The NHS Modernisation Agency Learning Exchange,
Harrogate Conference Centre November 2003
Brief:
·
to illustrate the problems expressed by people
working for the MA, in particular those concerned with peripatetic working
(Sketch 1)
·
to illustrate the negative way Modernisation Agency
staff can come across to NHS professionals they are trying to help and advise
(Sketch 2)
Format
Two sketches which ‘interrupted’ key note speeches on the
first day of a conference
THE VERY FUNNY SPACE-MAN SKETCH
Lights dim.
Lights up on a saloon bar, a long time
ago, in a galaxy faraway. A barmaid is wearily cleaning glasses. It’s late.
Big musical fanfare (2001 music). Enter
astronaut with trolley dolly (‘beamed in’, with smoke etc).
Barmaid (
American accent):
Well
hello there, space cowboy.
(astronaut removes helmet)
Gee,
you look like you musta travelled a helluva long way, mister.
Uh huh
(removes more space-suit, revealing MA emblem à la Superman)
Wow,
you’re with the MA. Gee, we sure have been needing you in these parts, señor.
Cut
the compliments sweetheart, and get me a double beetlejuice. No wait, uh,
better make that a single. I won’t be able to submit an expenses claim till I
get back to the Andromeda system.
I have so wanted to meet one of you
guys. I mean, what you do is just so cool.
Well,
uh, huh, I guess it is.
So, uh, what is it you do?
I’m… I’m a fixer.
So, like, you fix things, right?
That’s right, baby, I fix things.
That’s just swell.
Maybe
it is, but it sure don’t feel that great all the time. Especially the travel.
You transport Virgin Galactic?
Uh huh.
Oh man, the worst. You know my mom went for a Club Mercury holiday with them once and ended up in Deep Space. You got family, fixer-man?
Astronaut
Uh huh. – (clicks,
and Powerpoint image of woman in kitchen appears upstage)
Barmaid
Hey, wow, how you do that?
Astronaut
Oh it’s this thing called Solar-point.
Barmaid
Solar-point?
Astronaut
Yup. It’s pretty neat. Watch this!
(Clicks, and graphics zoom in arrow points
at woman: “MY WIFE”)
Barmaid
Wow, cool graphics. I am so, like, impressed.
( images of
2 children are added, and graphics zoom in “MY KIDS”)
Barmaid
Hey they’re cute.
(image of
astronaut is added, “ME”, then, a computer, “MY OFFICE” arrow pointing at wife
changes to “MY SECRETARY”)
Your office is in your home?
Astronaut
Uh huh
Barmaid
Isn’t that ever a problem?
Astronaut
There are advantages
(image of typing while in swimming pool)
That’s my personal office, but this is my HQ. Impressive, huh?
(picture of Heron House:
graphics say “HQ”, with astronauts floating in and out of it, then picture of
David Fillingham, in space-suit, arrow points at him, graphics say: “MY BOSS”)
Hey,
now he’s really cute. Does he ever come out this end of the universe?
(graphics start flashing
“URGENT: CONTACT HQ, URGENT: CONTACT HQ, URGENT: CONTACT HQ”, then switch off)
Listen,
sister, I need to call base, looks like I got new instructions.
You got it, mister.
(She presses some buttons. Enter robot = Henry the Vacuum Cleaner, she starts it up)
That’s your communication system?
Hey, what’s wrong with him?
Look I can’t connect into that? What
planet you on baby?
Hey, don’t knock Henry. That’s what everyone uses in this galaxy, mister.
Where you staying?
Black Hole Tavern
Hey,
you won’t find any communication system there. Why you staying there? Black
Hole sucks, man.
This
is an expensive planet, kid. On other planets I’d stay at the Inter-Galactic,
but HQ couldn’t justify the extra. We gotta prove ‘value for money’. They’re
even suggesting I can’t transport first class. It’s a scandal. I mean, how am I
expected to prepare for a meeting with a whole family of mutant Venusians being
sick all over my pod?
Oh
that sounds horrible. Well Agent Fixer, I think you deserve a lot
better. (Moves up close, flirty)
I thought so too kid, but I guess my annual expenses claim did cost the galactic tax-payer the equivalent of the entire gross national product of Uranus.
I can’t believe you came all the way to the end of the universe to make a joke that bad. Shame on you.
Honey,
you ain’t seen nothin’ yet. O.K., I’ll just have to contact the job direct. Can
you get your, uh, Henry here, to call the Health Care Trust?
The Health Care Trust?
You heard me.
But
them folks are not on this planet any more, they’re not even in this system.
They merged with this big hospital on, uh, Krip.
Krip?
That’s right, Krip
Krip?
Yeah, Krip, you know, the
Foundation.
I
don’t believe this.
(starts to put space suit back on)
Hey, don’t go, Mister.
Sorry, kid, gotta go. I gotta go to
Krip.
Tonight
Astronaut
That’s right, Krip, tonight
Both
Kriptonite!
Both look at audience in a ‘howzat?!’ pose. Blackout.
After a few
more speeches and stuff, the same actors (heavily disguised) present
Lights up on
NHS manager, sitting in office chair behind desk. Smart suit.
The NHS Manager turns to the audience.
NHS MANAGER (played
straight, a tad sad)
Hello everybody,
I’m an NHS manager. That’s right, I manage things. Only trouble is, I don’t
seem to be terribly good at it. You all look very sympathetic, so I’ll let you
into a little secret. My Health Care Trust is the only one in the country to
have a negative star rating. Yes, we are officially classified as minus-three
stars. We have a 100% failure rate. It’s not really a very good record, is it?
Oh, I wish I could do better. I keep thinking that there must be a way to make
things work but it seems to be somewhere out of reach, somewhere I can’t ever
seem to get to…
(stands up & comes out from behind desk. Short skirt, stockings, boots, pantomime)
(Sings)
Somewhere over
the rainbow,
Through the
mists,
Departments
communicate
Appointments are
never late
And there aren’t
any waiting lists.
Somewhere over
the rainbow,
Skies are blue,
And our National
Health Service
Does what it’s
supposed to do.
(Big Sigh)
Anyway, look
what I’ve found? (shows lamp) I was down in the basement and I
discovered this nice old oil lamp. Quite an interesting old thing don’t you
think? I thought of perhaps entering it in the Antiques Road Show. A bit
tarnished and dirty, though, isn’t it, but I bet it’ll buff up nicely. Let’s
see.
(Takes out large check pocket handkerchief and rubs the lamp. Blackout, lots of flashing lights. Explosion. Big fanfare. ‘Scherezade’ or something. Enter Genie, in suit .)
GENIE (bad suit,
grey wig, trolley dolly)
I am the genie of the
Modernisation Agency. What is your wish master?
NHS MANAGER
Well I was actually
wanting to improve my Health Care Trust
GENIE (efficient, slightly academic, very fast, but very clear)
Right well it’s clear
straight off from your failure rate that you need an entirely new NWW, and
we’re talking Whole System Development here. Pinpoint your PCTs within your
SHAs. Deploy paradigm approaches to Programme evaluation. Concentrate on the
three R’s and follow the five simple rules, and you’ll find you soon start to
significantly improve your outcomes. Are you instituting CWP? If not, you
definitely require an ADP, in fact, I’d recommend a total Role Redesign, if not
Accelerated Redesign throughout the
outfit. This is about Protocols and Pathways and about Process (“pathway”)
Capability. If you don’t have the SPC you can’t even begin to develop a
Competency Framework. Look, we’re here to help you. Use us. Use NatPaCT, use
GPwSIs, in fact use a whole variety of agencies with acronyms in a mixture of upper and lower case. We’re AHPs.
We want IPH. We
want to help you reduce
your DNA.
NHS MANAGER
My DNA?
GENIE 1
I recommend LEO.
NHS MANAGER
Actually I’m a Sagittarius
GENIE 1
Are you making use of MES?
NHS MANAGER
You mean our rubbish
disposal?
GENIE 1
No, it’s a ‘toolkit’…
NHS MANAGER
(murmering)
Ah yes, a toolkit.
GENIE 1
…to support service
improvement. What about RAID?
NHS MANAGER
Raid what?
GENIE 1
LIFT?
NHS MANAGER
You want me to raid the
lift?
GENIE 1
I don’t seem to be getting
through. It’s a bespoke vehicle
NHS
Wow, like a Jensen Healey?
GENIE 1
…for premises investment.
SIT?
(NHS MANAGER sits down)
Well?
NHS MANAGER
Sorry, I thought you
wanted me to sit down.
GENIE
No, I was asking you if
you have a Service Improvement Team. IDEA?
NHS Manager
I thought you were
supposed to have them.
GENIE 1
No, I mean, IDEA, Ideal
Design of Emergency Acess.
NHS MANAGER
Ah, Nice.
GENIE 1
NICE? Yes, they’ll be
happy too. As will CHAI
NHS MANAGER
Oh I know that one.
Commission for Health Improvement.
GENIE 1
No it’s the Comission for
Healthcare Audit and Inspection. Look, if something has a simple name you must
give it a complicated one that sounds much more like it might be in the private
sector although of course at the same time the private sector is trying to take
complicated names and make them simpler but never mind about that as any
complicated name totally impresses the politicians because their vocabulary is
twenty years behind the times. This is the language of modernisation. Try
wherever possible to use the same words as both nouns and verbs. It’s time to
roll out your roll out and impact your impact. We need your lead in order to
lead. Or, if possible, use nouns as verbs and verbs as nouns. So right now I
suggest you scope all the available alternatives and I look forward to getting
your steer on this at the next critical after action incident review forum.
Exit genie,
Pause
NHS MANAGER
My steer? Perhaps he was
actually someone from DEFRA. Oh well, might as well go on with cleaning up this
old lamp.
(rubs lamp, same effects. Enter Genie.)
GENIE 2 (hippy,
dreadlocks)
I am another Genie of the
Modernisation Agency
NHS MANAGER
Another one. Gosh.
GENIE 2
What is your wish master?
NHS MANAGER
Well, this nice chap was
here a minute ago but I couldn’t understand a word he said
GENIE 2 (slow,
stoned)
Hey, I know where you’re
coming from man. I’m listening to you and I hear what you’re saying OK? It’s
all about Partnership, man, OK? Collaboratives man. Transformational change,
OK? Protecting Time, know what I mean man? Time and space to learn from each
other. You need headroom. Take a step back, OK? We are pursuing perfection. I
mean let’s go on that Patient’s journey man, but listen man, take small steps as
well as big leaps. All-touch, all-learn, man. Listen to the small voices, OK?
Renewal, redesign, respect. Look, dude, you are on a pathway, OK. And in front
of you is a gate. You see that gate? You see that gate?
NHS MANAGER
Er,
GENIE 2
That is the Gateway to
leadership, man.
NHS MANAGER
Wow
GENIE
Yeah, far out, huh? Hey
see you at the next critical after action incident review forum OK?
Exit genie
NHS MANAGER
Well wasn’t all that a bit
obvious? I mean, I know all that stuff about communicating. How are my staff
going to react if I start giving them all that New Age touchy-feely stuff? (polishes
lamp) They’ll just tell me to stick it up my
GENIE 3 (pith helmet, drill sergeant voice)
ATTENTION: (NHS
MANAGER stands to attention) CHIN UP, CHEST
OUT. RIGHT, LET’S GET YOUR CHAPS ORGANISED PROPERLY. YOU NEED TEAMWORK
EFFECTIVENESS. GOT THAT?
NHS MANAGER
TEAMWORK EFFECTIVENESS,
YES
GENIE 3
YES, SIR.
NHS MANAGER
SORRY, YES, SIR.
GENIE 3
RIGHT. PROCESS MAPPING.
TRACK THE PATIENTS JOURNEY. GOT THAT?
NHS MANAGER
TRACK THE PATIENT’S
JOURNEY, SIR.
GENIE 3
CUT OUT THE BOTTLENECKS,
SYNCRONISE WATCHES. ROUND UP THE USUAL SUSPECTS. BASE STAFFING LEVELS ON
DEMAND. MAKE SURE EVERYONE KNOWS WHAT THEIR JOB IS. RATIONALISE YOUR QUEUING
SYSTEM. ELECTRONIC BOOKING. COMPUTERISE YOUR DIARIES. AND FOCUS ON THE
FRONTLINE.
NHS MANAGER
FOCUS ON THE FRONTLINE,
SIR.
GENIE 3
DEVELOP YOUR PERFORMANCE.
IMPROVE YOUR RETENTION. CREATE MOMENTUM. AND YOU’LL START TO IMPROVE YOUR FLOW.
NHS MANAGER
DEVELOP MY PERFORMANCE.
IMPROVE MY RETENTION. CREATE MOMENTUM. AND I’LL START TO IMPROVE MY FLOW, SIR.
GENIE 3
THERE ARE 15 KEY PERSONAL
QUALITIES FOR LEADERSHIP EXCELLENCE. DO YOU KNOW WHAT THEY ARE?
NHS MANAGER
Er...
GENIE 3
DO YOU KNOW WHAT THEY ARE?
NHS MANAGER
NO SIR.
GENIE 3
THEY’RE ALL PERSONAL
QUALITIES I HAVEN’T GOT. DIVERSITY IN LEADERSHIP? GOT THAT?
NHS MANAGER
DIVERSITY IN LEADERSHIP,
SIR
GENIE
THAT MEANS MORE BLACK
LEADERS, MORE ETHNIC MINORITY LEADERS, MORE WOMEN LEADERS, MORE YOUNG LEADERS,
MORE OLD LEADERS, MORE GAY LEADERS, MORE LESBIAN LEADERS, MORE LEADERS FROM
DIFFERENT PARTS OF THE COUNTRY, MORE LEADERS FROM WITHIN THE NURSING
PROFESSION, BASICALLY LOTS MORE LEADERS THAT AREN’T ANYTHING AT ALL LIKE ME.
GOT THAT?
NHS MANAGER
Well, yes I can see that
would be quite an attractive proposition.
GENIE
RIGHT, AT EASE, SEE YOU AT
THE NEXT CRITICAL AFTER ACTION INCIDENT REVIEW FORUM, OR ELSE.
Exit genie
NHS MANAGER
Phew. Hm. Well, I suppose he does have some good points. Only problem is, supposing I do manage to get everyone organised better, what exactly are they supposed to do? (rubs lamp, same FX, Enter Genie 3)
GENIE 4 (Scarf on
head like Queen, mad old lady voice)
Supposed to do, Supposed
to do.
NHS MANAGER
What?
GENIE 4
What? What?
NHS MANAGER
Er, you’re just copying.
GENIE 4
Just copying, just
copying.
NHS MANAGER
Copy what?
GENIE 4
Copy what? Copy what?
NHS MANAGER
Er, other Heath Care
Trusts? Oh I know, I know this one,
it’s in my NHS plan. You mean examples of best practice.
GENIE 4
Best practice best
practice
NHS MANAGER
OK, so, er, suppose I want
to take action on, er,
GENIE 4
Action on. Action on.
NHS MANAGER
God, you’re irritating.
GENIE 4
God you’re irritating
NHS MANAGER
Goodbye
GENIE 4
Goodbye
NHS MANAGER
I hope you won’t be
at the next critical after action incident review forum.
GENIE 4
Critical after action
incident review forum, critical after action incident review forum.
Exit genie
NHS MANAGER
Well, this advice stuff is
all very well. But who’s going to pay for it all?
GENIE 5 (rap-singer,
with microphone, baseball cap, shades, gold chains)
Hey, da, Manager, don’t be
funny.
You is just gotta manage
your money.
Listen to me man, what I
got to say,
You is gotta save for da
rainy day.
You is really need these
grades at all?
You is gotta rob Peter, to
pay Paul.
Agenda for change
Expand your range.
Before you decide on
remunerations,
You is better do some
evaluations,
You need a mass movement
To get on with that
improvement
Early interventions make
for crisis resolutions.
Measurable objectives
offer workable solutions.
Improve your staff
efficiency with informative inductions
You is gonna get yourself
some serious reductions.
All right, you is da man. (they
do high fives, badly)
NHS MANAGER
But look, I know this
agenda for change thing. That means changing all the pay-grades. The unions
won’t ever accept it. I can’t just impose it on them you know – they’ll all
just walk out.
GENIE 5
Hey, da, Manager, what you
say is true
So here is what you gonna
have to do.
Tell everyone to modernise,
then tell them: ‘Just wait!’
Don’t modernise the pay
grades till two thousand and eight.
By then Tony Blair is have
made himself King.
And you is on your
pension, so its someone else’s thing.
(does that hip thing with his fingers)
All right, Manager! You is
gotta plan,
See youse at the critical
after action incident review forum, man.
Exit genie
NHS MANAGER
OK, so let me get this
straight. I’ve got to RAID my MES, and SIT on my LEO and then I get have to
follow the patient’s journey through the Gateway of Leadership, then I improve
my performance using Teamwork Effectiveness, examining examples of best
practice to see how it’s done. And of
course I need to sort out my finances. But if I follow that last chap’s advice,
I’m just supposed to postpone any big financial changes till 2008. Anyway, I’d
better begin to scope my steer, or was it steer my scope? And pin-point my
roll-out. Or was it roll-out my pinpoints?
Oh to be quite honest,
I’ve had quite enough of this old oil lamp, all these genies are just confusing
me. (throws it over his shoulder, but it floats magically over to a
quaint Dickensian woman in bonnet and shawl. She holds up the lamp and it
lights up. Very short burst of James Bond theme)
FLORENCE NIGHTINGALE (for it is she)
The name’s Nightingale,
Florence Nightingale.
NHS MANAGER
Florence, is it really
you?
FLORENCE NIGHTINGALE
Yes, it is I, the lady of
the lamp.
NHS MANAGER
Oh Florence, all these
genies have given me great advice, but I still feel really confused. I mean, I
want to do all that stuff, but, well, some of it I simply can’t understand, and
the bits I do understand seem to be a bit self-contradictory. Oh, I do so want
to be a Really Modern Manager. (Big Sigh) Oh
Florence, please help me.
FLORENCE NIGHTINGALE
Poor you. Let me take your
hand in a wonderfully healing way. (She takes his hand in a wonderfully
healing way.)
NHS MANAGER
Gosh I feel better already
FLORENCE NIGHTINGALE
All these different
approaches do have something to offer you, you know. Remember, there’s no one
‘right’ way of delivering health care. You just need to recognise some
principles for change, and give yourself a range of options. Listen to all the
advice, but make sure you implement a programme that suits your own
circumstances. Above all, Remember Who You’re Working For?
NHS MANAGER
You mean, (kneels
and crosses himself) Tony Blair?
FLORENCE NIGHTINGALE
(pulling him up)
No, you stupid little man, the PATIENT. Goodbye, good luck. (voice starts to get fainter. Spooky echo FX for Florence’s mike).
NHS MANAGER
The Patient? Wait, I don’t
understand. Please stay and help me, Florence?
FLORENCE NIGHTINGALE
Don’t worry, there are
loads of nice people right here in this hall to help you.
NHS MANAGER (looking out to audience)
Who, them?
FLORENCE NIGHTINGALE (disappearing, plaintive voice, to audience)
That’s right, you’ll help
her, won’t you?
NHS MANAGER
Oh no they won’t
FLORENCE NIGHTINGALE
Oh yes they will
NHS MANAGER (to
audience)
Oh no you won’t
AUDIENCE
Oh yes we will.
NHS MANAGER (to
audience)
Oh no you won’t
AUDIENCE
Oh yes we will.
NHS MANAGER (to audience)
Oh no you won’t
AUDIENCE
Oh yes we will.
NHS MANAGER (to
audience)
Oh, well, thanks
awfully, well, all I need now is a handsome prince.
(looks at
David Fillingham) Oh,
David.
Blackout
A version of this sketch was used for the
Cornonary Heart Disease Collaborative seminar, December 2003
© Big Wheel
T.I.E. 2003