The Liverpool Care Pathway catastrophe

For students and practitioners of organisational change (as I have been for over 30 years) the NHS’s withdrawal of the palliative care protocol is only too common a story.

As The Times said, “when the system, devised at the Marie Curie Palliative Care Institute in Liverpool, worked properly, it worked well, offering high quality and compassionate care. But as yesterday’s report from an independent review found, in too many cases the LCP was so badly implemented that it became a byword for negligence.”

But what was implemented precisely? 

It was a process, a set of instructions about inputs.  What was not implemented elsewhere were the supporting resources, the feedback systems and the leadership that existed in the Marie Curie Institute. 

It is notoriously difficult to transfer good practice, much to the frustration of politicians and Whitehall- (or Leeds-) based civil servants. 

But it’s their own fault.

So long as organisations are viewed as machines that can be re-programmed at will through the adoption of a new process in isolation, or a new structure or a new management information tool, failure is almost inevitable.  Only by addressing the whole system, in all its exasperating complexity, will change stick.

Sadly the Department of Health, under all recent administrations, has been swallowing organisational change snake oil.  It needs better advice.

You wait for ages and three come along at once

Somewhat like buses (so I’m told), official pronouncements calculated to raise the blood pressure come in packs.

So, following hard on from yesterday’s release of the Parliamentary Commission on Banking Standards, my attention has been drawn to Pension Minister Steve Webb’s comments on CDC. 

Yes, you might well ask. It turns out to be nothing to do with communities, development or corporations, but is about pensions: Collective Defined Contribution arrangements, to be precise.

Webb’s beef is that now that almost all the good old final salary (and other defined benefit) pension plans are being closed down (except for many public servants, of course), people’s only real option to save for retirement is to build up their own individual fund. 

They and (thanks to auto-enrolment) their employer will pay specified amounts into the fund which, they hope, will grow to fund pension benefits later on. 

The problem is that lots of small individual funds cost a lot to run, and individual members are at the mercy of the investment markets at the time they want to cash in, so whilst some people will do well, others will cash-in at a bad time. 

And many will be put into “lifestyling” funds which gradually move their pension into boring funds with (probably) lower returns in the last few years before retirement – swapping the potential of decent returns for some safety.

So what’s his idea? It’s using a collective approach which pools investment returns and annuity mortality. That got me thinking. 

What if someone could design an investment fund which took the worry away from individual investors and smooth out their returns? 

It could collect contributions and invest widely in equities, property, gilts, etc and decide on a yearly basis how the profits should be allocated among members – let’s call it an “annual bonus”. 

In a good year, it could tuck some excess return under the mattress so that in a bad year, it could continue to provide a smoothed return. Once profits had been allocated, they couldn’t be taken away. 

And if, when a person retired, there was still cash under the mattress, they could be given a special “terminal bonus” to reflect the overall return made on their contributions.

Suppose we took it a stage further? What if it were a mutual company offering such a fund? All the profits would be available for the members, even the mortality profits when annuitants die before their allotted three-score and ten.

Now there’s an idea – a mutual company  running a fund with smoothed returns and with profits for its members. Hang on…

Change your culture or go to jail

Paul Myners has said, in response to this morning’s release of the ParliamentaryCommission on Banking Standards, that “nothing much will happen at least for 24 months”.

That seems to us to be a reasonable assessment of the prospects for action by a Government besieged by banking lobbyists and conflicted by its own desire to keep the economy going.

Yet, despite the industry’s efforts to keep all this change at arm’s length, there is some evidence that the patient may be recognising the need to heal itself, beginning perhaps at Barclays, in response to the Salz Review.

The key word, in our view, is “fiduciary”: the implicit duty of the Board of a company to act in the interests of those who have entrusted their monies to it. Shareholders, in the case of listed companies, and members in the case of mutuals.

Sadly, the executives of mutuals have been no less generous in rewarding themselves than those of listed enterprises.

“When I hear the word ‘culture’, I reach for my gun” has, apparently, been wrongly attributed to Hermann Goering. But the truth in that aphorism is that changing the culture of an organisation is not a task to be undertaken lightly.

And we have advised more than a few clients to find a more effective way of achieving behavioural change than just announcing a new set of corporate values, supported by so-called town hall meetings involving all staff.

Above all else, what matters is what the guy at the top does. And what the people then do. And what gets measured.

Cultural cross-over, a hybrid or something else?

According to my freshly ironed Times, one “attraction” at the Chelsea Flower Show this year is a “DMZ Forbidden Garden” where “a wooden watchtower glowers over a patch of soil littered with landmines and cartridge cases”. This “pays homage to the demilitarised zone between North and South Korea”.  

I suppose it is an inevitable consequence of the courageous decision by the RHS Board to put the direction of their show in the hands of the Turner Prize selection committee. 

At least we have been spared a video installation of Amazonian deforestation or a spontaneous interactive event on the theme of Genetically Modified lawnmowers.

Germany to exit eurozone?

Germany stands to gain the most from the retention of the euro, but refuses to support it. 

Rather than visiting ruin on Greece, and then Spain, Portugal and beyond, perhaps the other euro economies should demand that Germany alone reverts to its previous currency, which could then find its appropriate value without the encumbrance of the spendthrifts.

Civil service tax loopholes: Thousands on special contracts

More than 2,000 public-sector workers could be avoiding the full rate of income tax through special contracts, Government research has found.

Quite apart from the headline’s defective capitalisation, which would certainly not impress Lynne Truss, nor your average mandarin, the statement is simply tosh.

Civil Servants are employed by the Queen on contracts which guarantee generous holiday, maternity and sick pay provisions, a defined benefit pension and a measure of job security.

The vast majority of the 2,000 mentioned will be individuals working on time-limited or interim contracts that offer none of these benefits.

Moreover they will be paying their own NI and income tax.

They may be working in public sector roles but they are not Civil Servants. 

Geddit?

5,300-year-old Iceman Oetzi may have been lactose-intolerant

We apologise for a posting that may seem unrelated to current business and financial concerns (except for students of the social construction of health conditions and longevity-watchers), but yesterday's story from Agence France Presse does in our view demand wider circulation:

'The mummy of an iceman named Oetzi, discovered on 1991 in the Italian Schnal Valley glacier, has been displayed at the Archeological Museum of Bolzano since 2011.

Oetzi, the 5,300-year-old "Iceman" mummy of the Alps, lived for some time after being shot in the back by an arrow, scientists said on Tuesday after using forensic technology to analyse his preserved blood.

Contrary to a leading theory, Oetzi did not expire immediately from his wounds, they reported in the Journal of the Royal Society Interface, published by Britain's academy of sciences.

Scientists led by Albert Zink of the Ludwig Maximilian University in Munich, southern Germany used nano-scale methods to probe the oldest blood known to modern science, preserved by thousands of years of alpine chill.

Using a so-called atomic force microscope able to resolve images just a few nanometers (billionths of a metre) across, they identified corpuscles with the classic doughnut shape of healthy blood cells.

"To be absolutely sure that we were not dealing with pollen, bacteria or even a negative imprint of a blood cell, but indeed with actual blood cells, we used a second analytical method," Zink said.

They deployed Raman spectroscopy, in which refracted light from a laser beam gives chemical clues about a sample.

This showed the presence of haemoglobin and fibrin, which are key components in blood clotting, at the arrow wound on Oetzi's back.

"Because fibrin is present in fresh wounds and then degrades, the theory that Oetzi died straight after he had been injured by the arrow, as had once been mooted, and not some days after, can no longer be upheld," Zink said.

Oetzi's remains were discovered by two German hikers in September 1991 in the Oetztal Alps in South Tyrol, northern Italy, 3,210 metres (10,500 feet) above sea level.

Scientists have used high-tech, non-invasive diagnostics and genomic sequencing to penetrate his mysterious past.

These efforts have determined Oetzi died around the age of 45, was about 1.60 metres (five foot, three inches) tall and weighed 50 kilos (110 pounds).

He suffered a violent death, with an arrow severing a major blood vessel between the rib cage and the left scapula, as well as a laceration on the hand.

According to DNA analysis presented in February, Oetzi had brown eyes and hair and was allergic to milk products.

This supports the theory that despite the increasing spread of agriculture and dairying at the time, lactose intolerance was still common.

According to a theory aired in 2010 by an Italian archaeologist, based on seasonal pollen found in his stomach contents and at the burial site, Oetzi did not die at the spot where his remains were found. Instead, he was only ceremonially interred there.'