David Meates

In their latest In the Loop podcast Niall Dickson and Roy Lilley grapple with the topic many believe is the Holy Grail of effective healthcare – integration. How do you create a system where physical and mental, hospital and community, health and social care services all collaborate effectively together in the interests of clients and patients rather than institutions or vested interests? Well one place in the world claims to have – at least for a while – cracked it – the Canterbury region of New Zealand. Niall and Roy’s guest in the former chief executive in Canterbury David Meates who, with his team, transformed health and care services between 2009 and 2020, and apparently created a single system which achieved so much of what everyone aspires to. That meant preventing unnecessary hospital admissions, enabling patients to be discharged effectively into the community, removing barriers between organisations and professions and much else. David’s recently published book with health strategist Caroline Gullery, One System: How relationships based on trust and a shared purpose transformed Canterbury's health system is coming out now in paperback and it argues that if introduced in the right way, the model works and, in spite of a political system that has sought to undermine it, David argues that it is still delivering real benefits for Canterbury residents. In the podcast Niall and Roy explore with David what really worked during those years and whether it was sustainable? And they probe why so many other healthcare systems, including Scotland, have tried and failed to replicate the Canterbury model. If you want to understand more about integration its potential and the obstacles to delivery, join Niall, Roy and David In the Loop wherever you listen to your podcasts. 

In the Loop – the Big Questions Anita Charlesworth With Niall Dickson and Roy LilleyDo you regard the NHS as an efficient organisation that provides good value for the huge sums that sustain it? How much bang do UK taxpayers get for their NHS buck? This is the latest topic in the In The Loop podcast series in which Niall and Roy consider the controversial and challenging topic of NHS productivity, the subject of new report from the Health Foundation’s NHS Productivity Commission.  Their guest is Anita Charlesworth CBE senior economic advisor  at the Foudnation and  co chair of its Commission. Anita is one of the most prominent economists focussing on the public sector having been Director of Public Spending at the Treasury under Gordon Brown, and overseeing the seminal Wanless report into NHS funding;  in 2018 she co-authored the influential study titled "Securing the future: funding health and social care to the 2030s," with Paul Johnson then of the Institute for Fiscal Studies. She is a member of the advisory panel for the Office of Budget responsibility. The Commission’s report Breaking the Cycle - how to build a more productive NHS concludes that the NHS in England is simply not set up to deliver sustained productivity growth. The health service, it claims, often obstructs sound decision making and impedes efficient delivery, with local NHS organisations subject to structural instability, competing priorities, and relentless short-term pressures. The commission concludes that significant productivity gains will not come from short term fixes.  And it rejects suggestions that our tax funded system is in any way to blame for our performance against other advanced healthcare system in the OECD.  Instead it recommends the creation of a system with greater stability, a shared purpose, an engaged workforce, clearer accountability, more freedom at local level and one that can develop the capability to improve care.Few may disagree with the diagnosis, but as well as exploring why our NHS is not delivering to its potential, the podcast considers the potentially huge impact of AI and technology, the role of professional vested interests and whether Anita and her fellow Commissioners have the right solutions. Crucially, it also considers whether the Commission has worked out how these reforms can be delivered and whether there is the political insight and will to bring them about.If you want to understand the debate about productivity and how the NHS might be transformed, please do join Niall, Roy and Anita for a fascinating journey In the Loop.   It’s a great listen – find it now wherever you find your podcasts. 

Have you ever wondered what is the reality of working in intensive care? This  is one of the most demanding areas of clinical practice, with staff not only having to manage   organ failure with patients who are so often at the edge of life and death but also families who are anxious and distressed.  In this their latest In the Loop podcast Niall and Roy explore the modern reality of this highly pressured environment in a revealing exchange with the President of the Intensive Care Society, Professor Shondipon Laha.Shond is a critical care consultant at Lancashire teaching Hospitals and this is an encounter full of surprises.  While he highlights the continuing shortages of intensive care beds in the UK which was cruelly exposed when Covid hit in 2020 (and remains a challenge today) he also points to the desperate need for social care reform and for rehabilitation services. Both of these he argues are essential if we are to achieve the right outcomes for patients who have been through intensive care.Shond acknowledges the technical and drug advances that have been made in recent years, ironically helped by the dreadful experience of Covid. Yet for him, the greatest progress in his specialty has been the development of strong multidisciplinary teams in which the key roles of nurses, physios, pharmacists, OTs, dietitians and others are recognised and team working is making care effective. As for doctors, he sees the development of the intensive care speciality and the move away from it being a branch of anaesthetics as vital with the development of education, training and dedicated intensive care posts.If you want to validate or challenge your view of intensive care, or just develop a better understanding of a unique area of healthcare, please do join Niall, Roy and Shond In the Loop.