Latest / Embedded / NHS England in Disarray: Who Do You Sell To Now?

Transcript

NHS England in Disarray: Who Do You Sell To Now? · Embedded

0:05
Thanks Joe and uh welcome everyone. I am
0:08
really grateful to you for joining uh
0:10
the session why strong NHS strategies
0:13
fail to land. Um I really do appreciate
0:16
your time. Um, as Joe said, I'm going to
0:18
try and speak for about 40 minutes and
0:20
then we'll give you a good time for a a
0:21
Q&A at the end and I will make sure that
0:23
everybody gets their questions answered
0:25
because I can produce a little question
0:27
and answer sheet at the end on anything
0:28
that we don't uh we don't get covered.
0:31
What I want to talk about uh today is
0:34
something that I see basically all the
0:36
time in my work and it's what I would
0:39
as a gap between what we think should be
0:43
happening within the NHS and actually
0:45
what does happen in reality and more
0:48
specifically why we can have really good
0:51
strategies that just don't land. Now
0:53
when I say that what I'm not saying is
0:55
that the strategies are poor. In fact I
0:57
mean quite the opposite. I mean that
0:59
we've got strategies out there that are
1:01
really well structured, well thought
1:03
through, clinically sound, backed by
1:05
great data, supported in the room,
1:08
including the customers, and yet still
1:10
nothing moves. So just to give you some
1:14
context um in terms of where I'm
1:16
actually coming from is that a lot of
1:18
you will know that I spend about 70%
1:22
of my work week inside the NHS where I
1:26
work with clinical leads, operational
1:28
leads, financial leads. I work with
1:30
general practice with GP federations,
1:32
big acute trusts, foundation trusts and
1:34
all providers, mental health as well
1:36
community services. The rest of my time
1:39
I spend with the pharma, medtech and
1:40
device industries um helping them
1:43
basically navigate the system and to
1:46
help you get your innovations embedded
1:48
into NHS pathways but more importantly
1:50
to then keep them there. So I kind of
1:52
straddle both sides are sit right in the
1:53
middle between what should happen and
1:56
and what does actually happen I would
1:57
say most of the time.
2:00
So let me start with this. Most of the
2:02
strategies don't fail because they're
2:04
wrong. they actually fail simply because
2:06
we don't land them. And I want to stress
2:08
that's a really important distinction
2:10
because if something's wrong, we would
2:12
step back and we'd fix it. But if it's a
2:14
case of something just isn't landing,
2:17
we're actually dealing with a completely
2:19
different problem. Now, what I see time
2:22
and again is really strong thinking,
2:24
great intent, good evidence,
2:26
really strong clinical support, but no
2:29
movement.
2:31
And it's that that I'm really going to
2:32
look at and try and unpack with you
2:34
today because I have got some
2:36
suggestions and some ideas on how you
2:37
can actually work your way through the
2:39
blocks and get your projects fully
2:41
landed. So where this comes from um I
2:44
want to stress first and foremost this
2:46
is not theory. This is actually examples
2:48
out of my day-to-day work from the NHS
2:51
kind of week in um week out seeing how
2:54
decisions are actually made and who you
2:56
need in the room to actually get it to
2:58
go. and then my other work working with
3:00
industry teams, you know, to help you
3:02
navigate that. So, what I'm going to
3:04
share today is not really how the system
3:07
is supposed to work. I'm actually going
3:09
to share with you what I see happening
3:11
and how it works in real life. And it
3:14
matters because a lot of your con um
3:17
frustration will come because we confuse
3:20
the two. Um we confuse what we think
3:23
should happen with the and believe
3:25
that's actually what is happening. And
3:27
more often than not, that absolutely um
3:30
is not the case.
3:33
This will probably feel very familiar.
3:36
You have a great meeting, you get strong
3:37
clinical engagement, you hear something
3:40
along the lines of, "It makes sense.
3:41
It's a no-brainer. I hear that a lot. We
3:43
need to do this. This would really
3:45
help." It'll be language like that that
3:46
you'll pick up on. And then you walk out
3:49
thinking, "Oh, that's great. I've had a
3:50
really great meeting. This is absolutely
3:51
moving." But then nothing happens. We
3:53
don't get the follow-up. There's no next
3:55
step. there's no implementation and it
3:57
starts to go really quiet and really
3:59
silent. Um I think many of you will have
4:02
had that experience. Certainly most of
4:04
us working in the space will have had
4:06
that and what starts to happen is we
4:09
then start to question is it our data?
4:11
Is it our timing? Have I got the right
4:13
customer? Is it me? Am I doing something
4:15
wrong? And actually often it's really
4:18
none of these things. I really do want
4:20
to stress that you are not being
4:22
rejected. The reality is that you're
4:26
literally being absorbed by the system.
4:28
And that's a very different problem to
4:30
solve because your rejection would be
4:32
visible. They would tell you. In fact,
4:33
it was a question I had this morning.
4:35
Scott, how do we know this customer is
4:37
really um genuine? I'm like, it's one of
4:40
my NHS customers. I was introducing one
4:42
of my pharma companies um to that that I
4:45
work with. And I said, because I know
4:46
this customer well enough to know that
4:48
if they didn't like it, they would tell
4:49
us. The problem with absorption is it's
4:52
silent. You're not being told no. You're
4:54
not being told yes, you're just not
4:56
moving. And that's why it's frustrating
4:58
because the signals in the room often do
5:00
feel very positive, but then the system
5:03
doesn't convert it into action. And
5:05
that's really where our frustration then
5:07
begins to build. So the mistake most of
5:10
us make, and it is genuinely an
5:12
understandable one, it's not something
5:13
that's a um that's a real secret, is
5:16
that we treat the NHS really as a
5:19
strategy problem. We think if we've got
5:21
the right message, the right evidence,
5:23
the right meeting, the right
5:24
stakeholder, we've tied it to one of the
5:26
NHS priorities, things are almost
5:28
guaranteed to move. But unfortunately,
5:31
the NHS primarily isn't a strategic
5:34
system. It's an operational system. it
5:36
is dealing with the day-to-day um grind
5:40
of being the NHS of seeing patients and
5:42
dealing with them and trying to move
5:44
them through and the pathways from you
5:46
know diagnosis to treatment and
5:48
hopefully discharge back to life again.
5:50
And what that means is that your idea is
5:53
not arriving into a blank space or a
5:56
blank canvas where people are calmly
5:58
looking at it, assessing it on merit and
6:01
making a decision. it's arriving into
6:04
real pressure. And a lot of the time you
6:07
will hear things like, "I've got no head
6:08
space. I've got no thinking time. I just
6:10
don't have any time to consider." If you
6:12
listen out for it, you will hear the
6:14
clues. And actually, the reality is that
6:17
the NHS just doesn't adopt ideas. It is
6:21
constantly absorbing pressure. Um, and
6:24
if I make that completely practical, if
6:27
you are working with the NHS currently,
6:30
you will know that right now we're
6:33
trying to recover um, still trying to
6:35
recover from the pandemic. I would
6:37
highlight general practice is the only
6:39
part of the NHS that has currently
6:41
recovered its preandemic levels of
6:44
operational activity. And in fact, it's
6:46
delivering 20% more activity dayto-day.
6:49
The hospitals are still not quite caught
6:52
up there. So you'll hear lots about
6:54
waiting list, clinical backlogs,
6:56
workforce shortages, the financial
6:58
pressure, the delivery targets, the
6:59
operational risk. You will hear that
7:01
literally day by day. So when your idea
7:05
arrives, when you pitch your idea, it's
7:07
not judged on the merit of the idea.
7:11
What it's judged on is what does this do
7:13
to my workload today? If I implement
7:16
this now, what does it do to my workload
7:18
immediately? How will it help my clinic?
7:21
What does this do to the wider team that
7:24
I'm working with? What does this do to
7:27
my budget? Have I got the workforce to
7:29
actually deliver it? Those tend to be
7:31
the filters that are instantly applied.
7:34
And of course, if you don't understand
7:36
that's how it's going to be filtered,
7:38
you're then pitching your idea on merit.
7:40
And then you don't understand why when
7:42
you get all the positivity that things
7:44
stall. So, if your strategy isn't
7:48
landing, in my experience, it's usually
7:50
one of four things um not always in in
7:54
fairness, but it's usually one of four
7:57
four things um that stand in the way of
8:00
even great ideas and why they why they
8:02
don't go anywhere. So, I'm going to take
8:03
you through them kind of one by one and
8:05
see if we can unear some of the the
8:07
things. This is one that comes up a lot.
8:10
We're solving the wrong problem. Now,
8:12
that probably sounds like I'm being
8:14
really, really harsh. That's not how
8:16
it's meant. Let me try and explain it to
8:18
you. Most of our industry conversations
8:21
are framed around things like clinical
8:24
improvements, better patient outcomes,
8:26
the fact that it's innovative, it's a
8:28
new innovation, it's the latest drug
8:30
treatment technology, piece of
8:32
equipment. Um, you know, when you're
8:34
bringing in best practice, all of that
8:36
is there and all of that clearly
8:38
matters. But often you will find that
8:40
that's not what the system is
8:42
prioritizing. It is usually you will
8:44
find prioritizing instant pressure in
8:47
clinics, pressure on theaters, lack of
8:50
workforce, um bed space, you know, um
8:53
length of stay,
8:55
follow-up clinics, access targets.
8:58
That's what's going through the NHS's
9:00
mind as it's weighing up your project.
9:03
So you're pitching one thing, clinical
9:06
improvement, better outcomes,
9:08
innovation, best practice, etc. And it's
9:10
thinking, does that address the pressure
9:12
in my clinics today? Does it help me
9:13
with my workforce? Will that help the
9:15
lack of ed space? So the sol if the
9:17
solution that you're pitching doesn't
9:19
immediately connect to the problems that
9:21
they are seeing. So if it doesn't save
9:24
time, if it doesn't reduce appointments
9:25
or touch points or create some form of
9:28
operational capacity or headroom, it
9:31
might well be liked and admired. The
9:33
risk is it then won't be prioritized.
9:36
And that's one of the biggest
9:37
disconnects that I see is that we're
9:39
literally solving the wrong problem.
9:42
The second one tends to be that we're
9:44
talking to the wrong part of the system.
9:48
Um, and that's probably again one of the
9:51
real big ones that I I see. You meet the
9:54
clinical lead and you're brilliant at
9:55
winning the clinical arguments. They
9:58
often understand the problem. They very
10:00
um often will like the ideas that come
10:02
from industry. Um, and they can
10:04
absolutely see the value and you think,
10:06
great, that's it. I've got my buy in.
10:08
But then the problem is that the real
10:10
world then kicks in. the real world
10:11
environment that they work in then comes
10:13
to life and it moves from clinical lead
10:16
and this is the bit that most strategies
10:17
really don't navigate and it moves into
10:20
right so who's going to deliver this
10:22
where does it sit what gives way what do
10:24
I stop doing to be able to do this how
10:26
how do I get paid for doing this that's
10:28
a massive question in the NHS right now
10:30
particularly if you're going to go and
10:32
deal with general practice and you want
10:34
to move work into general practice it'll
10:36
be one of the first things that you get
10:38
asked who who's going to pay for this
10:40
you'll also get lots around who owns the
10:42
risk of of of doing this and changing it
10:44
and you'll get asked about where it
10:46
aligns with current priorities. Now,
10:48
that's not the NHS 10-year plan or the
10:51
operational planning guidance. That is
10:53
the local plan. It's the provider plan
10:56
for what they're delivering. So, in
10:58
other words, there's a batting pass from
11:00
winning the clinical argument into the
11:02
operational team. And that is where a
11:05
lot of this comes undone because there's
11:07
no system movement because the
11:08
operational teams don't have the same
11:11
outlook that the clinical team might
11:12
have about oh it's new and it's
11:14
different. So a lot of the strategies
11:16
that you have stop too early because
11:18
they stop at clinical agreement and
11:20
mistake that for a decision whereas what
11:23
I'm going to um advocate for you is that
11:26
you really need three legs on your
11:28
stool. You must win the clinical
11:30
argument absolutely that there is no
11:32
escaping that. In fact, I would go as
11:33
far as to say if the clinical argument
11:35
isn't one, it's almost no point in
11:37
talking to contracting and to finance.
11:40
But you need the operational teams to
11:42
then operationalize it. So clinically
11:44
led and managerally enabled would be my
11:47
observation. Two sides to the same coin.
11:51
You get the clinical buyin, but then
11:52
you've got to move into the operational
11:54
team. And that will mean people like
11:56
contracting and finance and of course
11:58
the integrated care board.
12:01
If I look at number three, um this again
12:04
is one of these things that comes up a
12:06
lot. The solution that we've got doesn't
12:07
fit the current pathway. Um this is a
12:10
subtle one, but it's actually quite a
12:12
critical one because if you stop for a
12:15
minute and think about it, all the
12:16
things I've mentioned earlier about
12:17
workload, backlogs, bottlenecks,
12:19
workarounds in the pathways, all of that
12:21
is the current pathway. They are
12:23
constrained in terms of time. They're
12:26
constrained in terms of resource. A lot
12:28
of pathways are quite fragile and a lot
12:30
of them will ultimately break down with
12:33
the the meest hiccup in day-to-day
12:35
delivery. The pathway will grind to a
12:37
halt. So even if your proposition is a
12:39
good step, if it creates any sort of
12:43
friction with the current pathway, and
12:45
of course friction usually slows things
12:47
down or makes them more difficult. This
12:50
is where I often see things come
12:52
unstuck. And of course, what you've also
12:53
got to keep in mind is one extra step.
12:56
Even if it is just one tiny extra step,
12:59
it will add an extra touch point and
13:01
touch points add cost. And that's where
13:04
an extra handoff, an extra appointment,
13:06
one extra approval, one repeat test, an
13:09
extra conversation, all of that has cost
13:11
attached to it. And that again is
13:13
another filter that often they'll run
13:16
your solutions and your your um your
13:18
propositions through. And I've got a lot
13:21
of my customers, a lot of my NHS
13:22
customers will simply say if it adds any
13:25
sort of friction, it's not going to
13:27
land. If I have to log into something
13:29
else alongside what I'm already doing,
13:31
it's not going to land. It has to be
13:33
interoperable with what we're doing now.
13:36
And that's where if you do things in in
13:38
any way that are isolated from the
13:40
pathway or add any friction or anything
13:43
um extra, you often find it just doesn't
13:46
land no matter how good the idea is.
13:50
And this is a biggie. I mean there is
13:52
there is no point in me dressing this up
13:54
in any other way. If there's no payment
13:56
mechanism then you are really going to
13:59
struggle. And this is actually one of
14:00
the biggest misunderstandings.
14:02
Um people will say yeah they can do it.
14:05
Yes I can absolutely. But will they? If
14:08
there's no funding route that also means
14:10
there's unlikely to be a contracting
14:11
route because one follows the other.
14:13
It's why I usually have clinical
14:15
contract and finances. three people that
14:17
are essential to my to my conversation
14:20
because if you don't get a contracting
14:21
route, you've really got no agreed
14:23
mechanism. And what we then end up with
14:26
is we're asking the NHS at any point to
14:28
take on extra work, extra risk, and
14:30
extra operational burden, but without
14:33
any funding mechanism. And that is an
14:35
absolute recipe for disaster in today's
14:37
climate, whether it's um hospital teams,
14:40
community services, mental health
14:41
trusts, and of course general practice.
14:43
I find this is a major stumbling block
14:46
because unfunded work does not usually
14:50
get openly rejected. It's just very
14:52
quietly ignored and bumped somewhere
14:54
else. It quietly sits at the bottom of
14:56
the to-do list and it just doesn't
14:57
happen. And of course, what then happens
14:59
is your project gets deprioritized
15:02
behind everything else that's funded,
15:04
measured, or already happening because
15:06
of a a known system pressure. So if you
15:09
want movement, you've got to think not
15:11
just about the idea, you've absolutely
15:14
got to think how it comes to life
15:15
financially and operationally. So
15:17
clinically led by all means, absolutely,
15:20
but it's then got to be managerially
15:22
enabled or you are really going to to
15:25
struggle.
15:28
What do the systems respond to? So this
15:31
was a question I had in advance when we
15:32
announced this and I was actually
15:33
building the the slide for it. Somebody
15:35
said, "Well, Scott, I kind of know where
15:37
you're going to go, but tell me, what
15:38
does the system actually respond to?" In
15:41
simple terms, what it responds best to
15:44
is things that absolutely reduce
15:47
pressure. It's the most common question
15:49
I get in my NHS work. Scott, what have
15:52
you got that would potentially either
15:54
reduce my workload or increase my
15:56
capacity? In other words, something that
15:58
will fit the workflow that we've got or
16:01
if there if there are known incentives.
16:03
So in secondary care now a lot of the
16:06
contracting is has defaulted this year
16:08
to a contracting mechanism known as
16:10
aligned payment incentive where we get a
16:15
block element that covers the the cost
16:26
an ability to create incentives. So if
16:27
you can align your project around an
16:29
incentive that the hospital is actually
16:31
working on. So that could be reducing
16:33
routine follow-up appointments, cutting
16:34
non-elective admissions, left shift and
16:36
work out to primary care. There's a big
16:38
long list of things that could apply
16:40
there. That absolutely could be a
16:44
mechanism where you would align the
16:45
incentives and they would actually want
16:46
to engage and work with you. And of
16:49
course the big thing I would observe is
16:50
you have to really support the pathway.
16:52
Don't disrupt it. You know that you've
16:54
got to be in a a space where you're
16:57
actually supporting what they do. So if
16:59
it saves time, if it reduces unnecessary
17:01
steps, if it removes repeat work or
17:04
duplication, creates headroom, if it's
17:06
really easy to operationalize, you will
17:09
get to that point where you're having a
17:10
totally different conversation. So what
17:13
I'm really getting at here is the
17:14
question becomes not just is this any
17:17
good, but really does it help to run my
17:21
service more safely, more efficiently,
17:23
and with less kind of stress and strain.
17:26
That's what goes down well when you're
17:28
pitching the customers. In fact,
17:30
it be about probably about a month, six
17:32
weeks ago, I had one of the customers
17:33
say to me, I was about to talk to them
17:35
about a project idea um that I thought
17:38
would really work for them. And one of
17:39
the GPS interrupted me and said, "Scott,
17:41
can I just check? Is this going to
17:42
reduce my workload? Because if it's not,
17:44
I probably don't want to hear it."
17:47
That's kind of where the NHS is right
17:49
now. So, you have to think about what
17:50
they're likely to respond to.
17:54
So the reason this matters is because
17:56
the NHS just does not think in products.
18:00
Much as we might want it to, as much as
18:02
we might hope it would, it doesn't. It
18:05
thinks in terms of what you can see on
18:07
screen, pathways, patient flow. Does the
18:10
patient flow work and does the money
18:11
follow the patient through the system? A
18:13
lot of the time it will be thinking
18:14
about where the bottlenecks and backlogs
18:16
are. This is a great pressure point for
18:19
you in a pathway to really open up your
18:22
conversation. If you get into pathway
18:24
thinking rather than product thinking,
18:26
actually isolating where the pathway
18:28
breaks down, where does it bottleneck
18:31
up? What what goes wrong at that point
18:32
that creates that bottleneck? Because
18:35
invariably when we get a bottleneck,
18:36
they'll come up with a workaround rather
18:38
than address the whole pathway. We tend
18:40
to find they'll then create bottleneck
18:43
bott workarounds to the bottlenecks that
18:45
they've got. That would then lead you
18:47
into things like the waiting list, the
18:49
workforce pressure. you know, it thinks
18:51
in capacity terms. That is gold dust. By
18:54
the way, um, a lot of the time, this
18:57
might surprise you, but a lot of the
18:59
time I don't have massively financial
19:02
conversations or financially driven
19:04
conversations with the NHS. I have lots
19:06
of conversations about
19:08
lack of capacity. So, when I'm pitching
19:11
them a pathway idea, what I'm usually
19:13
talking to them about is, actually, if I
19:15
could give you that capacity back, what
19:17
would you do with it? And do you know
19:19
what you get back is you get well I
19:20
would get into my backlog. I would be
19:22
able if I could move and free that
19:24
capacity by changing my pathway so that
19:27
I'm not dealing with those patients that
19:28
maybe moved out to primary care or they
19:30
don't need followed up at all or they're
19:31
in home care. What then tends to happen
19:34
is people think about well actually I
19:35
could now get into my backlog and I
19:37
could start um to address that. And
19:40
actually if you move into pathway
19:42
conversations it's a very different
19:44
start point from most industry
19:46
conversations. And what I mean by that
19:48
is most industry conversations start on
19:51
the left hand side of the screen. We
19:53
talk about the product, we talk about
19:55
the evidence, we talk about our
19:57
indication, we talk about acquisition
19:58
cost, our nice technology appraisals,
20:01
the guidelines that have been published,
20:03
the formulary position. All of that
20:05
absolutely important and I'm not
20:07
diminishing that in any size, shape or
20:09
form. But NHS leaders are often thinking
20:12
about the left, the right hand side of
20:14
the screen, something completely
20:15
different. They'll be thinking about
20:17
where do my patients get stuck and why?
20:19
Where is my capacity constrained or
20:21
being lost or consumed in a way I hadn't
20:23
planned for? Where do I see my demand
20:26
escalating? It's it's out gunning the
20:28
capacity that I've got available to
20:30
deliver.
20:32
Where is my workload becoming completely
20:34
unmanageable? And that's why literally
20:37
this slide is why two people can walk
20:40
out of the room at exactly the same time
20:42
having been in exactly the same meeting
20:43
and think they've had completely
20:45
different conversations because on one
20:47
side we're thinking product and on the
20:49
other side they're thinking pathway.
20:54
And this is why I think pathway wins
20:56
because when you start with the pathway
20:58
instead of the product, I think you get
21:00
something that's a lot more interesting
21:01
because you stop talking about adoption
21:04
and you start to talk to them about
21:06
reducing pressure, releasing capacity.
21:08
Big one. That's a massive one. If you
21:10
can get into that, you start thinking
21:12
about how you might help them and
21:13
support them redesign care. So what does
21:15
it look like currently? What could it
21:17
look like in a future model if we made
21:19
changes? You'll start to talk to them
21:21
about improving patient flow,
21:23
potentially improving money flow,
21:25
definitely about how you might help them
21:26
stabilize demand. And these are exactly
21:29
the things that NHS leaders are being
21:32
held to account for. This is the kind of
21:34
stuff that comes up in my NHS
21:36
conversations all the time because
21:38
that's where the the um they're held to
21:41
account and that's why a pathway
21:43
conversation with you will land much
21:45
better because you're solving a system
21:48
problem, not just pitching them or
21:51
presenting them with a product.
21:57
much as we might like to think they do,
21:59
one of the things I'm going to stress to
22:00
you is the NHS doesn't adopt the best
22:02
idea. It adopts ideas that fit.
22:07
That's absolutely key. Ideas that fit
22:09
are the ones that get adopted. And
22:12
that's probably my single most important
22:15
line in everything that I'm going to
22:16
talk to you about today. Because what I
22:18
see happening time and time and time
22:21
again is we get some really great ideas
22:23
that just go nowhere. And I I want to
22:26
stress right as I did at the beginning,
22:27
not because they're wrong, simply
22:29
because they don't fit. And that could
22:32
be they don't fit the pathway, the
22:34
budget, the workforce, the timing is
22:36
just wrong, or one of the big ones is
22:39
they just don't fit the operational
22:40
reality that the NHS is working with at
22:43
that point. And that's before we get to
22:46
is this going to create risk in my
22:48
pathway?
22:50
And that's why you have to think about
22:52
what's the what's the idea you're
22:54
taking? You've got to keep refining your
22:56
approach. Pathway over product is very
22:58
much um the the piece for me because you
23:02
have to redesign how it fits the reality
23:05
of the way that they work in the NHS. I
23:09
often find better doesn't win. What I do
23:11
find is that good fit with the way that
23:14
they work and their current pathways
23:16
absolutely wins out more often than not
23:20
in terms of what you could do
23:22
differently. Um,
23:25
stop starting with the idea. Stop
23:28
starting with the product. Absolutely.
23:30
Go in there and start with the pathway.
23:33
Start to map and understand where the
23:35
pathway pressure is. Because the pathway
23:38
pressure is your opportunity. That's
23:41
where your opportunity to then see how
23:43
you can help and support them, how you
23:45
could design something that fits the
23:46
reality of the way that they work
23:48
currently. not something that looks good
23:50
in isolation and critically something
23:53
that would absolutely exist within how
23:55
the system lives and works daytoday.
23:59
If you take a step back and you start to
24:01
think about who owns the pathway, who
24:04
delivers it, how did they get paid and
24:06
then how would my idea scale? Because
24:08
this is another really common problem
24:10
that we develop pilots. The I often
24:12
highlight the NHS has got more pilots
24:14
than EasyJet do. But the reality is we
24:17
end up with pilotitis, but the pilots
24:19
then don't scale. We get pockets of
24:21
brilliant and it it doesn't actually
24:23
scale. So what we're really trying to do
24:25
is to go from this is a good idea to
24:28
this actually works.
24:30
And not only does it work, but it's a
24:33
something we could scale. And that's
24:35
what you got to keep in mind. A lot of
24:37
the pathways are different. A lot of the
24:39
systems are different one to the other.
24:41
So you'll get the barriers showing up in
24:43
slightly different ways in in each of
24:45
the different systems. But that's why
24:47
you want to stay close to them. That's
24:49
why you want to take a pathway approach
24:50
over a product approach because once you
24:53
understand the pathway and you can map
24:55
it and show them how what they're doing
24:57
currently and potentially what that
24:59
costs and then show them what a map of
25:01
your rework pathway would look like and
25:03
what that would cost and what capacity
25:05
it releases or efficiencies it brings to
25:07
the table. That's where you're going to
25:09
get a completely different response back
25:13
because you will be solving a known
25:15
problem within the system and that's why
25:17
pathway over product really will help
25:20
you um if you take it forward that way.
25:24
So I've got something extra for you
25:27
because what I've done today for me
25:29
isn't a one-off thought. It might be the
25:32
first time you've heard it me talking
25:33
about pathway over product but for me in
25:35
my work it's very much a pattern. And I
25:37
see lots of conversations across
25:39
different systems, different pathways
25:41
and different customers. And that's why
25:44
I've quietly in the background been
25:46
building embedded edge to help you go
25:48
that bit deeper. Now, I hasten to add
25:50
this is not something that we're going
25:51
to charge for. It's something that you
25:53
will be able to sign up for. I've put
25:54
the link into um the
25:59
the chat function, not the Q&A, I was
26:01
going to say into the chat function and
26:02
you'll be able to find it there at the
26:04
end of the session. This is going to
26:07
help you look at real pathway barriers,
26:09
real system dynamics, real examples from
26:11
my NHS work that I'm able to anonymize
26:14
and it will actually help you move
26:16
forward. So, I've been quietly
26:17
developing this in the background. The
26:19
first one um that we're going to publish
26:21
is on the left shift and what it is and
26:23
how it works and how you might include
26:25
that in your work. The second one is
26:27
going to be on pathway over product and
26:30
how you turn that for what it actually
26:31
means and how you turn that into the way
26:33
that you work and um how we apply that
26:36
within your work. Um so it's a it's a
26:39
very very different way of doing it. And
26:40
then the la the third one is going to be
26:42
on integrated neighborhood teams. I
26:45
haven't got to number four yet and
26:46
that's the kind of the first three
26:47
months um of the work just being drawn
26:50
together now. So, the first one will go
26:52
live and after today, you'll be able to
26:54
sign up to that on the website and then
26:56
you'll get any alerts and updates that
26:58
go with it. As I say, no cost to it.
27:00
It's it's absolutely um uh helping you
27:04
stay close to literally what's going on
27:05
inside the NHS right now.
27:09
So,
27:10
embedded edge um is the kind of the
27:13
start point, but there are other things
27:14
that might um actually come to to help
27:18
you. Um so embedded edge as I say
27:20
completely free. Um it's where I share
27:23
things I'm seeing literally in real time
27:25
across my work with the NHS the policy
27:27
changes that matter um the pathway
27:30
developments that matter the operational
27:32
realities that are actually shaping
27:33
decisions dayto-day. So this is very
27:35
much designed to help you just
27:38
stay connected to what's actually
27:40
happening in the system rather than
27:42
relying on either yesterday's thinking
27:44
or some assumptions about what you think
27:46
might be going on because um what's
27:49
clear to me is that when people come and
27:51
talk to me, I get a whole range of
27:53
different levels of support that people
27:55
um might need. Um so for some of you,
27:58
it's just a one-off question. For
28:00
others, you need a bit more input. So
28:01
that's why we created two other levels
28:04
um you could that you could tap into. So
28:06
you've got Ask Scott. Um occasionally
28:09
you might have a challenge that you just
28:10
feel is too big or you want me as a
28:12
sounding board or you want to change
28:14
strategy or you're needing to develop a
28:16
business case or a case for change or
28:18
just unlock a specific market access
28:21
challenge. That's where um a one-off ask
28:24
Scott could could come in. I've got some
28:26
companies that come to me and want more
28:28
dedicated support and that's where um we
28:31
created the NHS um sprints uh focused
28:35
pieces of work that are designed to help
28:36
you move something forward quite
28:38
quickly. So you might have five of these
28:40
over a kind of four-week period over a
28:42
month and we help you you know very
28:44
rapidly uh make progress. So that needs
28:47
a little bit more um input and a little
28:49
bit more support. So this, as I say, is
28:52
to try and, you know, open up the
28:55
opportunities uh for you and really help
28:57
you land your messaging um into the NHS
29:00
in a slightly different way that is
29:02
going to help you get traction and help
29:03
you land and embed those projects.
29:07
So today, I thought it would be worth
29:10
just turning Ask Scott Live. Um we can
29:13
literally do it. I'm going to take the
29:16
gamble on the questions that you're
29:17
going to give me. So for the next kind
29:19
of 20, we got what we got about 25
29:21
minutes. Yeah. Um and I I would say this
29:24
is probably the part that I enjoy most
29:26
because whilst all the frameworks are
29:28
useful and the strategies are useful, I
29:30
often find that the real value comes in
29:32
the application and and really trying to
29:34
help you with the situations that you're
29:36
dealing with right now. So, if you've
29:38
got something right now that's stuck,
29:40
whether it's a real customer, a real
29:42
pathway, a challenge, something that
29:44
just isn't moving for you, you know,
29:47
bring it to me just now and let's see
29:49
whether or not we can help. Um, and I'm
29:52
more than happy to take um any
29:54
questions. I'm going to stop sharing my
29:56
my screen and um and we'll open it up
29:58
and see if I can find questions in the
30:01
in the question and answer box with you.
30:04
And let's see what we've uh see what
30:05
we've got.
30:08
Ah, so nobody's asked me a question so
30:10
far. So it's a good job. I did ask
30:12
people in advance um if ask a few of the
30:16
customers was there anything particular
30:17
that they wanted to know and the the
30:21
question I first question I got back was
30:23
Scott that's all you know well and good
30:26
but how do I map a pathway was it was
30:29
one of the things that I that I got.
30:30
It's all right saying map a pathway, but
30:32
what would I actually do?
30:36
And the way that I do it is I have a
30:38
little template and what I look at is
30:41
each step step by step. So number one,
30:44
who delivers the step? That's number
30:46
one. Who delivers a step? What grade are
30:49
they? Because I can then work out the
30:50
hourly rate from there. Then I can add
30:52
the on cost. So you need to add well it
30:55
ranges between 27 and 32%. You can check
30:58
with the individual customer what their
31:00
on cost rate is and you can then
31:02
multiply that into the hourly rate. Then
31:05
you need to know how long is the
31:06
appointment. Then I want to know is um
31:10
what consumables get used. Then from
31:12
there I start to inquire as to whether
31:14
or not this is the bottleneck or the
31:16
backlog in the pathway. And you build a
31:19
picture literally step by step by step.
31:22
And what you will unear is where the
31:24
bottlenecks and the backlogs are, where
31:26
the workarounds are and the handoffs
31:28
are. And that's where you really get the
31:30
opportunity to then say, "Right, this is
31:32
what you're doing currently." And
31:33
actually, we can look at what that
31:34
costs. If I showed you what a rework
31:36
pathway working with my company could
31:39
look like, this is what it would look
31:40
like, and that's what it cost. And
31:42
here's the capacity that we could fee
31:44
for you. And that's where your
31:45
conversations will change because then
31:48
the opportunity comes to talk to them
31:50
about the product and where your product
31:52
would fit. But now you're having a
31:54
different conversation because you're
31:56
having a conversation about your product
31:58
as an enabler of the pathway. So you
32:02
become a pathway partner rather than a
32:05
product vendor. So mapping pathways
32:07
would be one of the key things for you.
32:09
And the thing I would add to that is the
32:11
reason that I get you to map them or
32:13
would encourage you to map them is
32:15
because if I got anybody to come off
32:16
mute just now, in fact, if I was to say
32:19
to Joe, Joe, tell me how you make a cup
32:21
of tea. Joe would say something along
32:23
the lines of first and foremost, Scott,
32:25
are you for real? But then she would
32:27
probably say something along the lines
32:29
of, "I put water in my kettle. I boil
32:32
it. I put a tea bag in the cup. I pour
32:34
the water on top. I put my six sugars
32:36
in. I take the tea bag out. Add a splash
32:39
of milk and I drink it." Because that's
32:41
what we would all see pretty much how we
32:43
make a cup of tea. The reason I want you
32:45
to map the pathway with them and
32:47
potentially go and observe the clinic is
32:50
what that doesn't tell me is that to put
32:52
water in the kettle, I've got to go way
32:54
down the corridor to the kitchen to fill
32:56
the kettle up. I then bring it back and
32:57
I put it on to boil on my desk. Then I
33:00
think I'm going to need milk, right?
33:01
I've now got to go to the cold store
33:03
where we keep all the the milk and
33:05
everything. I go up the other end. I
33:06
then get interrupted on the way back. So
33:09
now by the time I arrive back, my
33:10
kettle's already boiled and gone cold.
33:12
So, I start rebiling the kettle and then
33:14
I get an interruption. So, now I
33:15
disappear off to deal with that and I
33:17
come back, my kettle's gone cold again.
33:18
So, I boil it again. I then get another
33:20
interruption cuz there's an emergency on
33:22
the ward. I've poured the water into my
33:24
my cup by now. So, right. Oh, take Oh,
33:27
no. Go and deal with this. By the time I
33:28
come back, it's gone cold. So, now I've
33:30
got to go and pour it out down the sink.
33:31
The point I'm making is this is what
33:33
happens in NHS pathways. So, don't let
33:36
them tell you what they think happens.
33:38
actually observe what happens and get a
33:40
real pathway picture and that's going to
33:42
give you the best chance to have a
33:43
conversation with them.
33:46
Okay. So Lucy, I find that clinicians
33:49
just don't have time to speak to me. I'm
33:50
asking them to meet to talk about our
33:52
support services but no movement. So I
33:56
think here I I would be talking to them
33:59
about the pathway about where you think
34:02
you can support them in the pathway and
34:04
that could just be part of the reason
34:06
that they don't have the time is because
34:08
they're firefighting constantly. So what
34:10
you would like to do with them is to try
34:12
and understand whether or not there's
34:14
anything in the way that the pathways
34:15
run currently and the way that the
34:17
patients flow through the system and
34:19
would they be open to letting you map
34:21
the pathway with them and then having a
34:22
conversation. And I think if you if you
34:25
do that, I think you'll then have um a
34:30
chance you you'll have a chance to get
34:31
them around the table because a lot of
34:33
them um will recognize the fact that
34:35
they're absolutely struggling with
34:37
workload right now. So I would kind of
34:39
take a pathway approach to and see if
34:40
they'd be prepared to let you um engage
34:43
around mapping before you offer any
34:45
solution because currently what they're
34:47
probably hearing is here's somebody that
34:48
wants to talk to me about a support
34:50
service.
34:51
No, actually talk to them about the
34:53
pathway problem and where the support
34:55
service would be an enabler of the
34:56
pathway. So, a little bit of
34:57
investigative work I think might open
34:59
that up for you.
35:02
Alli, hi Scott, great webinar. Oh, thank
35:05
you. That's that's very kind. Can I ask
35:07
about digital solutions in Scotland? The
35:09
difficulty I'm having. If it's not a
35:11
Scottish developed solution, they're
35:13
less interested to engage. Any tips?
35:15
Yeah, back to the pathway again. So,
35:17
this comes up a lot. Scotland, Wales,
35:20
Northern Ireland, and England. Um,
35:23
excuse me. It's quite an interesting one
35:25
because I don't I've never found this in
35:28
Scotland, but I did find this in
35:30
England. And it's it's worth me just
35:32
telling you this because it makes the
35:33
point that you're coming up against
35:35
quite well. Um, so, and if anybody wants
35:39
a copy of this, if you message me, if
35:41
you email me, we'll sort you a copy of
35:43
this spreadsheet. So this spreadsheet
35:45
comes from 2012 and it's it's called the
35:48
most comparable local authority and it
35:51
kind of tries to tackle this very point
35:54
Alli that we all believe our patients
35:56
are different and I used to get this a
35:59
lot um back in the day so I'm going back
36:01
to it must have been around 2012 13 when
36:03
this was rife in my work um I always
36:06
remember Sulford in Newcastle used to
36:08
say oh Scott what you don't understand
36:09
is we're really different and I went try
36:12
hunting to try and improve prove that
36:14
the patients in reality are really not
36:15
that different. And I came across this
36:17
spreadsheet called comparable local
36:19
authorities. And what it does in column
36:21
one, you pick the local authority for
36:23
Newcastle for argument sake. And you
36:25
click that box and it shows you the five
36:27
most comparable. So the like for like
36:29
and lo and behold, Sulford was one of
36:31
the ones that matched Newcastle. So I
36:33
then put Sulford and lo and behold,
36:34
Newcastle showed up in the Sulford one.
36:37
And I was able to start to not instantly
36:39
but to very quickly show them that
36:40
actually the patients are not really
36:42
that much different. you've got very
36:43
similar demography.
36:46
So the other thing that I would advocate
36:48
that you that's one is to try and find
36:50
an area that's already done it that's
36:51
got similar demography to the area that
36:53
you want to work with. Second thing I
36:55
would do with this one is have a
36:58
reference site. So I find um and I do
37:02
this a lot. I'll get my NHS customers
37:04
talking to each other rather than
37:06
hearing it from me. One of my best
37:07
examples of that um was I got Newcastle
37:11
and um North Warikshire the hospitals to
37:13
talk to each other and so in Newcastle I
37:16
had organized the hospital subcontract
37:18
to the GP federation. I loved the
37:20
project and very quietly and carefully
37:23
said to the hospital would you be happy
37:26
to speak to the George Elliot Hospital
37:29
in North Warshire and they said if you
37:31
can connect us directly Scott we'll
37:32
happily do that. So I was meeting quite
37:34
a bit of resistance at that point.
37:35
However, I managed to get them connected
37:36
and they took care of it for me. And
37:39
from that point on, I've always made a
37:41
point in my projects of developing what
37:43
I call a reference site. So, when I'm
37:45
developing my demonstrators rather than
37:47
pilots, I don't like the pilot word
37:49
because pilots stop whereas
37:51
demonstrators demonstrate and then
37:53
become the routine of the way that we
37:54
work. So, I tend to talk I'd like to
37:56
demonstrate this with you and develop a
37:58
proper demonstrator site. And at that
38:00
point I'm thinking about when we scale
38:03
this and it becomes the routine of the
38:04
way they work. I want to be able to get
38:07
replication material. So I want to know
38:09
the pathway, the standard operating
38:11
procedure, the governance, the patient
38:13
flow, the money flow, all of that should
38:15
come with it so that when I then move it
38:17
to a different even if it's a different
38:19
country, Northern Ireland, Wales,
38:22
Scotland, I've got the material so that
38:24
they're not starting from scratch and
38:27
again I can connect one customer to the
38:29
other. So I think with that one, Alli, I
38:31
do get the the kind of the the
38:33
resistance. It's it's clearly not
38:35
changed since my day in industry because
38:37
I covered Scotland and used to have
38:39
exactly the same the same uh the same
38:41
issues. It's clearly not changed. But
38:43
that's how we try and do is try and have
38:44
a solid NHSbased reference site that
38:47
might be prepared to speak up on your
38:49
behalf rather than the customer hear it
38:51
from you because with the best will in
38:52
the world, they're always going to have
38:54
that not doubts maybe not the right
38:56
word, but if I use that word, you'll
38:57
know what I and they'll have that
38:58
question in their mind. Am I really
39:00
getting everything out of this? Whereas
39:02
if it's NHS to NHS, there's nothing
39:04
really to hide and there's no axe to
39:06
grind. And that's potentially how I
39:08
would uh how I would I would do that.
39:12
Uh next question, how can we encourage
39:15
collaboration if the budgets are still
39:16
siloed and already allocated? This is a
39:19
really great question. So this actually
39:21
taps into the left shift idea. It also
39:25
taps into um risk share um approaches.
39:28
Now I've got quite a bit of this going
39:30
on in my work just now where um we've
39:33
identified quite significant savings for
39:36
argument sake in hospital but actually
39:38
general practice needs to do a bit more
39:40
work. So what we're looking at is using
39:43
some of the budget that's allocated in
39:44
secondary care and moving it to primary
39:47
care to get the extra work done on the
39:49
basis that it will cut avoidable
39:51
outpatient referral and cut avoidable or
39:54
inappropriate referral and avoidable
39:56
non-elective admission to secondary
39:57
care. So the fact that the budgets are
39:59
siloed, we now have an ability because
40:03
we're heading towards integrated
40:04
neighborhood teams and we now have an
40:06
ability where people are much more
40:08
interested in well if actually I can
40:10
move the work and I can move the budget
40:11
to go with that. So I've got some great
40:14
examples in my work. Some of them are
40:15
long-standing. I've got hospital
40:17
subcontracts that are um I've got one
40:20
that's 12 years old. I've got three that
40:22
are between 8 and 10 years old. So
40:24
they've been around long before it was
40:26
called left shift. And we actually have
40:29
a standard template part B service
40:32
subcontract for subcontracting clinical
40:35
services. So you can absolutely
40:37
encourage collaboration using the
40:39
subcontracting model. And the
40:41
subcontractal model means that the
40:42
budget still sits with the hospital but
40:44
now it might be paying general practice
40:46
or community services or even the
40:48
voluntary sector to manage a piece of
40:50
work for them. And it's a a really great
40:52
question. And it's absolutely one that
40:54
you can bring to bring to life because
40:56
it's the whole system is being geared up
40:59
to do that today. So although the
41:00
budgets are still siloed, there is a way
41:02
that you can work around that using um
41:04
hospital subcontracting or even a risk
41:07
share agreement where you might have a a
41:09
hospital department that can save I
41:11
don't know £300,000
41:14
and they think there's a load of work to
41:15
be done to do that. will put forward a
41:17
proposal to contracting and finance that
41:19
says we can save 300 but I want a 100 of
41:22
that back to cover the cost of doing the
41:24
work and then to invest in this that
41:26
will avoid non-elective admissions
41:28
repeated referral followup whatever you
41:30
can take that approach there are ways
41:32
that you can do it
41:36
Robert uh what do you do when there is
41:39
no way to get around the fact that the
41:41
what you propose adds another step to
41:43
the pathway ah i.e Home care delivery of
41:45
medicines from hospitals requires a wet
41:47
signature. There does not seem to be a
41:49
way to get around this because of the
41:51
law. Rupert, I need to know a bit more
41:53
about what's creating that as a um as a
41:57
problem because um my thing there with
42:00
with home care is I've got quite a few
42:02
projects just now where they're actively
42:04
looking at home care delivery because
42:06
we've now taken the time to map the
42:08
pathway and we've looked at what ongoing
42:10
hospital delivery costs. not what we
42:13
think it costs, what it actually costs
42:15
to do it versus letting it go to home
42:17
care and the reduction in some of the
42:19
loss making services that we now run in
42:22
secondary care. And suddenly I've found
42:23
a whole load of people that are more
42:25
than willing to move heaven and earth to
42:27
move that work out to home care to bring
42:29
down the overall resource consumption in
42:32
secondary care. So a lot of that comes
42:34
back to do we understand the difference
42:36
between turnover profit and cash flow.
42:38
Um, a lot of services don't understand
42:41
the difference. Um, but when they do,
42:43
what they then see is I'm I'm managing
42:45
these ongoing stable patients. We see
42:48
them once a month, once every six weeks,
42:50
once a quarter where we inject them,
42:52
infuse them, whatever it is we do with
42:55
them. And actually, it doesn't add up.
42:58
The what I'm being paid to do that
42:59
doesn't get covered by the payment. Oh
43:01
my god, I'm just I thought I was racking
43:03
up millions in income and actually what
43:04
I'm doing is racking up quite
43:06
significant losses. When you get to that
43:08
point, you will find that the
43:09
willingness to then move work um
43:12
suddenly opens up and um I've got a few
43:15
home care projects you say where people
43:16
are actively looking at how do we
43:18
increase home care because we cannot go
43:20
on delivering this and racking up
43:22
losses.
43:26
Josh, what are your thoughts on the
43:28
MedTech funding mandate? It's now
43:31
included in the NHS payment scheme, but
43:33
the intention of it doesn't land despite
43:34
the focus of pathway capacities cost
43:36
reduction.
43:38
Well, I think we're it's a bit early to
43:40
know whether or not that this is really
43:42
going to land. Um, I do think I'm I'm
43:45
going to come back to the map the
43:47
pathways actually take the time to show
43:51
them the cost of what they're doing
43:52
currently. Um, it never fails to amaze
43:55
me the number of times that people their
43:59
view will change in a blink of an eye
44:01
when you're able to show them that what
44:03
this this is what you do currently. Here
44:04
are all the steps and this is what it
44:06
cost you. Oh, and that's what you're
44:08
being paid. And suddenly they realize
44:10
that I'm not generating income. I'm
44:11
actually generating losses. And then you
44:15
could show them what a reworked pathway
44:17
working with you with your new piece of
44:18
kit, your medtech, and what it would do,
44:20
what capacity it would release, what
44:22
resources it would release, that's where
44:25
you're going to get your traction. It it
44:27
I know that probably sounds like, oh my
44:29
god, but I promise you, if you take the
44:32
time to map the pathways with them, I
44:35
have a a a great example. I'm not going
44:36
to get into the hospital trust or even
44:39
the disease area but simply by mapping
44:43
the pathway with them and I met a lot of
44:45
resistance. I met a lot of resistance
44:47
from the consultant and team thinking I
44:49
don't know why we're doing this. I don't
44:50
see the point and that was basically
44:52
based on the fact that they're all
44:53
really busy. Their view was nobody's sat
44:56
about with any slack in the system.
44:57
We've got no spare time. So that that
44:59
view was if we're all really busy and
45:01
all flat out what's the point in mapping
45:02
anything? Cutting a long and boring
45:04
story short, once I mapped the pathway
45:06
with them and we looked at where the
45:08
bottlenecks were created, what we
45:10
discovered that actually treatment
45:11
choices and the way they managed the
45:13
patients drove a lot of the downstream
45:15
workload and a simple change earlier in
45:18
the pathway meant that all that
45:19
downstream workload was lost and it
45:21
freed up nearly a million pounds a year
45:23
in the department budget and they were
45:25
under pressure to save 300,000 and we're
45:27
actually thinking about making people
45:29
redundant to make the saving. So it's a
45:31
bit early for the medtech funding
45:33
mandate. It is now part of the payment
45:34
system as you rightly point out and it
45:36
will be really interesting to see you
45:38
know how that develops. Um I'm also very
45:40
grateful to you that you've enjoyed the
45:42
webinar and that's why we put these on
45:44
and the hope that you will and enjoy
45:46
them. So if it's been good thank you
45:47
Josh. I'm delighted you were able to
45:49
give time and come and join.
45:52
Uh Lynn, how can you leverage space with
45:56
these customers when you're working in
45:57
disease areas that are not priorities
45:59
across the ICB? Okay, good. That's a
46:01
good question. So, I
46:05
I'm certainly not going to dismiss what
46:07
you're saying, okay? So, don't take what
46:08
I'm about to say as me being dismissive
46:10
in any size, shape, or form. But what I
46:13
actually find is we make the assumption
46:16
that things like diabetes,
46:18
cardiovascular disease, respiratory
46:20
disease are the big the big the big
46:22
areas, the big priorities. And actually,
46:24
often they're not. A lot of the
46:27
priorities are driven by passionate
46:29
clinical leads. If you've got a clinical
46:32
champion that really buys into what you
46:34
want to do, they can move heaven and
46:36
earth for you. They're much more
46:37
powerful than we might give them credit
46:39
for or realize. Uh if you can win that
46:41
clinical argument, you can often make
46:44
things a priority. It's why over many
46:47
years I've been able to do things in dry
46:49
eye disease, pediatric allergy, tiny
46:51
numbers. Schizophrenia, tiny numbers.
46:54
Migraine, again, bigger numbers, but
46:57
certainly not on a par with asthma,
47:00
COPD, type 2 diabetes, heart failure,
47:03
chronic kidney disease. No, they're not
47:05
that kind of size. So, it really is
47:08
about leveraging the argument with the
47:11
clinical lead and getting them to see
47:12
the potential of what you could do both
47:14
in terms of workload and workforce. And
47:17
I think that's how you'll get your your
47:19
traction. I also find that um the I
47:23
spend less and less time now with ICBS
47:28
until we absolutely need their input.
47:30
And again, I'm not knocking the role of
47:32
ICBS or in any way diminishing their
47:35
role. What I'm simply reflecting is that
47:37
now they've moved they've become bigger
47:40
geographically smaller in in people
47:42
numbers. So you know I mean if I give
47:45
you I had one in the Midlands which went
47:47
from 843 staff down to just over 400
47:50
staff over the last four months. Um
47:53
people being made redundant. So from
47:54
kind of January, February, March, April
47:56
through to the beginning of May that
47:58
change was made. So at that point we
48:00
very quickly got the message we're not
48:02
going to be involved in the pathway
48:04
discussions. the providers need to come
48:05
to the ICB with their ideas for pathway
48:08
changes. So that meant working with the
48:10
provider collaborative and that's a big
48:13
step change. So now you're finding the
48:14
systems are much more providerled than
48:17
they are commissionerled. So that's when
48:19
I mean win the clinical argument then
48:22
move to the budget holder for the
48:23
department then get contracting and
48:25
finance involved. Why those two roles
48:27
Scott? Because they're connected to the
48:29
ICB. Every month in life, we will have a
48:32
contracting meeting between the hospital
48:34
trust or the provider and the ICB really
48:37
along the lines of what's going well,
48:38
what's going less well, um what should
48:41
what do we need to change, what's
48:42
actually overheating and we need to do
48:43
something about. So that's where you get
48:46
the opportunity to then bring the ICB
48:48
round the table on something that the
48:50
hospital sees as a priority. And in
48:52
fact, I'm going to tell you a little bit
48:53
extra. I had one of my very friendly
48:56
commissioners, very senior commissioner
48:58
as well. Um, and again in the Midland
49:00
say to me, "Actually, Scott, there isn't
49:03
much point in industry really targeting
49:05
me these days because even if I love the
49:07
idea, if I think what they're pitching
49:09
is a brilliant idea,
49:11
I've then got to go and persuade the
49:13
provider that they've got to change what
49:15
they're doing and that's not really my
49:16
role. That's their role. I I need them
49:18
to persuade the provider to make the
49:21
change and then the provider can bring
49:22
it to me as a commissioner and say we
49:24
want to make this change because and
49:25
then I'm either going to agree or
49:27
challenge or disagree completely but
49:29
that's the route for the the proposal to
49:32
come. So it's probably a little change
49:34
in in where you are win the clinical
49:36
argument then move it over into the
49:38
operational teams and they will get the
49:40
ICB involved but neurological conditions
49:43
are absolutely doable. I've got some
49:45
work just now in things like um multiple
49:47
sclerosis. Um I've got work in in
49:50
migraine um as well and I'm not saying
49:53
it's easy but they are um becoming MS is
49:56
another area I've done some work in as
49:58
well. There are ways that you can bring
49:59
this to life.
50:03
Uh anonymous is quaft still a driver of
50:07
GP activity and therefore revenue for
50:08
the practice? It is and it isn't. I
50:11
wouldn't say it's a massive driver. not
50:13
the way it was back in kind of the the
50:16
early naughties in the the kind of 2006
50:18
7 8 9 um kind of from 2010 onwards as it
50:22
started to wither a little bit and now
50:24
although there's still money tied into
50:26
it but I wouldn't say it's a
50:28
conversation that comes up a lot in my
50:29
work um helping deliver qua what I would
50:33
say is helping them optimize patients
50:36
that might then also knock on into qua
50:39
that is something that I do see general
50:41
practice having a real interest in um
50:44
lots of projects just now that I see
50:46
going on where we're getting pharmacists
50:48
or nurse teams from industry who are
50:50
supporting them to optimize patients and
50:52
the knock-on effect is we get quaft done
50:54
at the same time that absolutely still
50:56
has a a role to play and and people are
50:58
absolutely engaging with that.
51:04
Anyone else with a a quick last minute
51:06
question? And if not, um we can we can
51:09
draw it all to um to a close for you.
51:22
Okay. Well, thank you all for coming and
51:24
joining us um today. What I've really
51:27
want to stress to you that what I've
51:28
tried to talk to you about today isn't
51:30
that unusual.
51:32
what it's not is just one system or one
51:35
pathway. What I observe is it's a
51:37
pattern across all the different um ICBS
51:41
and providers that I work with. And it
51:43
really it's the it's the reason that I
51:45
do these I do these webinars. It's also
51:47
the reason that I've built embedded edge
51:48
as well so that you can understand the
51:51
pattern. Um but that doesn't change
51:53
anything. Applying it consistently does.
51:57
And what I know in my work is that
51:59
pathway mapping and really helping
52:01
people understand where the bottlenecks
52:03
are, where the backlogs are, where the
52:05
handoffs are, where the workarounds are,
52:07
and then helping them go from this is
52:09
what it looks like currently and what it
52:10
cost to this is what our rework path we
52:12
could look like with freed capacity and
52:14
freed resources. That's where you'll get
52:17
to to really get traction. I think um if
52:21
this reflects what you're seeing in your
52:23
own work, that's where my recommendation
52:26
would be that you take the time to start
52:28
to work with your customers in a
52:30
slightly different way. Lead with the
52:32
pathway, not with the product.
52:34
Understand where the pressure is and
52:36
then you you'll absolutely get the
52:38
traction to go ahead and work with them,
52:39
but it will be um in a different way.
52:42
I've just seen one last quick question
52:44
pop up. Will there be a recording to
52:45
watch back? we have recorded it and I'll
52:47
sort that out with uh with Joe and the
52:50
team at Story22, how we make that
52:51
available to you. Um but that aside, I
52:54
hope you've enjoyed it. I hope that's
52:55
been helpful and I look forward to
52:57
catching up with people um in passing.
53:00
Um one very last quick thing, if I go
53:04
back to my slideshare,
53:07
um
53:09
I can give you the the contact details
53:12
as well. Well, if you're not registered
53:14
um on the mailing list, I would
53:16
encourage you to do that cuz that way
53:17
you'll get all the the updates that we
53:19
do. You'll also get the newsletter as
53:21
well, which comes out fortnightly. Um
53:23
that will get you signed into Embedded
53:25
Edge. You'll get the link for that in
53:26
the chat. And last, but by no means
53:28
least, if you're not connected to me on
53:30
LinkedIn, please feel free to reach out,
53:31
send me a LinkedIn um uh joining
53:34
request, and I will absolutely, I
53:36
promise you, I will accept. Many thanks
53:39
again everybody for joining. I hope you
53:41
have a really good rest of the day.
53:43
Thanks again,