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Are we asking the right questions about changes to the NHS? – Nadim Fazlani

Dr Nadim Fazlani is Chair of Liverpool CCG and chair of the NHS Commissioning Assembly CCG Development Working Group:

We all hear that the NHS needs to change but the question is what do we need to change to and how do we arrive at the answer?

Perhaps we are not asking the right questions. Maybe we should go back to seeing what questions we need to ask before trying to find the solutions…what exactly DO we need to change? And what must we retain at all costs?

So, how do we get the right answers? We start by asking the right questions, of course. Taking time, and even asking questions about the questions which we are asking can be a useful strategy for gaining creative solutions

I recently attended an event organised by a Foundation Trust in Liverpool and by the end I felt that this was the way we could ask the right questions and ensure that we protect what needs protecting.

The Trust finds itself in a position that according to rules laid down by Monitor it could be potentially in a not too distant future be in breach of its license in terms of financial numbers. Foundation trusts live by numbers don’t they?

This incident reminds me of a real event which happened at that Trust. A 35-year-old woman learnt of her diagnosis and that the condition had advanced leaving her with only a short time to live. The lady in question wanted to get married to her long-standing partner but she was now too ill to leave the hospital for the ceremony.

Staff within the trust organised within four hours to have a wedding licence and book a registrar to visit the hospital and marry the couple. Flowers and a wedding cake were also organised.

None of this was in terms of licence for that particular Trust, but if we cannot retain the humanity which allows us to do what is right for a fellow human being then there would be nothing left to retain.

At the event, there were a large number of front-line clinicians along with members of the board and senior management team. I, together with Chief Officer of Liverpool CCG and NHS England were there as Commissioners.

Nobody at the event talked about organisation or Trust imperatives .The questions that we were framing and trying to ask were what is best for women and new born children in Liverpool and beyond?

If that meant the Trust did not exist, or there had to be colocation of some of the services, then so be it. Clinicians, board member and members of management team were frank and open and it was also clear that we would have to ask further questions.

Collectively, we recognised the risks of ‘doing nothing’- a stand-alone unit without the other specialities was a great risk, but so was the risk of the transition and there may be different solutions while we have to manage the interdependencies.

We have not come to a definite solution but we are now beginning to frame the right questions.

The proverbial elephant in the room for this event was ‘tariff’. We were well aware of the elephant and the issue, as tariff and cost of delivering a service are just different concepts.

Tariff is very much framed in terms of measurable units of activity and is discrete. Cost is in terms of infrastructures, human resources and drugs/instruments, are largely fixed and deliver a number of tariff activities.

So the question of tariff is part of how we pay for the cost of a service. At the event, we did not come to a solution but we did agree that we would create Clinical Reference Groups which will frame and answer the questions.

A clinical congress will see if these are the right questions and see what the interdependencies, trade-offs and risks are. These will be distilled to series of options with evidence and advantages /risks for each group.

A leadership group will have all the providers investigate these in terms of financial and logistics and other perspectives. This will then allow further distillation of options and advantages /risks in a wider sense.

A decision making group with the appropriate commissioner including NHSE will have to make the final appropriate decisions and look at how we go out for engagement and consultation.

It’s early days, we are still working all this out and I will share with you in my future blogs the trials and tribulations of the exciting journey we have embarked on.


Image of Dr Nadim Fazlani, GP and Chair of Liverpool CCGDr Nadim Fazlani is Chair of Liverpool CCG and has been a GP in Kensington Liverpool for the past 22 years, having worked in the NHS since 1983.

A Fellow of the Royal College of General Practitioners, he  was Chair of Liverpool Health Care Practice Based Consortium from 2006 – 2011 and Chair of Liverpool Central Clinical Consortium from 2011 to 2012, before being elected as Chair of Liverpool CCG.

He has also been a long standing GP trainer and an examiner for MRCGP conducted by Royal College of General Practitioners since 2004.

In addition, he is also a performance assessor for General Medical Council, a role he has undertaken since 2005.

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One comment

  1. “None of this was in terms of licence for that particular Trust, but if we cannot retain the humanity which allows us to do what is right for a fellow human being then there would be nothing left to retain”

    This is exactly why we work for the NHS to ensure that we do what is right and what is needed for every fellow human being. Well Done to all concerned.