Interview With Head of Derby Hospital – Brexit, Budget & Staff
The man at the helm of Derby and Burton’s hospitals has spoken candidly about Brexit, budget pressures and hard-working staff.
Gavin Boyle, the chief executive of the University Hospitals of Derby and Burton (UHDB), sat down for an interview with the Local Democracy Reporting Service.
The merger between the two hospital trusts is still in its infancy and will mark its first anniversary this summer.
Mr Boyle started working in the NHS more than two decades ago and took up the role as chief executive in Derby in 2016, before the merger with Burton last year.
Here is what Mr Boyle had to say.
On Brexit
Planning for Brexit in the NHS is being led at a national level. Every day we at the hospital are keeping in contact with the national planning structure.
Most of the planning relates to the possible event of a ‘no deal’ Brexit. Thankfully that it is looking less and less likely now than it did a few weeks ago.
Of course, a significant amount of our medicine is manufactured in the EU and we are doing everything we can to make sure that is not impacted.
About 300 of our staff are EU nationals from outside of the UK and a big part of our job is to make sure that they feel welcome and that they are supported to remain here. They are a key part of our workforce and work hard to support us. They are important not just for us but also for patient care. We have more EU staff now than we did before – we used to have around 250 and now we have about 300. It may be counter-intuitive to what people expected but that is just fact.
It is definitely a good sign that we are not losing people but gaining. Freedom of movement is important for that – it makes it so much easier for people to come here from within the EU. Stopping freedom of movement could cause problems for us in the future – but not at the moment.
On hardworking staff
We have many hard-working people in the NHS and certainly in UHDB – they do a huge public service. For these people it is definitely a vocation not just a job. They want to do their best for us. They have an intrinsic desire to provide a public service. And the NHS has always been this organisation that no matter who or where you are, it will be here for you.
We can’t overly rely on goodwill – but it is really important to keeping the NHS going. We don’t want to lose that.
On budget pressures and demand for services
Although money is tight we are still investing in services.
We continue to invest and there is a clear commitment from central government to increase NHS funding by 3.4 per cent over the next five years. This is better than other public services.
But we can’t go on as we are now. Over the last three years we have seen a four per cent rise in admissions into our hospitals – this is not sustainable.
Local authorities and health providers in Staffordshire and Derbyshire have been working more and more together to be more efficient – through creating a ‘Place’ approach.
It may be that the best place for a patient is not in hospital but out there, in the community.
We are very conscious of waste in the hospital and are always looking for efficiencies.
We have been looking at practice in private industry to help us find more efficient ways of doing things.
One example is Toyota, which has inspired companies with its ‘lean’ approach. (This system aims to eliminate waste in order to boost productivity and make the most of available resources)
In the USA some hospitals have now adapted the way they do things through adopting this model – the Virginia Mason Hospital in Seattle for instance. It is all about improving quality.
The approach from Toyota in healthcare is now being called the Virginia Mason model and seven hospitals in England are now trialling this model – we are one of them.
We are bringing the system back home almost – with Toyota on our doorstep, of course.
It is difficult to understand why Gavin Boyles is so determinedly upbeat when the reality is so grim.
e.g. Derby Royal has missed its 4 hr A&E waiting targets for 36 consecutive months – and this is part of a national failure which the Tories are now proposing to address by abandoning these targets altogether!
Nowhere in his interview does Gavin mention the £95 million Derbyshire NHS budget shortfall last year, the £98 million budget shortfall this year and the continuing large funding gaps to come in 2020/21 2021/2 and 2022/3, which were reported at Derbyshire Health Scrutiny in March – to the dismay of county councillors. Nowhere is there mention of last year’s serious NHS service cuts all over Derbyshire, or the still greater ones to come this year.
Gavins’ comments about the need to reduce hospital admissions must be seen in the wider context of horrendous Government cuts to all the other parts of the social care system outside hospitals and to other areas, like housing improvement and public health budgets, which impact health. This dangerous disconnect is well expressed by what the Patient’s Association says about the NHS Long Term Plan: ‘The publication of a plan for the NHS in isolation highlights the Government’s complete lack of any strategic approach to stewarding the health and wellbeing of the nation. We recommended, as the plan was being developed, that the Government should ensure that its policies in all areas that relate to people’s health and wellbeing should be aligned. This includes housing, social care, public health and the benefits system (all subject to cuts and underinvestment in recent years), as failings in these areas harm people’s health, and leave the NHS to pick up the pieces. Instead, the Prime Minister has described the Government’s decision to partly close the NHS’s funding gap as leaving ‘less room for manoeuvre’ in spending on other services. Not only is it not clear that there is any bar on investing more in other services, but it is certainly not a virtue: restraining investment in other policy areas that affect people’s health is a classic false economy, and leaves the NHS having to stretch its resources even further.”
As to Virginian Mason Hospital in Seattle and Toyota as models of ‘lean management’ to follow in our hospitals:
The Virginia Mason Hospital link looks a little less impressive when we read this:
https://www.seattletimes.com/seattle-news/virginia-mason-is-denied-full-accreditation-after-lapses/
Lean has had its critics, even from the original Toyota persective: an ex employee, Darius Mehri says Toyota is ”guided by a distinction which is fundamental to understanding Japanese culture and business: tatemae(what you are supposed to feel or do) and honne (what you actually feel or do). Mehri believes that international enthusiasm for the Toyota Production System results from western observers’ failure to discern the honne within the tatemae. He lifts the curtain of formality and messages from management at Toyota—the tatemae—that obscures the realities— the honne— of the Toyota Way: limited potential for creativity and innovation, narrow professional skills, worker isolation and harassment, dangerous conditions on the production line, accident cover-ups, excessive overtime, and poor quality of life for workers.” is this what we want for our hospitals?
”Tatemae” and ”Honne” now seem to be the opposite polls of the NHS, between senior manager wishful thinking and what front line staff ( and patients) actually experience day to day, as a result of privatisation and years of totally inadequate funding for the NHS and the wider health support system.