HEALTHCARE ESTATES 2021 KEYNOTES
The exhibition at Healthcare Estates 2021 saw a strong attendance, and as usual, provided excellent networking and opportunities.
hospitals; they’re actually part of the new agenda moving forward. Particularly with the health and social care agenda coming together, in your role in holding the system to account in Lancashire, how do you ensure that the leaders of both those sectors really buy into this agenda, and work together, in a way which delivers the change I think everybody wants to see?”
Bound together by cases for change David Flory responded: “We’re all bound together by two compelling cases for change. The first is the inequalities that exist across the populations we serve. We discussed many times how the pandemic and our response to COVID through the whole vaccination programme, the care programme, and the testing phase through all parts of that, has exacerbated, rather than narrowed, those inequalities. We’ve got an even bigger challenge going forward. Alongside that, I think for us as a health and care system there is an indefensible situation with the variations in outcomes – the different models of care, the different pathways; multiple examples of that across our patch. I think the standardisation of best practice not only contributes hugely to our efficiency and productivity challenges, but that this new hospital, when it comes along, will serve the whole of the population. It will also be a catalyst for change in the way the pathways work in and out of acute care, from health into social care, and the multiplicity of providers we have. It will be a very physically present catalyst for some of those changes; it causes great excitement in the patch with the opportunity it gives us. However, we can’t use just to upgrade old ways of working; it has to deliver those changes that you suggest.”
Time out in Qatar
Pete Sellars next asked: “David, Thinking about those changes in your five or six years in Qatar, I suspect it must be a similar agenda there? What lessons did you learn there, which could actively come in and influence what we do here in the United Kingdom?”
David Flory replied: “I’m sure some of
those in attendance today will have spent some time working in another country, in a completely different culture. You learn so much about things. It’s a real test of yourself in the way you’ve always tried to lead. To manage change, to solve problems, and to rise to challenges in a very different environment, requires a completely different approach, mindset, and skills, so I’ve learnt a huge amount. The health and care read between Qatar and the UK isn’t that great, because in Qatar there isn’t a huge social care element. In that culture families take responsibility for the care of their own people. In a in a country of three million people, 75% are ‘expats’ and overseas workers building infrastructure or running public services. For the nationals, it’s a different system. However, we opened about eight new hospitals in the five years I was there, and there were three big things I’ve reflected on since I’ve come back in terms of lessons that I learned from that.”
No easier with a ‘limitless’ budget “The first,” he continued, “is that it’s not any easier when the budget is limitless. In fact it just brings a different set of problems. I worry generally that when the bottom line doesn’t matter as much, the attention to make sure you get everything right first time – not just in the way you spend money, but equally in the way you deliver care – just isn’t there. There’s a perception that if we get it wrong first time, we can just do it again, and that if we buy the wrong thing, we can just go and find the right one.” He added: “The absence of some of the business case constraints or conditions that we have here, helps speed things along, but it doesn’t necessarily mean that you’ve got a better product at the end. So, we grumble often about the hoops we need to jump through and the tests we need to pass, but actually, I grew to love them more in their absence.
No ‘shortcutting the detail’ “The second lesson was is that you can’t shortcut the detail. You can try and get things open very quickly, and in the culture in Qatar one of the lovely things is the way
in which new facilities and new services are celebrated and welcomed by everybody – as a big measure of success and progress, and a source of great pride for the country. So, there’s a real pressure to get everything done as quickly as possible, but you still need the detail and expertise. For instance we had to be sure that we had the sinks the right size for the infection control protocols there. We were accredited by a Joint Commission, which was very precise on lots of the processes and operating model standards. You can’t shortcut all of that; we found that when we did, we invariably had to go back and pay all the attention to the detail. There’s no shortcut on that, even if there is on some of the business case processes, that in the UK take significant time. The third thing I would say is that in Qatar the doctors were in charge. There are some aspects of it that we wouldn’t like or recognise; the nurses reported to the doctors, but what I learned from that is designing, building, opening, commissioning, and opening, new hospitals – as today’s audience will know – is a highly professional expert job, with a multiplicity of professionals coming together. If you haven’t got all of that right in Qatar, the doctors just say: ‘Well, I’ll design this like this, and we’ll have less like that’. You get clinical leadership; we often struggle to get proper clinical engagement and leadership into some of these big, big programmes here, and it’s an important part of it, but when it becomes the dominant part, you’ve got lots of other problems.”
A question of balance
Pete Sellars said: “It’s indeed like everything in life; it’s a balance, and listening to you talking there, most of us would love to see a streamlined approvals process which enables us to get on and deliver and build quicker and faster. What we’ve heard from you, however, is actually that when you’ve got that, it might be just as difficult. It’s about the balance in streamlining in the approval process to a point where it’s acceptable for what we’re doing, rather than being a kind of a bureaucratic nightmare to work your way through. In
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