Coffee Break No 61

News updates this fortnight covers leadership, mental health and the future of the NHS. The coffee break is split into sections so you can easily scroll through each area of interest.

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Future of the NHS

Firstly this fortnight, in this opinion piece, the Kings Fund argues that “that there should be much greater emphasis on shared responsibility for improving health and care between patients, the public and the NHS.” The article explains that “shared responsibility is not the same as personal responsibility, which places the onus on people to ‘look after themselves’ and ‘use services responsibly’. Our starting point is that most people already take responsibility for their health and care, but that more could be done to reduce over dependency on services and to draw on people’s own expertise.”

An article published by NHS England explains how the NHS has been able to save a record £300 million after negotiating deals with five manufacturers on low cost versions of the health service’s most costly drug.

The huge anticipated saving, the biggest in NHS history from a single drug negotiation, was unlocked by the introduction of ‘biosimilar’ versions of adalimumab. The deal should mean hospitals pay around a quarter of the more than £400 million each year they currently spend on adalimumab, which is used to treat severe hospital treated conditions such as rheumatoid arthritis, inflammatory bowel disease and psoriasis.


Mental Health

Moving on, NHS Clinical Commissioners publish their report detailing ten recommendations from a joint international summit on urgent and emergency behavioural healthcare, hosted by NHSCC, England and RI International, USA. The summit defined its aim as ensuring an effective response to all in psychiatric emergency, with an approach equal to medical care. “The report expands on some of the evidence and drivers for the changes required. It also seeks to identify good practice in systems around the world that can be adapted and adopted in other regions.”



An article by the Harvard Business Review looks at women in leadership. The article explores how women face the need to be warm and nice (what society traditionally expects from women), as well as competent or tough (what society traditionally expects from men and leaders). The Harvard Business Review conducted interviews with 64 senior women business leaders in the US and found that there are four paradoxes confronting women. They are required to be: demanding yet caring; authoritative yet participative; advocating for themselves yet serving others and maintaining distance yet being approachable. The article goes on to identify 5 strategies to manage these paradoxes.

A further article in the Harvard Business Review gives an inspiring account on how Intermountain Healthcare is able to escalate issues from the ground floor to the executive leadership within 24 hours. The US health care system, uses 15 minute huddles to quickly address issues and impediments to their service across 23 hospitals, 170 clinics, and 850,000-member health insurance plan.

Beginning at 8:45 AM, care teams and managers gather in more than 1,500 Tier I huddles. At 9 AM, their reporting is considered in about 170 Tier II huddles, consisting primarily of directors of hospitals and clinics. These reports are escalated up into Tier III, Tier IV and Tier V huddles and by 10 AM, vital information has risen to the executive leadership (Tier VI), which includes the CEO.

Finally, staying with leadership, Dr Kin Yee Shiu is a consultant at the Royal Free London NHS Foundation Trust and took part in the Kings Fund’s Leadership for consultants programme in 2017. In this article by the Kings Fund, she talks about her experience of the programme and the challenge of leading change as a consultant. She explains that “You are taught to be a doctor, you train to be a consultant – but there’s not the same clearly defined path to becoming a leader as there is in clinical medicine. “