41
  Speaker 3: exactly the same contract as an NHS provider would have. Now,
• 26:47
  Speaker 3: in competitive tendering, and particularly in the days of primary
• 26:51
  Speaker 3: care trusts, maybe 10, 12 years ago, Gordon Brown came
• 26:58
  Speaker 3: up with the idea of a walk-in clinic, a Darcy clinic.
• 27:05
  Speaker 3: I was responsible with five primary care trusts across the
• 27:08
  Speaker 3: country for implementing that scheme. And those contract tenders went
• 27:13
  Speaker 3: out to anybody who was interested in tendering. So there
• 27:17
  Speaker 3: were NHS hospitals, NHS trusts who were tendering, and there
• 27:21
  Speaker 3: were private health provider organizations that tendered. And the most
• 27:27
  Speaker 3: economically advantageous tenders were always from the private sector, always, 100%.
• 27:34
  Speaker 3: And this is an important fact. It's not about the
• 27:36
  Speaker 3: cheapest bid. It's about the most economically advantageous tender. And
• 27:42
  Speaker 3: where people are very concerned about the purported privatization of
• 27:50
  Speaker 3: the NHS, I think they are mistaken. The NHS, I mean,
• 27:55
  Speaker 3: you have to go back to founding principles. You cannot
• 27:58
  Speaker 3: create an entrepreneurial business innovative creative organization from a 36
• 28:05
  Speaker 3: layered bureaucracy that is stodgy unmoving entrenched and incapable of
• 28:13
  Speaker 3: moving outside of its own parameters of thinking out of
• 28:17
  Speaker 3: its own little box of thinking so when you come
• 28:20
  Speaker 3: across tenders for creative new services and that's worked in
• 28:26
  Speaker 3: psychiatry as well as acute services as well as primary care,
• 28:30
  Speaker 3: frontline services. What you're looking for is innovative, creative solutions
• 28:36
  Speaker 3: to an established, recognised problem. Now, what I would suggest
• 28:40
  Speaker 3: is that we don't need to privatise the NHS. What
• 28:44
  Speaker 3: we do need to do is denationalise it. And that's
• 28:47
  Speaker 3: a very subtle difference because privatising it is selling it
• 28:50
  Speaker 3: off to the highest bidder. Denationalising it is taking it
• 28:54
  Speaker 3: out of the hands of the politicians and the bureaucrats
• 28:57
  Speaker 3: and letting local organizations flourish and develop and respond to
• 29:03
  Speaker 3: local priorities in a way that they otherwise can't do
• 29:07
  Speaker 3: because of national targets and medical protocols and whatever else.
• 29:12
  Speaker 3: So if you remove that blockage, that massive blockage, and unchain,
• 29:20
  Speaker 3: and you unchain the energy that is inherent within the
• 29:24
  Speaker 3: professional people that work within the NHS, We've seen that
• 29:28
  Speaker 3: happen where doctors who complain about the NHS being privatized,
• 29:33
  Speaker 3: toggle off down the road in their Jaguars and their
• 29:35
  Speaker 3: Bentleys and work in the private hospital five miles down
• 29:38
  Speaker 3: the road and get enormous salaries for that privilege. And
• 29:42
  Speaker 3: our stakeholders, their shareholders in those private hospitals, even geriatricians
• 29:47
  Speaker 3: and psychiatrists do the same. So it's very much a
• 29:52
  Speaker 3: false narrative. And I think that unless we can face
• 29:58
  Speaker 3: up to the fact that that the NHS as it
• 30:01
  Speaker 3: stands today, as it functions today, it can't carry on
• 30:06
  Speaker 3: like this. We cannot go on like this. We have
• 30:09
  Speaker 3: to create something better and different. And I think the
• 30:12
  Speaker 3: primary answer to that falls into two categories. One, we
• 30:16
  Speaker 3: need quality assurance driven by contracts. And secondly, we need
• 30:21
  Speaker 3: to denationalise and create out of what are currently NHS trusts,
• 30:26
  Speaker 3: we need to create private enterprise that is owned by
• 30:32
  Speaker 3: the public, governed by public authorities, but has the entrepreneurial
• 30:37
  Speaker 3: capacity and permission to function like a private company in
• 30:42
  Speaker 3: that locality. And until we get to that level, we're sunk. Yes.
• 30:49
  Speaker 2: Duncan, absolutely fascinating to hear you say that. And as
• 30:55
  Speaker 2: you were talking through nationalisation, two things came into my mind.
• 31:03
  Speaker 2: One was, it's a shame that David Scott is not
• 31:06
  Speaker 2: sat with me because this is one of the areas
• 31:09
  Speaker 2: that he's talked about numerous, to me, not on record,
• 31:15
  Speaker 2: but he's spoken to me about how he sees healthcare provision.
• 31:21
  Speaker 2: And he's talked about the fact that going back in time,
• 31:26
  Speaker 2: you would have the doctors serving their local community and
• 31:32
  Speaker 2: people might be paying the doctors in those days direct
• 31:36
  Speaker 2: you go and see the doctor and the doctor does
• 31:38
  Speaker 2: something and he's paid direct by the patient but that
• 31:41
  Speaker 2: was also a time when if necessary the doctor would
• 31:45
  Speaker 2: travel to the home of the patient to see them
• 31:48
  Speaker 2: so there was quite a simple element of commercial transaction
• 31:55
  Speaker 2: together with the provision of the healthcare at the doctor level.
• 31:59
  Speaker 2: But of course, the other thing was that the centre
• 32:03
  Speaker 2: probably of healthcare would be based on the local hospital.
• 32:09
  Speaker 2: And that might have a couple of elements to it,
• 32:12
  Speaker 2: because we could have the local hospital, which could be
• 32:15
  Speaker 2: relatively big. And in bigger cities, it would be supported
• 32:20
  Speaker 2: by even more local cottage-style hospitals, which I can just
• 32:27
  Speaker 2: about remember in my own lifetime would have provided either
• 32:33
  Speaker 2: simple medical treatment, somebody got a bad cut or they'd
• 32:41
  Speaker 2: broken a leg, they could go to the local cottage
• 32:43
  Speaker 2: hospital for that. But the other thing that the local
• 32:46
  Speaker 2: cottage hospital might do is provide care for a very
• 32:52
  Speaker 2: elderly patient who was perhaps recovering after an operation in
• 32:55
  Speaker 2: the slightly bigger hospital. What I'm really describing is that
• 33:00
  Speaker 2: the health care was centred around these hospital units, which
• 33:05
  Speaker 2: were automatically at a local level. Is it the case
• 33:12
  Speaker 2: that we should be thinking about perhaps going back to
• 33:15
  Speaker 2: this This idea, instead of a vast hospital, one in Plymouth,
• 33:24
  Speaker 2: Derriford Hospital, I think on a full capacity day has
• 33:28
  Speaker 2: about six and a half thousand people in there, patients
• 33:31
  Speaker 2: and staff, that we should be sort of decentralising and
• 33:35
  Speaker 2: heading back towards this local hospital provision. Does that make sense?
• 33:42
  Speaker 3: Yeah, that makes absolute sense. And it would be good
• 33:45
  Speaker 3: to have a conversation with your colleague about that. And
• 33:48
  Speaker 3: I think there are, again, a couple of problems associated
• 33:52
  Speaker 3: with this, with the current format, the current disposition of
• 33:56
  Speaker 3: the NHS. I think your colleague and yourself have come
• 34:00
  Speaker 3: across one of the great answers to one of the
• 34:03
  Speaker 3: great problems of step-down facilities. Now, we have hospitals full
• 34:10
  Speaker 3: of people who are medically fit, The medical system can't
• 34:14
  Speaker 3: make any further contribution to their medically fit for discharge.
• 34:18
  Speaker 3: But home care, social care can't get them out. So
• 34:20
  Speaker 3: we have bed blocking, which is a very unpopular phrase.
• 34:24
  Speaker 3: But nevertheless, it describes exactly what is happening. And if
• 34:28
  Speaker 3: we had step down facilities that a hospital could say, OK,
• 34:33
  Speaker 3: someone is medically fit, but not socially fit for discharge.
• 34:36
  Speaker 3: They can go to a step down facility in days
• 34:40
  Speaker 3: of yore. that would have been the community hospital. And
• 34:44
  Speaker 3: one of the most unfortunate jobs I ever had was
• 34:47
  Speaker 3: to decommission a community hospital. And everybody locally was up
• 34:51
  Speaker 3: in arms because it was seen as an absolutely pristine
• 34:55
  Speaker 3: facility supported by a league of friends, money poured in,
• 34:59
  Speaker 3: but nevertheless, the local health authority were determined to bulldoze
• 35:02
  Speaker 3: it and did. So if we had step-down facilities where
• 35:08
  Speaker 3: patients could move out of acute hospital settings, into a
• 35:11
  Speaker 3: caring environment that would be led by not just nurses,
• 35:15
  Speaker 3: but occupational therapists, physiotherapists, so that the therapeutic element was
• 35:21
  Speaker 3: still there, was very much present, very much there on demand,
• 35:25
  Speaker 3: but you'd moved out of the medical sphere of influence
• 35:29
  Speaker 3: into the therapeutic sphere of influence. That, I think, would
• 35:32
  Speaker 3: be an absolutely essential step forward for the NHS to
• 35:36
  Speaker 3: embark on. The second element to this is the role
• 35:39
  Speaker 3: of the general practitioner. The general practitioner is divorced from
• 35:43
  Speaker 3: the wider NHS. They live in little silos in little
• 35:48
  Speaker 3: private businesses dotted all over the place. And my experience
• 35:53
  Speaker 3: of working with NHS GPs is that after about year
• 35:57
  Speaker 3: seven in post, they're bored out of their tree. So
• 36:01
  Speaker 3: if we could get GPs integrated into the wider clinical sphere,
• 36:05
  Speaker 3: so you could have a GP who was an orthopaedic specialist,
• 36:09
  Speaker 3: recognized as part of the hospital orthopedic team a gastroenterology
• 36:14
  Speaker 3: specialist part of the gastroenterology team in the general hospital
• 36:18
  Speaker 3: you could start integrating properly the hospital and primary care
• 36:23
  Speaker 3: into a seamless service where specialists and expertise move between
• 36:28
  Speaker 3: the two at the moment you're stuck in a silo
• 36:33
  Speaker 3: you can't get out of it and it it it
• 36:36
  Speaker 3: wrecks the clinical pathway, it wrecks the service line management,
• 36:40
  Speaker 3: it costs us a fortune in terms of NHS budgets,
• 36:45
  Speaker 3: and it delays patient care. So I think your colleague
• 36:48
  Speaker 3: and yourself in that conversation have hit the proverbial nail
• 36:51
  Speaker 3: on the head.
• 36:53
  Speaker 2: Okay, thank you for that. I lost over the number
• 36:56
  Speaker 2: of people employed, I got that one badly wrong, but
• 37:02
  Speaker 2: I've clawed some points back on this one. What did
• 37:07
  Speaker 2: I want to say on that?
• 37:08
  Speaker 3: Yes, okay.
• 37:09
  Speaker 2: Well, if this has got the seeds of a good
• 37:14
  Speaker 2: idea about it, have you ever seen this sort of
• 37:17
  Speaker 2: thing proposed to the people at high level who are
• 37:21
  Speaker 2: supposedly worrying about the demise of the NHS and what
• 37:27
  Speaker 2: to do to save the beast?
• 37:32
  Speaker 3: Yes, I have made that suggestion. And when I was
• 37:34
  Speaker 3: on the Care Act, implementation task and finish group, a
• 37:40
  Speaker 3: glorified title if ever I heard. I and two or
• 37:44
  Speaker 3: three others were very keen to promote the idea that
• 37:47
  Speaker 3: you should have step-down facilities and that it would be
• 37:50
  Speaker 3: entirely legitimate for the NHS to open nursing homes for
• 37:54
  Speaker 3: want of a better title so that people could move
• 37:57
  Speaker 3: out into a care environment. And I think the The
• 38:06
  Speaker 3: bigger picture in terms of trying to get that idea
• 38:10
  Speaker 3: across immediately comes up against the NHS Hospital Trust turf, territory.
• 38:21
  Speaker 3: And hospitals get their money in different ways from various methods.
• 38:29
  Speaker 3: But the problem for them would be How would they
• 38:32
  Speaker 3: get the money to pay for those step-down facilities, for
• 38:35
  Speaker 3: those community hospitals? Would it be a separate organisation? Should
• 38:39
  Speaker 3: it be a separate organisation? Or should the main major
• 38:44
  Speaker 3: hospital hang on to it, control it and run it?
• 38:49
  Speaker 3: And there's a case to be made for either. But
• 38:52
  Speaker 3: in terms of taking that idea up to the Department
• 38:55
  Speaker 3: of Health, and as I say, particularly when I was
• 38:58
  Speaker 3: working on an implementation task force up there, They wouldn't
• 39:03
  Speaker 3: hear of it. It was absolutely unheard of. They would
• 39:07
  Speaker 3: not entertain the idea that the major thrust is consolidation.
• 39:12
  Speaker 3: You get all the major services into one big hospital.
• 39:16
  Speaker 3: You look at St. James's in Leeds, massive, monumentally huge hospital.
• 39:21
  Speaker 3: And one of the arguments that was very much currency
• 39:25
  Speaker 3: at the time was that small hospitals can't provide the
• 39:29
  Speaker 3: level of expertise to keep consultant medical staff and clinical
• 39:35
  Speaker 3: nurses up to speed with the latest developments. You need
• 39:39
  Speaker 3: a big university teaching hospital to do that. So small
• 39:42
  Speaker 3: hospitals of about 350 beds or less their future is
• 39:48
  Speaker 3: very much under threat. So you have this huge industry
• 39:54
  Speaker 3: around big hospitals, and we haven't learned the lessons that
• 39:59
  Speaker 3: France and Germany and other countries have, where you have
• 40:02
  Speaker 3: smaller community facilities that can accommodate a lot of the subacute,
• 40:08
  Speaker 3: step-down patients. And that is a serious... error in planning
• 40:17
  Speaker 3: a serious mistake in thinking about how to organize and
• 40:22
  Speaker 3: corral the resources and the energy you've got in the
• 40:25
  Speaker 3: health system.
• 40:28
  Speaker 2: Right that's extremely interesting because um uh i'm still coming
• 40:37
  Speaker 2: to terms with the fact that you took away the
• 40:39
  Speaker 2: privatization bit which i'm very happy to accept but this
• 40:44
  Speaker 2: in my own mind was one of the key problems.
• 40:47
  Speaker 2: And now you've got me thinking that in the first instance,
• 40:51
  Speaker 2: we've got the power of the bureaucratic monster, which is
• 40:56
  Speaker 2: going to defend itself at every opportunity because people have
• 41:00
  Speaker 2: got jobs and they're very highly paid. I was always
• 41:04
  Speaker 2: very interesting when I started to realise that we'd suddenly
• 41:09
  Speaker 2: gone to degree chief executives a management degree, chief executives
• 41:17
  Speaker 2: of hospitals. So these, I don't know how many years
• 41:20
  Speaker 2: ago this started, but it was the professional training of
• 41:26
  Speaker 2: hospital CEOs. And those individuals were then walking into extremely
• 41:33
  Speaker 2: highly paid jobs. I mean, I think some of the
• 41:36
  Speaker 2: bigger teaching hospital chief executives are on about £ 260, 000 or
• 41:43
  Speaker 2: or were a few years ago. And that always says
• 41:46
  Speaker 2: to me that people who are in a job on
• 41:48
  Speaker 2: that level of payment are not going to give up
• 41:51
  Speaker 2: their job easily. And they're also going to defend their
• 41:55
  Speaker 2: patch against anything which they think is a threat, you know,
• 42:00
  Speaker 2: to their livelihood. So I can see through money itself
• 42:06
  Speaker 2: how people can quickly be controlled. But the other thing
• 42:10
  Speaker 2: these chief executives demonstrated was a break between people going
• 42:16
  Speaker 2: into the medical system out of a desire to help people,
• 42:23
  Speaker 2: to look after them, to care for the sick and injured.
• 42:27
  Speaker 2: And you had these professionals who were coming in from
• 42:31
  Speaker 2: a business management and a fiscal management point of view.
• 42:36
  Speaker 2: And I always felt that was the start of something
• 42:39
  Speaker 2: not very good in the NHS, that you no longer
• 42:44
  Speaker 2: had a hospital where probably the key decisions on all
• 42:48
  Speaker 2: matters were made by consultants.
• 42:53
  Speaker 3: Yes, it was and remains a significant problem. And there
• 42:59
  Speaker 3: were two occasions where I ran into that head first,
• 43:04
  Speaker 3: as it were. On one occasion in a hospital in
• 43:08
  Speaker 3: the very southern end of the Midlands, they had employed
• 43:14
  Speaker 3: a 29-year-old directorate manager, directorate general manager, who was not
• 43:19
  Speaker 3: a clinician. He had come out of university with a
• 43:23
  Speaker 3: BA or something and gone straight in to do his MBA.
• 43:27
  Speaker 3: And at the age of 29, got an executive director's
• 43:30
  Speaker 3: role of a large medical unit in a district general hospital.
• 43:35
  Speaker 3: And it took about four months for the senior hierarchy
• 43:40
  Speaker 3: to realize that they had a catastrophe on their hands.
• 43:45
  Speaker 3: And on a second occasion, I met a 35-year-old who
• 43:48
  Speaker 3: had come from car manufacturing, done his MBA, and had
• 43:53
  Speaker 3: decided the health service was rich pickings and moved in
• 43:57
  Speaker 3: and lasted 15 months. And it then took the clinicians, nurses,
• 44:03
  Speaker 3: two years to sort the mess out. Now, that's not
• 44:05
  Speaker 3: to say that people coming in from outside are bad.
• 44:10
  Speaker 3: I've got an MBA myself because I recognised early on
• 44:14
  Speaker 3: in the early 90s that you were going to get
• 44:15
  Speaker 3: nowhere unless you had a DMS and an MBA. But
• 44:19
  Speaker 3: it soon became apparent that people who have no hospital experience,
• 44:24
  Speaker 3: no clinical background, take an inordinate amount of time to
• 44:30
  Speaker 3: assimilate themselves into the hospital culture. It is vastly different
• 44:34
  Speaker 3: And there was that apocryphal case of the brigadier who
• 44:37
  Speaker 3: took over Nottingham General Hospitals and assumed that the medical
• 44:41
  Speaker 3: consultants would be his officer's mess and that they would
• 44:45
  Speaker 3: have power hours in the officer's mess until the clinical
• 44:49
  Speaker 3: consultants ganged up on him and threw him out. And
• 44:52
  Speaker 3: he didn't last very long at all. That brigadier was
• 44:55
  Speaker 3: severely traumatised by that situation. So I think we need
• 45:01
  Speaker 3: to get a real sense of balance about about how
• 45:06
  Speaker 3: we're led and about how NHS Trust are led. Undoubtedly,
• 45:10
  Speaker 3: you need business acumen, but I think it's probably more
• 45:14
  Speaker 3: important to know your product. I mean, would you employ
• 45:17
  Speaker 3: a medical doctor to run the production line at Ford
• 45:21
  Speaker 3: Cars or the nuclear submarine yard in Barrow-in-Furness? Well, probably not.
• 45:26
  Speaker 3: So you need to get a sense of balance around
• 45:28
  Speaker 3: it and you need to work hard on getting those
• 45:32
  Speaker 3: people up to speed in terms of the culture and
• 45:34
  Speaker 3: the operationalization of healthcare. And there was a fast track
• 45:40
  Speaker 3: course a few years ago where doctors, dentists who decided
• 45:44
  Speaker 3: they want to get into management could go on a
• 45:46
  Speaker 3: fast track system and work their way around a hospital
• 45:49
  Speaker 3: for a couple of years and then take over as
• 45:53
  Speaker 3: assistant chief exec or something. And that didn't last very
• 45:57
  Speaker 3: long either. It's a very fine, line you have to
• 46:03
  Speaker 3: walk in terms of getting the right skills the right
• 46:06
  Speaker 3: business acumen and the right industry knowledge to take over
• 46:10
  Speaker 3: and run a trust it's it's been done it's been
• 46:12
  Speaker 3: done well but there have been some serious accidents on
• 46:16
  Speaker 3: route okay and as for as for earning quarter of
• 46:21
  Speaker 3: a million quid i mean how many nurses could you
• 46:25
  Speaker 3: employ for quarter of a million quid i mean just
• 46:28
  Speaker 3: bonkers in it.
• 46:29
  Speaker 2: Yeah um OK, a number of points coming to my mind.
• 46:35
  Speaker 2: The other one that I was interested in was when
• 46:39
  Speaker 2: we started to see nurses put on degree courses. And
• 46:46
  Speaker 2: so originally a nurse would go to a hospital to
• 46:50
  Speaker 2: begin training and she would inevitably in those days be
• 46:57
  Speaker 2: a she. Now, of course, it could be a man
• 46:59
  Speaker 2: or woman, but they go on the. the ward and
• 47:01
  Speaker 2: they start at the bottom. They would be changing beds,
• 47:06
  Speaker 2: they would be emptying bedpans, they would be doing all
• 47:11
  Speaker 2: of the menial jobs and then they would slowly work
• 47:15
  Speaker 2: their way up through responsibilities to whatever it is, staff, nurse,
• 47:21
  Speaker 2: nursing sister, matron. And I recognised that system because essentially
• 47:27
  Speaker 2: that was the system in the military as well. But
• 47:31
  Speaker 2: then we had the decision that nurses were going to
• 47:35
  Speaker 2: go to university to learn how to nurse. And then
• 47:39
  Speaker 2: we had the nurse with a degree but no experience
• 47:42
  Speaker 2: coming on the ward, almost being shocked that they were
• 47:46
  Speaker 2: going to be asked to do jobs, which inexperienced nurses
• 47:51
  Speaker 2: have been asked to do over a great many years
• 47:53
  Speaker 2: for a reason. It took them from the bottom to
• 47:57
  Speaker 2: moving up through. And I think could identify with some
• 48:02
  Speaker 2: of the criticism that came around this new system, because
• 48:06
  Speaker 2: at one stage in the Navy, at least, they decided
• 48:09
  Speaker 2: they were going to take more people in the officer
• 48:12
  Speaker 2: corps from degree courses. And in one particular year, you
• 48:17
  Speaker 2: had people who had come from university, but they had
• 48:21
  Speaker 2: two stripes on their arms. They were lieutenants. And in
• 48:28
  Speaker 2: quite a short space of time, there were some problems
• 48:31
  Speaker 2: occurred because these lieutenants had no experience whatsoever. But as
• 48:37
  Speaker 2: far as some of the more junior sailors were concerned,
• 48:41
  Speaker 2: if they had two stripes on their arm, they knew
• 48:44
  Speaker 2: what they were doing. And there was, on two occasions,
• 48:48
  Speaker 2: there were very nearly fatal accidents because the inexperienced lieutenant
• 48:54
  Speaker 2: had too much faith in their own ability and they
• 48:58
  Speaker 2: made decisions which were completely crass. But I'm just emphasising
• 49:03
  Speaker 2: a point here. Somebody made the decision that we wouldn't
• 49:07
  Speaker 2: sort of have an apprenticeship system for nursing. And the
• 49:11
  Speaker 2: same applies for doctors, really. We would bring in these
• 49:15
  Speaker 2: people who've been trained at university and they are unleashed
• 49:20
  Speaker 2: on the wards without any experience. And what I've always
• 49:24
  Speaker 2: wanted to know is who was the person, who were
• 49:28
  Speaker 2: the people who made the decision for this sort of
• 49:30
  Speaker 2: change in the organisation?
• 49:35
  Speaker 3: Yes, there's a bit of a history here. Going back
• 49:40
  Speaker 3: into the late 70s and 80s, the vocational calling that
• 49:47
  Speaker 3: was nursing gave way to a very strong drive to academize,
• 49:54
  Speaker 3: to turn it into an academic enterprise. So what had
• 49:58
  Speaker 3: been a vocational hands-on, minds-on course over three years, with
• 50:04
  Speaker 3: quite a lot of science and a lot of disease
• 50:07
  Speaker 3: and pharmacy and all the rest of it thrown in. Yes,
• 50:09
  Speaker 3: of course. But it was then under a scheme called
• 50:14
  Speaker 3: Project 2000 in the late 80s, mid 90s, took nursing
• 50:20
  Speaker 3: students out of hospitals and put them into universities, as
• 50:24
  Speaker 3: you rightly said, and it became an academic pursuit. And
• 50:29
  Speaker 3: the time that those academic students spent in the clinical environment,
• 50:35
  Speaker 3: on wards, in departments, was very limited. And certainly the
• 50:40
  Speaker 3: experience of senior managers like myself by the mid-90s was
• 50:44
  Speaker 3: that as a Project 2000 university graduate came out onto
• 50:49
  Speaker 3: the wards as a fully qualified nurse, they had to
• 50:54
  Speaker 3: be taken off those wards and put back into school
• 50:57
  Speaker 3: because they had never given out a drug round of
• 51:01
  Speaker 3: 34 patients. They had never given last offices to a
• 51:05
  Speaker 3: deceased patient. They had never gone into theatres. They had
• 51:09
  Speaker 3: never gone into mortuaries, let alone post-mortems. And we landed
• 51:15
  Speaker 3: up taking those nurses off the wards, putting them back
• 51:18
  Speaker 3: into school to teach them how to be nurses. And
• 51:22
  Speaker 3: that was quite a cultural shock for them because they
• 51:25
  Speaker 3: had been taught throughout that period, that university period, that
• 51:31
  Speaker 3: they would be the cream of the cream. They were
• 51:33
  Speaker 3: the qualified, they were academic achievers, and so on and
• 51:37
  Speaker 3: so forth. And when they actually got onto the wards,
• 51:39
  Speaker 3: they suddenly found that actually, not only were they the
• 51:43
  Speaker 3: bottom of the pile, but actually they were the ignorant
• 51:46
  Speaker 3: bottom of the pile. And there were unqualified care assistants
• 51:51
  Speaker 3: teaching them how to give drugs to patients, how to
• 51:54
  Speaker 3: perform last offices on a dead body, and so on
• 51:57
  Speaker 3: and so forth. A terrible, a terrible, shift in emphasis
• 52:04
  Speaker 3: for them and quite a cultural shock for lots of
• 52:08
  Speaker 3: them quite a few of them didn't survive and moved
• 52:11
  Speaker 3: on quite quickly um but you mentioned also about doctors
• 52:15
  Speaker 3: and one of the big issues that the medical profession
• 52:20
  Speaker 3: has gone through over the last several years is that
• 52:26
  Speaker 3: let's say 20 years ago you would you would go
• 52:28
  Speaker 3: and see a consultant orthopedic gastroenterologist thoracic surgeon whatever that
• 52:35
  Speaker 3: surgeon would be a consultant and to get to be
• 52:38
  Speaker 3: a registrar the rank below a consultant they would have
• 52:41
  Speaker 3: taken about 30 000 hours of academic and practical education
• 52:47
  Speaker 3: to get them to be good enough clinically uh to
• 52:52
  Speaker 3: be a consultant or a general practitioner now those the
• 52:58
  Speaker 3: doctors coming through the system now only get eight to
• 53:01
  Speaker 3: ten thousand hours of education in that context. So we
• 53:06
  Speaker 3: have fully qualified medical practitioners at consultant and GP level
• 53:11
  Speaker 3: who have about a third of the amount of post-registration
• 53:15
  Speaker 3: training that their counterparts 20 years ago would have had.
• 53:18
  Speaker 3: So the expertise of medical staff, particularly general practitioners, has
• 53:25
  Speaker 3: gone down. And for example, it has been calculated that
• 53:30
  Speaker 3: general practitioners miss eight out of nine new cancers so
• 53:37
  Speaker 3: nine people turn up with a suspected cancer eight of
• 53:40
  Speaker 3: them will get missed one of them will get diagnosed
• 53:42
  Speaker 3: as probable cancer and referred on to oncology so those
• 53:46
  Speaker 3: other eight well they develop higher higher level cancers go
• 53:50
  Speaker 3: to stage two three four and die so we have
• 53:53
  Speaker 3: that real problem within the health service about expertise and
• 53:59
  Speaker 3: successor planning Right.
• 54:03
  Speaker 2: Dungan, sorry to come back in here. My question then
• 54:07
  Speaker 2: is that if you've got a lot of experience in
• 54:11
  Speaker 2: the NHS, I haven't. My experience of the NHS is
• 54:14
  Speaker 2: from family connections and friends who've been involved in the NHS.
• 54:20
  Speaker 2: But I'll say that's on a spectrum from people involved
• 54:25
  Speaker 2: in nursing to a couple of hospital consultants. But you
• 54:30
  Speaker 2: and I are having this discussion, this conversation now, and
• 54:34
  Speaker 2: we've identified that a particular change in emphasis from learning
• 54:39
  Speaker 2: on the job to being trained in a university has
• 54:44
  Speaker 2: not delivered a good result. We can see this. Again,
• 54:50
  Speaker 2: who made the decision to bring it in? This is
• 54:53
  Speaker 2: what I always want to know. Who were the people
• 54:55
  Speaker 2: who said, we're going to change the structure. We don't
• 54:58
  Speaker 2: want to do it. as it's always been done, we're
• 55:01
  Speaker 2: going to bring in this new thing. Who are they
• 55:04
  Speaker 2: and how do they get away with introducing something which
• 55:08
  Speaker 2: I think has been very detrimental on the NHS?
• 55:15
  Speaker 3: Yeah, I mean, it's not one person or one group.
• 55:20
  Speaker 3: It's a cohort of people who come together And let's
• 55:26
  Speaker 3: just say a theoretical model, a discussion model would be
• 55:30
  Speaker 3: a group of people at the British Medical Association decide
• 55:34
  Speaker 3: there's an issue that they think needs addressing. They go
• 55:37
  Speaker 3: to the Department of Health with a paper that describes
• 55:41
  Speaker 3: the nature of the problem and the Department of Health
• 55:44
  Speaker 3: mull it over for several months. They form a working
• 55:47
  Speaker 3: party to drill down on it. Recommendations and ideas percolate
• 55:54
  Speaker 3: to the surface. Costings are applied to that. And if
• 55:58
  Speaker 3: you say, well, okay, we can save two years on
• 56:05
  Speaker 3: a medical, post-registered medical course, and that's going to save
• 56:11
  Speaker 3: X thousands of pounds, and we can get people up
• 56:14
  Speaker 3: to speed in terms of being a senior clinical practitioner
• 56:18
  Speaker 3: that much quicker, then it gets rubber-stamped after the working
• 56:22
  Speaker 3: party and the costings and all the rest of it.
• 56:24
  Speaker 3: So it's not one person. It is a massive bureaucratic
• 56:28
  Speaker 3: exercise where conflicting demands are put together and the balance
• 56:37
  Speaker 3: is made in terms of cost-benefit analysis, in terms of
• 56:41
  Speaker 3: environmental impact assessments. And it was decided that, particularly for nursing,
• 56:48
  Speaker 3: that Project 2000, taking students off the wards, putting them
• 56:51
  Speaker 3: into university, and creating an academic nurse was a far
• 56:57
  Speaker 3: better cost benefit to the NHS because you could then
• 57:02
  Speaker 3: reduce the number of nurses because they were more technically competent,
• 57:06
  Speaker 3: they were more advanced practitioners, you need slightly less nurses
• 57:13
  Speaker 3: per ward, and you could fill the gap with unqualified
• 57:15
  Speaker 3: care assistants. So there was that very defined approach in
• 57:22
  Speaker 3: terms of costs and what was thought to be improved services,
• 57:28
  Speaker 3: improved care, but it didn't work out like that. Yeah. Okay.
• 57:36
  Speaker 2: I've been interested in an organization called Common Purpose for
• 57:41
  Speaker 2: many years. Common Purpose calls itself a leadership charity. It
• 57:47
  Speaker 2: trains future leaders. And Certainly when I was really looking
• 57:52
  Speaker 2: into its activities 10 years ago, I was fascinated by
• 57:57
  Speaker 2: the fact that it had clearly latched onto the NHS
• 58:01
  Speaker 2: in a very, very big way. And so the NHS
• 58:05
  Speaker 2: was paying out some pretty substantial sums of money in
• 58:09
  Speaker 2: order to get people put on this course, which created
• 58:13
  Speaker 2: Future Leaders. But if I now follow through the NHS,
• 58:17
  Speaker 2: I can actually see that the NHS Leadership Academy is
• 58:23
  Speaker 2: itself virtually a wing of common purpose. So the common
• 58:28
  Speaker 2: purpose agenda now permeates the whole of the NHS. And
• 58:35
  Speaker 2: I don't know whether you've come across common purpose. If
• 58:38
  Speaker 2: you have, I'd be very interested. But it seems to
• 58:42
  Speaker 2: me that many of the.
• 58:45
  Speaker 2: Poor, sometimes disastrous, sometimes very strange decisions that are being
• 58:51
  Speaker 2: made within the NHS are actually coming from their own,
• 58:56
  Speaker 2: what they call their leadership centre of excellence. And this
• 59:02
  Speaker 2: to me now seems to have become a specialist area
• 59:06
  Speaker 2: of the NHS, which is doing a lot of damage.
• 59:10
  Speaker 2: because it's completely lost touch with the real aim of
• 59:15
  Speaker 2: the NHS to help make people, sick people better and
• 59:19
  Speaker 2: to care for people. It's gone into its own management
• 59:24
  Speaker 2: guru speak. Are you familiar with Common Purpose at all,
• 59:29
  Speaker 2: or the NHS Leadership Academy and what it does?
• 59:35
  Speaker 3: Yes, indeed. And I have to openly admit here that
• 59:41
  Speaker 3: my own view of Common Purpose is such that were
• 59:45
  Speaker 3: I to be magically appointed as Prime Minister tomorrow morning,
• 59:50
  Speaker 3: the first thing I would do is that anybody, anywhere,
• 59:54
  Speaker 3: in any organisation, that had been indoctrinated by common purpose
• 59:58
  Speaker 3: would be made redundant on the spot. Let's make no
• 1:00:03
  Speaker 3: bones about it. Common purpose is nothing more than an
• 1:00:06
  Speaker 3: ideological fifth column, because the whole ideological position of common
• 1:00:13
  Speaker 3: purpose is in the title. It is common purpose, and
• 1:00:18
  Speaker 3: it's infiltrated the police and various other agencies and organisations.
• 1:00:23
  Speaker 3: So I think in terms of the setting up and
• 1:00:28
  Speaker 3: running of an NHS leadership programme that reflects that common
• 1:00:34
  Speaker 3: purpose agenda, it's hardly surprising that what you get is clones.
• 1:00:39
  Speaker 3: You don't get people coming out of that who are
• 1:00:45
  Speaker 3: grounded in developing services. They come out ideologically indoctrinated and
• 1:00:53
  Speaker 3: it is catastrophic in its implications. Now, yeah, there may
• 1:00:58
  Speaker 3: be good people coming out. There may be not so
• 1:01:00
  Speaker 3: good people coming out. But let me think now, 22,
• 1:01:06
  Speaker 3: 23 years ago, the King's Fund ran a course called
• 1:01:10
  Speaker 3: Top Manager's Courses and Senior Manager's Courses. And they were
• 1:01:15
  Speaker 3: very focused on how to marshal your resources, how to
• 1:01:21
  Speaker 3: direct and create followership how to create leadership, which common
• 1:01:28
  Speaker 3: purpose doesn't. It's about ideology. And I think that the
• 1:01:36
  Speaker 3: consequences of setting up a common purpose mirror image within
• 1:01:43
  Speaker 3: the NHS, creating clones, will only reinforce the silo thinking,
• 1:01:49
  Speaker 3: will only reinforce the stodgy bureaucracy and will prevent the
• 1:01:57
  Speaker 3: NHS from ever being anything other than what it is today.
• 1:02:00
  Speaker 3: And the idea that we have seeded the management classes
• 1:02:06
  Speaker 3: with change agents is a complete myth. I'm sorry, but
• 1:02:12
  Speaker 3: you've got me on a soapbox with this one.
• 1:02:16
  Speaker 2: Well, Duncan, I've got to say, I'm utterly delighted because
• 1:02:23
  Speaker 2: You and I have not spoken to each other before today.
• 1:02:28
  Speaker 2: And so I threw that at you. I had no
• 1:02:31
  Speaker 2: idea what you were going to say, but I was
• 1:02:34
  Speaker 2: utterly delighted to hear somebody else speak with sort of
• 1:02:38
  Speaker 2: vehemence about what this organization is about and what it does.
• 1:02:43
  Speaker 2: While you were talking, I just went on to my
• 1:02:47
  Speaker 2: laptop here because I couldn't remember the date. And actually,
• 1:02:51
  Speaker 2: where are we? It's the 24th of May 2013. The
• 1:02:57
  Speaker 2: UK column posted a really excellent article about the penetration
• 1:03:02
  Speaker 2: of common purpose into the NHS. And it was called
• 1:03:06
  Speaker 2: the NHS common purpose towards a million change agents. And
• 1:03:13
  Speaker 2: it was written by a man called Martin Edwards, who
• 1:03:16
  Speaker 2: I've known for many years. And he's done quite a
• 1:03:19
  Speaker 2: lot of research. He's done a lot of research on
• 1:03:21
  Speaker 2: his own, but in the early days helped me research
• 1:03:25
  Speaker 2: common purpose. But in his particularly detailed article, he's got
• 1:03:31
  Speaker 2: a lot of quotes which have come from the common
• 1:03:34
  Speaker 2: purpose elements inside the NHS themselves. And a million change
• 1:03:41
  Speaker 2: agents was a suggestion by one lady that this is
• 1:03:45
  Speaker 2: what the NHS needed. in order to rectify all of
• 1:03:49
  Speaker 2: its problems. A million change agents. When I looked at
• 1:03:54
  Speaker 2: it with complete horror, because of course, what I have
• 1:03:59
  Speaker 2: seen over the years is that wherever common purpose initiated
• 1:04:04
  Speaker 2: its transformational change, the organization began to fall apart from
• 1:04:09
  Speaker 2: the inside. Don't know how you'd react to that.
• 1:04:16
  Speaker 3: Yeah. I can see where you're coming from on that.
• 1:04:19
  Speaker 3: I can see where your colleague who authored that piece
• 1:04:22
  Speaker 3: is coming from. I think the sort of, I mean,
• 1:04:25
  Speaker 3: for a start, the idea that you've got a million
• 1:04:27
  Speaker 3: change agents is just, well, it's pipe dream, isn't it?
• 1:04:32
  Speaker 3: I mean, it's Disney-esque fantasy land. And the further it
• 1:04:37
  Speaker 3: permeates down through the grade, through the rank structure within
• 1:04:40
  Speaker 3: the NHS, you land up with this Stepford Wives sort
• 1:04:44
  Speaker 3: of situation. where you have people who are completely indoctrinated
• 1:04:52
  Speaker 3: and completely beholden to this quasi-Marxist approach, you know, and
• 1:05:01
  Speaker 3: you start to wonder just what is happening to... Because
• 1:05:06
  Speaker 3: the mentality of this approach, you know, if the... inspiration
• 1:05:15
  Speaker 3: behind common purpose wasn't to upend western society and the
• 1:05:22
  Speaker 3: the organs of western society why do they why are
• 1:05:25
  Speaker 3: they doing it why why on earth go down this
• 1:05:28
  Speaker 3: road and and the more i see of common purpose
• 1:05:32
  Speaker 3: the more i appreciate that you know situation uh organizations
• 1:05:38
  Speaker 3: sort of like the uh uh world economic forum and
• 1:05:43
  Speaker 3: the uh Paul Alensis, such an organization in the United
• 1:05:48
  Speaker 3: States that Hillary Clinton and Obama were both aficionados and
• 1:05:53
  Speaker 3: followers of. There's this sort of slow burn, indoctrinating, quasi-Marxist
• 1:06:00
  Speaker 3: sort of approach. And if you project that sort of
• 1:06:08
  Speaker 3: cultural methodology forward, over the next sort of five or
• 1:06:14
  Speaker 3: 10 years, you can see that organizations are not going
• 1:06:19
  Speaker 3: to survive simply because the boundaries, the processes, the structures
• 1:06:25
  Speaker 3: are all going to be undermined. And you really have
• 1:06:27
  Speaker 3: got me on an ideological soap now, I'm afraid, but
• 1:06:31
  Speaker 3: it reeks of desperation that an organization as large and
• 1:06:38
  Speaker 3: as purposeful as the NHS should be can be subverted
• 1:06:44
  Speaker 3: by an ideological drive that's got absolutely nothing to do
• 1:06:48
  Speaker 3: with healthcare. It's got nothing to do with healthcare at all.
• 1:06:52
  Speaker 3: It is nothing more than an ideological institution. And it
• 1:07:00
  Speaker 3: bodes very unwell.
• 1:07:04
  Speaker 2: This is absolutely fascinating to hear you say this. Let's
• 1:07:08
  Speaker 2: throw in the next bit that when we investigated Common Purpose,
• 1:07:15
  Speaker 2: what we saw it doing was it's almost like a virus.
• 1:07:21
  Speaker 2: It gains a foothold in an organisation and then grows
• 1:07:26
  Speaker 2: inside it. And Common Purpose, from the outset, was always
• 1:07:30
  Speaker 2: very interested in people who were controlling budgets in organizations,
• 1:07:36
  Speaker 2: particularly if they had control over a training budget. Because
• 1:07:40
  Speaker 2: if Common Purpose could get in and do a little course,
• 1:07:45
  Speaker 2: and then they've recruited somebody in that organization, if they
• 1:07:48
  Speaker 2: could recruit somebody who had control over the training budget,
• 1:07:52
  Speaker 2: they could get several steps up the ladder to get
• 1:07:55
  Speaker 2: a bigger event going inside the organization. And they did
• 1:08:00
  Speaker 2: this inside the police. They did it inside the NHS,
• 1:08:04
  Speaker 2: inside education. They were everywhere in the public sector. But
• 1:08:09
  Speaker 2: the other bit that we became aware of is that
• 1:08:13
  Speaker 2: it wasn't as if they were simply putting people in
• 1:08:16
  Speaker 2: a room and talking to them. What qualified people explained
• 1:08:21
  Speaker 2: to us And I'm going to say one of the
• 1:08:23
  Speaker 2: gentlemen who taught me most in the early days was
• 1:08:29
  Speaker 2: well trained in psychology as a result of his work
• 1:08:32
  Speaker 2: in the NHS and social services. And he said to
• 1:08:37
  Speaker 2: me very quietly one day, well, but you realize, of course, Brian,
• 1:08:40
  Speaker 2: they're using NLP, neurolinguistic programming. And I had no idea
• 1:08:47
  Speaker 2: what that was. And so he started to explain to
• 1:08:51
  Speaker 2: me it was the use of applied psychology in order
• 1:08:55
  Speaker 2: to change the way people change their views and their values.
• 1:09:00
  Speaker 2: And he said it's a very powerful tool because you
• 1:09:03
  Speaker 2: can use it on a group of people and they
• 1:09:05
  Speaker 2: will have no idea what you're doing with them. And
• 1:09:10
  Speaker 2: this was the point at which we started to realize
• 1:09:13
  Speaker 2: that the common purpose courses themselves were taking control of
• 1:09:19
  Speaker 2: people by using applied psychology. And this made Common Purpose
• 1:09:25
  Speaker 2: an extremely dangerous organisation, I felt, because it buried its
• 1:09:31
  Speaker 2: way into an organisation largely by, I'm going to say,
• 1:09:37
  Speaker 2: deceit and stealth. It was certainly deceitful in what it
• 1:09:40
  Speaker 2: was going to do, but it was also using applied
• 1:09:45
  Speaker 2: psychology in order to capture its own audience and future
• 1:09:50
  Speaker 2: leaders inside that organization. And for the NHS, we not
• 1:09:56
  Speaker 2: only saw the common purpose elements taking control of the NHS,
• 1:10:03
  Speaker 2: now via the NHS leadership structure, we had also unleashed
• 1:10:09
  Speaker 2: the power of NLP inside hospitals. And before I hand
• 1:10:18
  Speaker 2: back to you, if I just add to this, that,
• 1:10:21
  Speaker 2: of course, once we discovered that the Cabinet Office in
• 1:10:25
  Speaker 2: 2010 was boasting that it was able to use applied
• 1:10:29
  Speaker 2: psychology to change the public's mind, this was all the
• 1:10:34
  Speaker 2: work of the behavioural insights team, which was run alongside
• 1:10:39
  Speaker 2: the Cabinet Office. But we now started to see policy
• 1:10:45
  Speaker 2: and future policy of organisations being framed on the basis
• 1:10:50
  Speaker 2: that they were going to use applied psychology to drive
• 1:10:54
  Speaker 2: the government's agenda. And this to me was an immensely
• 1:10:59
  Speaker 2: dangerous combination, particularly where you put it alongside healthcare.
• 1:11:08
  Speaker 3: Yes, absolutely. And there are several strands to this. I mean,
• 1:11:15
  Speaker 3: perhaps first and foremost, because the NHS is such a
• 1:11:18
  Speaker 3: monolithic enterprise and because it has such a high regard
• 1:11:23
  Speaker 3: within the public appreciation, it has almost become a religion. Therefore,
• 1:11:30
  Speaker 3: the amount of influence over policymakers, both at local, city,
• 1:11:37
  Speaker 3: county level, as well as national government, the capacity to
• 1:11:41
  Speaker 3: influence policy because of what it is, is immense. And
• 1:11:47
  Speaker 3: that is dangerous in itself. Now, you would expect a
• 1:11:50
  Speaker 3: large organisation, the biggest employer after the KGB, I think
• 1:11:53
  Speaker 3: someone once told me, you would expect it to want
• 1:11:58
  Speaker 3: to have some influence at policy level. But when that
• 1:12:02
  Speaker 3: becomes an ideological, unified ideological proposition, rather than local interest,
• 1:12:09
  Speaker 3: then you are automatically and immediately in a minefield. The
• 1:12:14
  Speaker 3: second element is that the ideology behind it is so
• 1:12:18
  Speaker 3: seductive that people who are politically less versed in the
• 1:12:25
  Speaker 3: machinations of government and decision making processes are easily seduced
• 1:12:33
  Speaker 3: by this very luxurious, smooth talking approach to you know,
• 1:12:41
  Speaker 3: how we all relate to each other, how we engage
• 1:12:44
  Speaker 3: with each other, how we feel about each other. So
• 1:12:48
  Speaker 3: that you get, you know, saying, if you get them
• 1:12:54
  Speaker 3: young enough, you can keep them forever. And I think,
• 1:12:57
  Speaker 3: you know, people who are at the beginning of their
• 1:12:59
  Speaker 3: careers who are indoctrinated in this stuff come out the
• 1:13:03
  Speaker 3: other end utterly convinced, utterly convinced that this is the
• 1:13:09
  Speaker 3: way forward. It's the only way forward. There are no alternatives.
• 1:13:13
  Speaker 3: And that is even more dangerous because it brooks no
• 1:13:18
  Speaker 3: opposition or challenge or competitive ideas or improving ideas. And
• 1:13:26
  Speaker 3: it entrenches this inbuilt silo thinking. It is grotesquely dangerous.
• 1:13:35
  Speaker 3: And then I think the other item is that NLP
• 1:13:39
  Speaker 3: is one of the most abhorrent faux sciences imaginable. I mean,
• 1:13:44
  Speaker 3: it is absolute Disney-esque witchcraft. It is, you know, we
• 1:13:48
  Speaker 3: hear in terms of, you know, when COVID locked down
• 1:13:50
  Speaker 3: and all that, and Susan Michie, the well-known communist, was
• 1:13:54
  Speaker 3: in charge of the nudge or involved in the nudge
• 1:13:57
  Speaker 3: units in terms of nudge psychology, nudging the population into
• 1:14:02
  Speaker 3: believing that lockdowns and masks were the be-all and the end-all.
• 1:14:06
  Speaker 3: It would save humanity from itself sort of thing. And
• 1:14:09
  Speaker 3: you realize that people like Susan Michie are involved with
• 1:14:12
  Speaker 3: common purpose and people of her ilk are involved with
• 1:14:15
  Speaker 3: common purpose. They use language, they use NLP to change
• 1:14:21
  Speaker 3: the meaning of words. They change the impact of words
• 1:14:25
  Speaker 3: so that your vocabulary means something different. Once you've changed
• 1:14:30
  Speaker 3: the language, once you've changed the meaning of the words
• 1:14:33
  Speaker 3: that are being used, then you start to change how
• 1:14:37
  Speaker 3: people think. You start to change how people appreciate and
• 1:14:41
  Speaker 3: you remove from them the capacity for independent thought. NLP
• 1:14:46
  Speaker 3: is a scandalous, absolutely scandalous faux science. And, you know,
• 1:14:53
  Speaker 3: it's witchcraft for the 21st century. And, you know, I mean,
• 1:15:00
  Speaker 3: I'm not for censorship by any stretch of the imagination,
• 1:15:02
  Speaker 3: quite the opposite. But really, you know, we have to look.
• 1:15:07
  Speaker 3: as a society, as what we allow to be done
• 1:15:10
  Speaker 3: unto us. And if we allow NLP, common purpose, to
• 1:15:15
  Speaker 3: do unto us what it is doing, then we're just
• 1:15:20
  Speaker 3: heading towards Stepford Wives. I'm sorry, but it's just a
• 1:15:24
  Speaker 3: nightmare scenario.
• 1:15:26
  Speaker 2: Duncan, I'm doubly fascinated now, because when I threw common
• 1:15:32
  Speaker 2: purpose at you, I thought with your experience, there's a
• 1:15:36
  Speaker 2: good chance that you might at least come across it
• 1:15:39
  Speaker 2: and therefore have something to say about it. But clearly,
• 1:15:43
  Speaker 2: you've not only come across it, you've really thought about
• 1:15:47
  Speaker 2: what it is and you're declaring you feel pretty uncomfortable
• 1:15:51
  Speaker 2: with what it is. Can I ask, when did you
• 1:15:55
  Speaker 2: first become aware of common purpose? And was that in
• 1:15:59
  Speaker 2: an NHS setting or was it somewhere else?
• 1:16:04
  Speaker 3: No, no, it wasn't in an NHS setting. I, for
• 1:16:09
  Speaker 3: a period of three years, was National Director of Clinical
• 1:16:14
  Speaker 3: Practice and Clinical Supervision for RELATE, which used to be
• 1:16:18
  Speaker 3: the Marriage Guidance Council, but is now called RELATE, and
• 1:16:24
  Speaker 3: deals with all manner of relationship issues, not just divorce,
• 1:16:29
  Speaker 3: which it started out with. And my job, I got
• 1:16:33
  Speaker 3: regional managers all over the place. And there are psychotherapists
• 1:16:39
  Speaker 3: and sex therapists and all manner of psychological practitioners. And
• 1:16:46
  Speaker 3: some of the programs, some of the schools of psychological
• 1:16:51
  Speaker 3: thinking that practitioners, I mean, we got 2,200 practitioners across
• 1:16:57
  Speaker 3: the entire country. and partner organizations in Germany, Scotland, Malta, Gibraltar, whatever, wherever.
• 1:17:04
  Speaker 3: And some of the schools of psychological thought that were
• 1:17:08
  Speaker 3: being practiced struck me as a psychiatric nurse with a
• 1:17:13
  Speaker 3: DMS and an MBA as being not quite right. And
• 1:17:19
  Speaker 3: I started to drill down seriously into things like Kelly's
• 1:17:25
  Speaker 3: personal construct psychology, Milan School of Family Therapy, NLP, and
• 1:17:32
  Speaker 3: there's a few other bizarre schools of psychological thought and practice.
• 1:17:38
  Speaker 3: And I soon realized that the psychological apparatus that was
• 1:17:44
  Speaker 3: being used to change people's thinking about relationships, change people's
• 1:17:51
  Speaker 3: thinking about not just relationship, man and wife, but relationships
• 1:17:55
  Speaker 3: between and within families, within extended families, in terms of communities, neighbors, streets,
• 1:18:02
  Speaker 3: all that sort of thing, were being adversely impacted by
• 1:18:08
  Speaker 3: these weird, perverse schools of psychological practice and thinking epitomized
• 1:18:17
  Speaker 3: by NLP. So we're going back to turn of the century,
• 1:18:21
  Speaker 3: you know, 2000. And since then, I've... One of my
• 1:18:27
  Speaker 3: many hobbies is to research into such things as this,
• 1:18:31
  Speaker 3: which took me into World Economic Forum and all that
• 1:18:37
  Speaker 3: sort of stuff as well. So you get labeled as
• 1:18:39
  Speaker 3: a bit of a conspiracy theorist at times. But when
• 1:18:42
  Speaker 3: you sit down and study NLP and you look at
• 1:18:47
  Speaker 3: the motivation behind people that are trying to impose the
• 1:18:50
  Speaker 3: principles of nlp to others you have a very defined
• 1:18:55
  Speaker 3: command and control psychology going on and it's the same
• 1:18:58
  Speaker 3: with common purpose it is a command and control psychology
• 1:19:01
  Speaker 3: program it is nothing else other than we will instill
• 1:19:06
  Speaker 3: in you the psychological framework where we can control your appreciation, analysis,
• 1:19:16
  Speaker 3: construction of social environments, social events, interpersonal relationships, relationships with patients,
• 1:19:24
  Speaker 3: and so on and so forth, in a way that
• 1:19:27
  Speaker 3: we can then control by importing into your awareness priorities
• 1:19:35
  Speaker 3: that you otherwise wouldn't have come across. And those priorities
• 1:19:39
  Speaker 3: are ill-disguised Marxist fifth columnist stuff.
• 1:19:45
  Speaker 2: Well, I always challenge the theory bit because a conspiracy
• 1:19:52
  Speaker 2: is a recognised event, state, activity. The adding of the
• 1:19:57
  Speaker 2: word theory was the attempt to take people's eye off
• 1:20:02
  Speaker 2: the fact that they need to understand conspiracies are real.
• 1:20:06
  Speaker 2: But What a fascinating discussion, because I never expected that
• 1:20:12
  Speaker 2: this afternoon, together with your good self, we'd end up
• 1:20:16
  Speaker 2: back on the subject of common purpose and what it's doing.
• 1:20:20
  Speaker 2: You have taken it far enough to say that it's
• 1:20:23
  Speaker 2: a fifth column organisation, and I completely agree. Is it
• 1:20:29
  Speaker 2: unrealistic of me to think that if a fifth column
• 1:20:33
  Speaker 2: organisation with a particular political agenda, you've likened it to Marxism.
• 1:20:39
  Speaker 2: We could debate that a bit, but I understand where
• 1:20:42
  Speaker 2: you're coming from. If that organisation has been unleashed within
• 1:20:48
  Speaker 2: the NHS, is it any wonder that the NHS is
• 1:20:53
  Speaker 2: in a complete state of chaos and breakdown at the
• 1:20:57
  Speaker 2: moment under NHS leadership? as it calls itself. Is it
• 1:21:04
  Speaker 2: any wonder?
• 1:21:07
  Speaker 3: No, I don't think it's any wonder to anybody who
• 1:21:10
  Speaker 3: has the nous to drill down and see what's happening.
• 1:21:17
  Speaker 3: And I think that if you take into consideration the
• 1:21:21
  Speaker 3: concept of the long march through the institutions, we have
• 1:21:25
  Speaker 3: an absolutely pristine example of a long march through the institution.
• 1:21:33
  Speaker 3: The Long March is ongoing. It's perpetual. It's nonstop. And
• 1:21:41
  Speaker 3: it brings about a revolutionary frame of reference because of
• 1:21:48
  Speaker 3: the slow burn approach. And one of the key elements
• 1:21:56
  Speaker 3: in this approach to infiltrating organizations, and I use the
• 1:22:04
  Speaker 3: word infiltration with great hesitancy, but one of the key
• 1:22:08
  Speaker 3: components of that ideological move into institutions is that you
• 1:22:14
  Speaker 3: break down the traditions, the heritage, the customs, the practice,
• 1:22:25
  Speaker 3: and the volition towards what the purpose of the organization is.
• 1:22:31
  Speaker 3: And the purpose of the NHS is that you have
• 1:22:33
  Speaker 3: a volitional commitment to helping ill people, sick people, curing people,
• 1:22:39
  Speaker 3: getting them better. And if you break down those profound
• 1:22:48
  Speaker 3: psychological components as to why you and the organization exist,
• 1:22:53
  Speaker 3: you absolutely create confusion and chaos. That is a design intention.
• 1:23:02
  Speaker 3: It's not an accident. It's not an unfortunate corollary of
• 1:23:08
  Speaker 3: this important program. It is a design intention. It's designed
• 1:23:13
  Speaker 3: to break down those pillars of accountability, responsibility, and authority
• 1:23:22
  Speaker 3: that allow the organization to function as a cohesive, coherent,
• 1:23:28
  Speaker 3: lined up whole, it's purposeful, common purpose. And I think
• 1:23:34
  Speaker 3: that until you recognize that, and until you take a deliberate,
• 1:23:41
  Speaker 3: intentional course of action to reestablish the moral values, the morality,
• 1:23:49
  Speaker 3: and the ethics of a caregiving organization, you will land
• 1:23:55
  Speaker 3: up with a self-satisfying, self-perpetuating bureaucratic entity who sees itself
• 1:24:02
  Speaker 3: as a change agent for society as a whole, through
• 1:24:07
  Speaker 3: influencing policymakers, influencing local decisions, and influencing how people think.
• 1:24:14
  Speaker 3: That is nudge politics. That is nudge psychology. That is
• 1:24:18
  Speaker 3: what was deployed during COVID and is being deployed in
• 1:24:23
  Speaker 3: large-scale in And we've seen the woefulness of the police.
• 1:24:29
  Speaker 3: And we've seen a couple of chief constables saying that
• 1:24:34
  Speaker 3: we must get back to solving crimes rather than policing
• 1:24:37
  Speaker 3: the internet and Facebook and Twitter and all that crap.
• 1:24:42
  Speaker 3: Because they have woken up to the fact that their
• 1:24:45
  Speaker 3: police force has been subjugated to this common ideology. That
• 1:24:51
  Speaker 3: is happening in the health service. So is that happening
• 1:24:53
  Speaker 3: in the civil service and other organisations? So I think
• 1:24:58
  Speaker 3: we have a monstrous ideological challenge ahead of us. And
• 1:25:03
  Speaker 3: I think there's not enough people that understand this.
• 1:25:08
  Speaker 2: Thank you very much for being so forthright on this.
• 1:25:12
  Speaker 2: And you're clearly showing that you've got a lot of
• 1:25:16
  Speaker 2: knowledge and you considered a lot of aspects around this.
• 1:25:20
  Speaker 2: I'm going to suggest that because I've lost a little
• 1:25:24
  Speaker 2: bit of track of the time, but I think we're
• 1:25:26
  Speaker 2: on about an hour and a quarter or an hour
• 1:25:28
  Speaker 2: and 20 minutes.
• 1:25:30
  Speaker 3: Hour 47.
• 1:25:33
  Speaker 2: OK, we had a little bit of a break, a
• 1:25:35
  Speaker 2: technical break there, so a little bit less. I think
• 1:25:38
  Speaker 2: we should stop here. But I'm going to say to
• 1:25:42
  Speaker 2: the audience that. In the little bit of text you
• 1:25:46
  Speaker 2: gave me towards, yes, he was at the end. You
• 1:25:51
  Speaker 2: were talking about current grief. So you were talking about
• 1:25:56
  Speaker 2: social care, the grief to end all griefs, waiting lists,
• 1:26:00
  Speaker 2: maternity services, mental health, COVID and lockdown. And then you
• 1:26:08
  Speaker 2: were talking about NHS care to sick people. The NHS
• 1:26:12
  Speaker 2: is a sick people service. If you would do me
• 1:26:17
  Speaker 2: the honour, it would be great to have a part
• 1:26:21
  Speaker 2: two with you. And I would propose that we start
• 1:26:28
  Speaker 2: looking at the use of this psychology at the beginning
• 1:26:32
  Speaker 2: of COVID. Well, that brings us into the spy bee
• 1:26:38
  Speaker 2: arena and sage teams of the government. But we can
• 1:26:42
  Speaker 2: have a look at this psychological element. And then we
• 1:26:45
  Speaker 2: can work the other way. We can follow through to
• 1:26:48
  Speaker 2: see what happened to care provision in the NHS following
• 1:26:55
  Speaker 2: the use of the COVID pandemic psychology. And I think
• 1:27:02
  Speaker 2: this would lead us back to your statement on what
• 1:27:08
  Speaker 2: the current griefs are. Because, of course, so many of
• 1:27:11
  Speaker 2: the problems today have been caused by the decimation of
• 1:27:15
  Speaker 2: the NHS under lockdown rules.
• 1:27:20
  Speaker 3: Yeah, sure. Yeah, fine. Look forward to that. Okay.
• 1:27:24
  Speaker 2: Well, Duncan, we'll end there. Thank you very much for
• 1:27:29
  Speaker 2: joining me today. And also thank you very much for
• 1:27:32
  Speaker 2: getting in contact with the UK column in the first place.
• 1:27:35
  Speaker 2: It just shows what happens when somebody takes the initiative.
• 1:27:39
  Speaker 2: So I'm going to say a big thank you to that.
• 1:27:42
  Speaker 2: And we will be in touch and hopefully we can
• 1:27:46
  Speaker 2: fix up a date fairly soon for a part two.
• 1:27:50
  Speaker 2: But thank you.
• 1:27:52
  Speaker 3: Pleasure.