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Blithering’s silver lining

Friday, 5 May 2017

Blithering’s silver lining

In the latest exciting episode from the country's most challenged health economy, Plackard deals with a crucial branding issue, while Rummage discovers the monetary value of patient involvement.

Liz Wanhope, accountable officer of Blithering CCG and co-chair of the STP, is keen to move to the next item on the agenda.

The Monday morning strategy meeting has already been going for an hour and has got no further than item one: the brand identity of the accountable care system.

“Surely it doesn’t matter what we call the bloody thing, as it doesn’t exist,” says Dr David Rummage, CCG chair and associate director of STP-wide innovation.

Martin Plackard, head of imagineering, gives Rummage the sort of look he usually reserves for truculent patient reps.

“It’s a branding issue, David,” he says, to settle the matter.

Plackard gets up, unholstering a marker pen.

“We aim to express how stakeholder collaborations will hope to evolve towards an accountable care system going forward,” he says, drawing a cluster of circles on a flipchart.

Stephanie Stent, head of the Blithering provider chain, weighs in, her voice laden with irony. “So this is exactly like an accountable care organisation but without any contractual role or meaningful governance or pooling of resources or risk sharing,” she says. “All that’s missing is the accountability.”

“And the organisation, which won’t kick in until the post-discovery phase,” says Plackard. “That’s why we’re calling it a system.”

Rummage puts two fingers to his temple and pulls an imaginary trigger.

HMS Plackard sails valiantly on: “We can worry about the operational details later, but we’re not going to take the public with us without a compelling mission and a strong and engaging brand,” he says.

Thirty minutes later, after the presentation of a proposal by independent brand consultant Natalie Plackard, it is agreed that the accountable care system would be known as the Blithering Stronger Together Partnership – or STP for short.

The transition to a full ACO, Ms Plackard explains, would be signalled by the addition of a plus sign to the logo and possibly a different background colour.

Post fax era

Liz Wanhope outlines the planned bid to make Blithering a global digital exemplar. If the application were to be successful, the programme could bring in £10m of new funding, she explains.

There is a brief discussion about the positive aspects of the scheme, including the light-touch PR requirements and the as-yet unspecified outcomes and evaluation framework.

Rummage is particularly keen on the idea, pointing out that it could build on the success of the patient record system installed at St Jordan’s at vast cost by his arms-length company Rummage Digital Solutions.

“When you say ‘build on the success,’ is that as in actually get working?” asks Stent, the hospital’s chief executive.

Rummage assures her that an operational system is a priority for phase two of the project, subject to funding and clarity on the impact of any Brexit issues on his team of offshore software developers.

Voice of the people

After coffee, Tessa Panel, lay member for patient and public involvement introduces NHS England’s new involvement guidance. All agree that Ms Panel’s standing item on the agenda should be increased to at least five minutes to reflect the growing importance of the patient’s voice in commissioning.

There is a surprising intervention by Dr Rummage, who is not known for his enthusiasm either for patients or official guidance. He makes an impassioned speech extolling the virtues of what he calls “this excellent and timely guidance”.

“We not only have a moral obligation to listen to the views of patients, we have a clear legal duty as set out in section 14Z2 of the 2012 Act, which we owe it to ourselves to observe,” Rummage says.

While his colleagues exchange baffled looks, a beaming Tessa Panel thanks Rummage warmly.

“Perhaps Mr Plackard could bring a detailed update on progress of the Blithering engagement plan to our next meeting,” she suggests.

A scowling Plackard agrees that this is a great idea.

Small change

A fax arrives from NHS England to say that there have been some small changes to the digital exemplar programme. Funding, which has been “incrementally reduced to £7000 in this case”, will not now be released until a number of new assurance conditions have been met.

“This is ridiculous. They want to see a business case for return on investment and evidence of past achievement. They obviously have no intention of awarding it to us“, says Rummage bitterly.

Later the same day…

“I must say I never had you down as a fan of involvement, David”, says Plackard peevishly.

“I’m not,” says Rummage, “but the new guidance has been very handy. Take a look at this. It came in during the meeting.”

He hands Plackard his phone.  On the screen is a piece from the Blithering Argus describing a legal challenge to a huge contract for community services which had been awarded with great fanfare to a consortium led by Stephanie Stent’s trust.

“Ah, I see,” says Plackard, brightening visibly. “Patients were all over this. Tessa Panel ran all those workshops where they agreed outcomes and were allowed to pretend they were choosing the provider. That’s the last we’ll hear about involvement for a while.”

“It’s better than that”, says Rummage. “Despite all the outcome-based malarkey, the CCG – that’s us – failed to give adequate notice of the consultation and the losing bidder cried foul, waving a copy of section 14Z2 and making threats of a judicial review.”

Plackard read on. “So it says here that the contract will most likely stay with the incumbent, RummageCare.”

“Indeed, Martin. Every cloud…”

Editor: Julian Patterson