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Article by Michael Julien with comments on the NHS and its need for improved management and emphasis on use of up-to-date equipment - 20.12.25

Based on my own experience of many years dealing with the NHS and with this website to publish this article, I have decided to speak out using as a basis the report from General Sir Gordon Messenger, former vice chief of the defence staff, who lead a probe in 2022 into health and social care in a bid to drive up efficiency and improve performance. His executive summary is below.


This article has also been inspired by the Taxpayer’s Alliance who have more than once drawn attention to the fact that the UK pays more out Taxpayer’s money than any other country in Europe where the balance is made up by personal contributions or by insurance in France only 70% is paid for out of taxes and the rest being paid for personally or by an insurance called “mutuel”.


Taking one example where scarce financial resources have not been spent on ensuring that the NHS is properly supported by up-to-date equipment is the lack of “PET Scanners” a cancer imaging service which I have personally experienced of which we have the worst experience in Europe with the UK having the least sufficient infrastructure with only 14.39% of requirements.


See below for an explanation of PET scanners by the NHS for what they are needed.


My article includes attachments of reports as follows:


NHS explanation of PET scan...…


Positron emission tomography (PET) scans produce detailed 3-dimensional images of the inside of the body.


The images can clearly show the part of the body being investigated, including any abnormal areas, and can highlight how well certain functions of the body are working.

PET scans are often combined with CT scans to produce even more detailed images. This is known as a PET-CT scan.


They may also occasionally be combined with an MRI scan (known as a PET-MRI scan).


Please click here for the full explanation in pdf.



Requirements for clinical PET: comparisons within Europe – by Michael Bedford and Michael N Maisey for the National Library of Medicine...…


The aim was to assess the requirements for a positron emission tomography (PET) cancer imaging service. The UK was used as an example to create a mathematical model for calculating the number of dedicated PET scanners and cyclotron/radiochemistry production facilities required to support the demand for PET studies in lung cancer. This was then extended to all oncological indications for PET and comparison was made with present infrastructure in the UK and Europe.


A clinical algorithm for the use of PET in lung cancer management was created and built into a comprehensive computer model with variable parameters. From lung cancer incidences, data reported in the literature and local data, the proportion of patients following each algorithmic path was determined and used to calculate the number of PET scans and hence PET scanners required for lung cancer, and all cancer indications.


Substituting lung cancer incidences, the PET infrastructure required for each European country was assessed. From this analysis, 29,886 PET scans per year for lung cancer investigation (provision of 12 scanners) and 121,589 PET scans (2,026.5 per million population) for all indications [provision of 49 scanners (0.82 per million population)] are required in the UK; at present there are seven scanners, and thus 42 new scanners are required.


Results reported here demonstrate considerable lack of investment in PET in Europe, with marked variation; Belgium has the most sufficient infrastructure (197.80% of requirements), and excluding France, which is soon to see extensive development, the UK has the least sufficient infrastructure (14.39% of requirements). Considerable investment is required so that cancer management can gain the clinical and cost-effective benefit of this functional imaging technique, which has been established.


Please click here for the full article in pdf.


 

NHS Report 2022......


Executive summary by General Sir Gordon Messenger, former vice chief of the defence staff, will lead a probe into health and social care in a bid to drive up efficiency and improve performance.

For a report like this to have the impact intended, it needs to speak to the community it affects. It must be supportive but honest. It must recognise the challenges and the context faced, but it cannot duck the difficult or uncomfortable. It should respect the everyday commitment, determination and goodwill of leaders and staff at every level to improve outcomes and experience for patients and service users yet also, through well-intentioned, constructive criticism, aim to provide a framework for improvement.


In that vein, we must confront the fact that there has developed over time an institutional inadequacy in the way that leadership and management is trained, developed and valued. Collaborative behaviours, which are the bedrock of effective system outcomes, are not always encouraged or rewarded in a system which still relies heavily on siloed personal and organisational accountability. Very public external and internal pressures combine to generate stress in the workplace.


The sense of constant demands from above, including from politicians, creates an institutional instinct, particularly in the healthcare sector, to look upwards to furnish the needs of the hierarchy rather than downwards to the needs of the service-user.


These pressures inevitably have an impact on behaviours in the workplace, and we have encountered too many reports to ignore of poor behavioural cultures and incidences of discrimination, bullying, blame cultures and responsibility avoidance. We experienced very little dissent on this characterisation; indeed, most have encouraged us to call it out for what it is.


These symptoms are not, we would observe, necessarily the fault of historical or existing leadership teams or their staff. They are the result of a combination of factors over many years; some structural, some cultural, some emanating from behaviours at the top, including politicians, some born of complex inter-professional and status issues in the workplace.

 

The important conclusion, however, is that they should not be tolerated as they directly affect care of the service-user as well as the staff, and that they can be tackled but only through determined cultural change from the top of the system to the front-line.


The recommendations of a one-off review cannot provide all the necessary ingredients for such a shift, but we do attempt to identify key interventions which we hope will deliver momentum and scale. We identify the point of entry as a critical opportunity to set cultural and behavioural expectations, and to emphasise that how one behaves is as much a component of professional acumen as what one does.


We propose a locally delivered mid-career development event, designed to bring together professionals from all parts of health and social care around the triple lens of collaborative leadership, broader cross-sector awareness and understanding, and behavioural expectations.

We encourage the medical profession to examine honestly their role in setting cultures, given their unique influence in the workplace dynamic.


Most critically, we advocate a step-change in the way the principles of equality, diversity and inclusion (EDI) are embedded as the personal responsibility of every leader and every member of staff.


Although good practice is by no means rare, there is widespread evidence of considerable inequity in experience and opportunity for those with protected characteristics, of which we would call out race and disability as the most starkly disadvantaged. The only way to tackle this effectively is to mainstream it as the responsibility of all, to demand from everyone awareness of its realities, and to sanction those that don’t meet expectations. EDI should become a universal indicator of how the system respects and values its workforce, and the provision of an inclusive and fair culture should become a key metric by which leadership at all levels is judged.


Beyond cultures and behaviours, we chose to focus on the current absence of accepted standards and structures for the managerial cohort within the NHS. With known exceptions, it has long been a profession that compares unfavourably to the clinical careers in the way it is trained, structured and perceived, and we received strong feedback from managers at all levels that greater professional status and more consistent, accredited training and development are required.


This training must be aligned to professional skills required in the future, including digital and transformation, as well as core managerial delivery. We make recommendations to that end.


This approach to career management spills over into how individuals’ particular skills and talents are encouraged and developed, and we heard frequently that managers do not always feel institutionally supported in their career choices. We did not find much evidence of a systemised career management function which exists to grow the right experience and talent and to place it where it is needed most.


While there are many examples of world-class leadership in the NHS, we would observe that it often exists through the endeavours of an individual rather than as a consequence of proper talent management. The flip side of this opportunistic approach to succession planning is that it lacks equity and does not guarantee that the most deserving leaders reach the top.


We would include non-executive director (NED) appointing in the same bracket. Despite the pivotal governance role of boards, the selection and development of NEDs is currently too localised and arbitrary to assure the right balance of skills, experience and background around the table.


It is clear that effective leadership can be an important, but by no means the only, component in addressing the thorny issue of geographical variation in the quality of care. We welcome the ongoing efforts by the current leadership to tackle this, and provide recommendations which seek to provide effective incentives for the right talent and teams to commit to these challenges, along with a package of support to give them the best chance of success.


The last section of the report is devoted to implementation, recognising that anyone can have great ideas but, if they don’t lead to action, they are for nought.


Please click here for the full report in pdf.



 Please click here for my article in pdf:



The flat bed is moved into the scanner before the scan begins - Credit: JEAN-CLAUDE REVY, ISM/SCIENCE PHOTO LIBRARY - https://www.sciencephoto.com/media/271519/view

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