‘The customer is king’

1. ‘The customer is king’ If there is one lesson to be learnt, I suggest that it is that people must always come before numbers. It is the individual experiences that lie behind statistics and benchmarks and action plans that really matter, and that is what must never be forgotten when policies are being made and implemented.

2. Qualifier or differentiator?

3. Qualifier or differentiator?

4. QIPP Transforming for QIPP • Establishing a sense of urgency • Forming a powerful guiding coalition • Creating a vision • Communicating the vision • Empowering others to act on the vision • Planning for and creating short-term wins • Consolidating improvements and producing still more change • Institutionalising new approaches John Kotter (1995)

6. National Health Service Act, 1946 Part I Central Administration 1. – (1) It shall be the duty of the Minister of Health to promote the establishment in England and Wales of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness, and for that purpose to provide or secure the effective provision of services in accordance with the provisions of the Act (2) The services so provided shall be free of charge, except where any provision of this Act expressly provides for the making and recovery of charges.

7. Although I am not myself a devotee of bigness for bigness sake, I would rather be kept alive in the efficient if cold altruism of a large hospital than expire in a gush of warm sympathy in a small one Aneurin Bevan’s speech on 30 April 1946 on the second reading of the NHS Bill

8. To be the best healthcare provider in the region To be the best healthcare provider by delivering excellent services to our patients

9. Joint Session of Congress 25 May 1961

11. Vertical v. horizontal integration What business are you in? Acute General practice Public health Local government Community

12. There is hardly anythingin the worldthat some mancannot make a little worsecannot make a little cheaperand the peoplewho consider price onlyare this man’s lawful prey. John Ruskin British poet, artist,

13. Portfolio analysis Markets Existing New Existing Market penetration Market expansion Products Diversification Product development New Risk Igor Ansoff (1957)

14. New markets? New services?

15. High risk diversification

16. Stars Problem children/ question marks Cash Cows Dogs Boston Box High Market Growth Rate 5% Low 0.1 Low 10.0 High 1.0 Relative Market Share (log scale)

17. modest cashflow (positive negative) large negative cashflow large positive cashflow modest cashflow (positive/negative) Boston Box – Cashflow analysis High Problem children Stars Market Growth Rate 5% Dogs Cash cows Low 0.1 Low 10.0 High 1.0 Relative Market Share (log scale) Successful product development Internal cash flows

18. Rolls Royce RB211 and Lockheed TriStar Highly complex engine needing lengthy development and testing to deliver guarantees on technology, thrust, weight and fuel consumption. RR insolvent 1971, privatised 1987.

19. Generic Strategies Strategic Advantage A uniqueness perceived by the customer Low cost position Overall Cost Leadership Differentiation Industry-wide – Broad Scope Particular Segment – Narrow Scope Strategic Target Focus Differentiation Focus Low Cost Porter (1982)

20. I’m thinking that every one of the one million parts behind and beneath me were built by the guy who put in the lowest tender Frank Borman, commander of Apollo 8 when asked “what’s it like, lying on your back at the top of a Saturn V rocket when the engines light up?”