These past 48 hours I have been musing on my recent visit to EHI Live 2012.

I have also been reflecting on an excellent article by Daloni Carlisle, Small is beautiful.

It is always a delight to be the recipient of a great and overpowering love; but I do question the unrequited nature of such emotions in reality.

And reality is the key here. Judge the policy makers by their deeds, not their words. A finely constructed sentence, delivered eloquently from a lectern needs to find substance on the ground.

Nonetheless I’m an optimist at heart and therefore I will feel the love. But if the NHS and SMEs are going to get this done, then we haven’t much time.  “Lovers ever run before the clock” [1]

We need leadership at the Centre; true visionaries who speak and act with authenticity and who are not afraid to fail.

Be assured such vision and leadership will be matched from within the SME community itself.

But if we SMEs are to be truly part of a brave new world then sitting back on the side-lines shouting “we told you so” is not enough. We must raise our game also. Indeed we have a duty to do so, because it may just be that our time has truly come.

Never before has NHS IT required the entrepreneurial spirit and creativity that is part of our DNA.

So to the policy makers and to our prospective customers I say, “Build it, and we will come.”

Then again, we never ever really went away.

[1]The Merchant of Venice – Act 2, Scene 6

Last Friday – 29th July – I was invited to speak at an event hosted and organised by a Social Enterprise called The Hope Street Centre.

http://www.hopestreetcentre.com/

The conference in question was a ‘Platform’ event focused on the topic of “How to create commissioning systems that create good outcomes for homeless people”. Chaired by Professor David Colin-Thomé and hosted by Alison Holbourn, Chief Executive Hope Street Centre, I had been invited to present a vision for how actionable data could be turned into commissioning intelligence to support better health outcomes.

During the morning an array of speakers principally, though not exclusively, representing social enterprises in Liverpool and Leicester, presented on how they were making life better for the homeless communities they served.

Two of these speakers were Kevin and Tom. Kevin and Tom were once homeless. Both are ex addicts and both had transformed their lives with the help and support of a number of support organisations working with the homeless in Liverpool.

Kevin and Tom are now employed by the very organisations that had given them a lifeline, and they are actively involved in helping make life better for some of the people with whom they had once shared a street, a needle and a bottle.

At the end of Kevin and Tom’s ‘presentations’ (without the aid of PowerPoint I might add) I witnessed delegates in tears. I am not ashamed to admit that I was amongst their number.

This was truly transformational stuff, real life examples of better healthcare outcomes. Success stories that we should all celebrate.

Moreover it demonstrated just what can be achieved when organisations, and more importantly the people in them, join up and work together towards delivery of a shared vision and cause.

This was compassionate commissioning at its very finest.

This was integrated care writ large.

This was people recognising that whilst some of the answers lay within themselves, some of those answers were also to be found elsewhere. This was joined up people, demonstrating joined up thinking and taking joined up action. This was the power of partnership.

Lessons here methinks for everyone out there currently seeking to play a role in delivering commissioning support.

Nigel Slone
05:07:2012

The original working title of this blog was “It’s the patients stupid”. Close followers of politics – and American presidential elections in particular – will be familiar with the now famous phrase coined by Bill Clinton’s strategist James Carville, who in 1992 stated…”It’s the economy stupid”.

So some months ago when I was first preparing this blog – and with a nod to James Carville – I had developed a nice line of reasoning, I thought, which spoke loudly about “It’s the patients stupid”.

Then John Appleby – Chief Economist, Health Policy at the Kings Fund – beat me to it when back in February of this year – in the Health Service Journal (23.02.2012) – he wrote a piece called “It’s the money stupid”.

As with much output from the Kings Fund, it is an excellent article and I would commend it to anyone with an interest in the current NHS reforms. And it got me thinking. What really lies behind these reforms? Is it about the patients (stupid) or is it really about the money?

My original intention was to focus on the importance of the patient as part of the reform agenda. It had occurred to me that the patient was getting rather lost in the continuing debate around ‘transition’, ‘assurance’ (process) and ‘organisation’. In my heart I think I still believe this and I hope to return to this theme in a later blog.

However last week I was reminded of the John Appleby article, and my thoughts came back to the question of money. Last week was a busy news week (Leveson, Murdoch, Hunt etc…), however the headline news was unquestionably the fact that the UK economy has fallen back into recession.

Even before that deeply worrying announcement, the new Chief Secretary to the Treasury – Danny Alexander – was announcing the need for Government departments to find a further £16bn savings. This represents a further 5% reduction in government departmental spending and I have seen no communications yet that suggest the NHS is immune from this further austerity measure.

By the middle of the week Professor Malcolm Grant – Chair of the NHS Commissioning Board – was briefing the Health Service Journal that, “There is going to be nothing by way of relief from austerity in the NHS for years to come, so we have to find new ways of doing things.”

Last month Anita Charlesworth – Chief Economist at the Nuffield Trust – was blogging on ‘What the budget means for the NHS?’ It is required reading. She makes it quite clear that the contents of the budget report have profound implications for NHS funding….”things look very tough, probably tougher than the current £20 billion efficiency target” she states. She concludes…”whatever happens, the NHS needs to plan for two more years of belt tightening and it needs to be prepared for them to be tougher than they are now”.

On a related theme, the Financial Times – also in March – was reporting that the £20bn ‘Nicholson Challenge’ could be looking more like £50bn challenge.

Which takes me back even further. To May 2010 in fact and the note left to his successor – David Laws – by the then Chief Secretary to the Treasury – Liam Byrne – which is said to have read… “Dear Chief Secretary, I’m afraid to tell you there’s no money left.”

So where is this all leading?

Well in simple terms these are the waters that the new clinical commissioners are navigating. In pure financial terms the waters are dark and choppy in both equal measures.

Of course for the Government, clinical commissioning is seen as the essential driver for delivering the efficiency savings demanded of the NHS. The vision is that they will do this by capping demand through service re-design. For my part, the elephant in the room here is de-commissioning.

But no sane government is simply going to put £65bn into the hands of a group of clinicians and simply let them get on with it.

The NHS Commissioning Board and its outposts will ensure that performance management and financial accountability is writ large across the system.

So what does this mean for emerging Clinical Commissioning Groups (CCGs) and Commissioning Support Services? (CSS) Well it means that these organisations had better get a grip on the money.

Which means of course that they need robust and reliable sources of data about the quantity, quality and cost of their activities. Furthermore the CEOs, COOs and FDs of these commissioning organisations need a precise understanding of financial risk.

Put simply information is key. You have to have the data and you need to analyse and understand that data. The era of Big Data is surely upon us.

So whilst we never forget that at the end of every piece of data there is a person, we also understand that at that same time there is inevitably a pound sign.

Maybe it is all about the money stupid?

Nigel Slone
30:04:2012

A few months ago I assembled all my colleagues at Sollis and invited them to consider the question “what kind of business do you think we are in”? For many – particularly those who have been with the company since 1994 when it founded – it must have appeared a very strange question to pose. Still pose it I did.

I did so because I think that at some point in any company’s evolution there comes a time when it is necesary to ‘step back’ and ask the question “What is our fundamental purpose? What are we in business for”?

I like to think there was a certain logic to the timing of the question. The current NHS reform agenda has of course created huge uncertainty,and this uncertainty touches all engaged with this iconic public service. In this regard the most important community of course is patients and carers, however suppliers and their customers are not immune from the ‘slings and arrows’ of what at times can feel like ‘outrageous fortune’.

The point of the question was to get everyone here at Sollis focused on what I believe we are really in business for and that is “to make a difference”. To make a difference for our customers and in the end analysis to make a difference for patients. In this sense we are very definitely not in the technology business. We are in the people business.

Now that is an easy statement to make, and it could be argued – with some justification - that any company in any realm of business could make the same claim.

But for Sollis it is particularly true. It is true because the NHS is the absolute focus of our operations. It is true because the products and services we supply to the NHS have to ‘add value’. In simple terms they must contribute to making life better. Better for our customers and ultimately better for the populations they serve. Better for patients.

Everyone here at Sollis understands that we deliver healthcare intelligence. But importantly, all of our people understand that at the end of every piece of data we present there is a person.