It wasn’t that Storm Sandy was particularly violent. Apparently it was just big and slow and coincided with cold air from the Arctic and some very high tides. It was the combination of factors that hit so hard. Just like the NHS?
The NHS is big and slow – it covers the whole country and seems to employ most of the people in it. Recently it has collided with a blast of cold air from that Arctic region called Budget Cuts and we are now reaching some very high tides what with the QIPP programme to say nothing of big waves of authorised CCGs. The analogy is complete. And if people say that it does not accommodate the change of hand on the helm of this great ship of state – we could include the sad sinking of the movie HMS Bounty and its missing captain.
Eye of the Storm
The current calm of NHS UK is the surprise but then that may well be because we are in the eye of the storm. Also I get the impression that people have their eyes down, focusing strongly on purse-making from the re-organisation pig’s ear, building CCGs and putting all the stuff in place for the ‘new’ re-organised NHS.
We have been talking to a range of CCGs all over Britain and it was a heartening experience to understand that once again, dedicated people are doing their best to deliver on the latest round of re-organisation. They have all had experience of the NHS and previous rounds of re-organisation and all understand that money is tight and difficult decisions have to be made. Increasing public and patient understanding of the hard choices to be made is integral to the management of the future.
Connected with Reality?
I wonder if things are going to be different this time ? I can’t help but remember a mention in the Spring Newsletter in March 2011 of a paper from the Lean Enterprise Academy The NHS Bermuda Triangle and hoping commissioners have read it too. The report makes the point that much of what a manager does in the NHS “has no connection with reality – how the work of the NHS actually gets done at the front line. Instead it (the management approach) creates a sort of parallel universe that mirrors and reflects this reality but somehow never really touches it”. Re-organisations delivered from on high means that managers look up and not down to the front line. The Lean Team worked out that a sample of managers in one hospital were running 515 separate projects – some of them had 50 projects on the go. At just one hour per project per week that is 50 hours work before that manager can even look at what is supposed to be his/her day job.
Fingers crossed that the new commissioning set-up which carries so many hopes for successful change in a better value for money NHS is not just another project and fingers double-crossed that there is still someone there doing their day job.
Since the summer we have posted seven blogs on matters of moment ranging from the new top of the pile washing up liquid to a powerful blog about Doom and the NHS. We have touched on re-validation of GPs by way of the much-loved but lethal Dr Shipman and the best way to set up the 111 number -why engage users of course! Even if you end up with something called 111URG. Very importantly from the patient and user point of view, we say no to the idea that patients need permission to be powerful. What they need is an experience of leadership and the support to be strong and discard the habit of deference. In a remarkable Joycean stream of consciousness, Caroline Millar invites you to step inside the mind of the service provider tasked with the patient engagement task and bear witness to those barriers and fears that do so much to impede patient engagement process.
Take a Risk – Be Optimistic
Even so, I would still assert from our CCG conversations that things could well be getting better. A new realism is abroad and with it the understanding that decisions built without public and patient consent are built on quicksands. The risk is that any optimism about the chances of success in any NHS re-organisation is equally ill-founded. But meantime it feels good to escape the shadow of Mount Doom and wish all those working so hard to set up their Clinical Commissioning Groups ‘Bon Voyage, me hearties’ and batten down the hatches – you are sailing into the teeth of a hurricane.