Habemus Epistola Pascha

3d postman with envelope and bag

Perhaps the time is overdue for the eminences of the national religion that is our NHS to retire into a conclave and finally decide who is in charge. We won’t be holding our breath for the white smoke – those of us left with functioning lungs. We will have staggered away – our walking frames creaking under the load of our obese bodies – for another ludicrously underpriced drink as a further (final) test of our battered livers. Life goes on – with only the prospect of getting our care free after getting through our last £72000 to sustain us. Enough for quite a few drinks there.

Francis to the Fore

Those who chronicle NHS doings are in a particularly fevered condition these days. Not because they have been refused antibiotics by their GP – go see your vet instead – but because they are all agog at the imminent start of the new regime of commissioning. That is the future but there is also an appalling legacy of the past chronicled in the Francis report which the NHS must understand before it can leave behind.

Andrew Craig wrote in February about moving engagement and goverance on from Francis arguing for investment in patient leadership, stronger local mechanisms and strengthening governance with more support for non-executive directors and governors in Foundation Trusts. Who carries the can for mid-Staffs? is a question occupying the media mind and we contrasted the uncertainties of the NHS with the clarity of the maritime chain of command. March 6th was the sad day when the ferry Herald of Free Enterprise sank and the brutally clear verdict of the  enquiry was the Master of the Vessel is the man in charge on the day and he suffered the consequences.

New Model Consultation Needed

National Voices pointed out that Francis had in fact the old and discredited model of patient consultation in mind – patients outside shouting in. Their report lays out a lot of what has to be done straight away without forming working parties in every unit and department of the NHS to consider the 300 odd recommendations reporting back months or even years later.

It is a sad fact of public life (and the NHS seems particularly prone to this malaise) that enquiries beget enquiries so surprise surprise (not) another enquiry into NHS complaint handling. We have take a fairly radical line and say that if after years of studying the topic and volumes of guidelines produced, NHS complaint handling is still not working then we have to start again from scratch and think of a different way of doing this. Are complaints too difficile for the NHS? Doing the same thing over and over and expecting different results – is this insanity?

Finding New Ways to Do Things

Innovation is vital and two pieces looked at ways of changing the way we access and use NHS services. Caroline Millar was very much in favour of GPs taking up Sainsburys’ offer of free premises in their stores. In Caroline’s view ‘Convenience of access for patients and decent premises are surely assets for any good GP practice and will contribute to high quality care and a good patient experience.’ She regretted the dog in the manger attitude of some GP trade spokepersons.  Mind you it is not just GPs that may have difficulty in changing their habits and knowing how best to promote or to access health services. The public needs to understand when A&E is the best place to go and when they can get help somewhere else. Andrew doubted whether a campaign under the mystery name of ‘notalwaysaande’  – do you get it? – was a good way of doing it. If you were in Spitalfields recently and saw a large wounded yellow figure, that was what that was about. Another attempt to promote the right way to use emergency services is the 111 number for ‘less urgent’ cases- again Andrew questioned whether Wandsworth was going about it a way callers could understand.

A&E is always a flash point and ‘reconfiguration’ of those services – otherwise known to the public as ‘closing my A&E department and condemning me and my family to dying in an ambulance’ – a particularly good way of getting people going and ensuring that change means confrontation. So it worried our man at the conference where Sir David N (have we mentioned his name before?) seemed to suggest that you could only have care plans if you saved money by reconfiguration of other services such as A&E – see above. Co-design of services is essential if these unproductive adversarial shouting matches are not to continue. We have seen the sad consequences in the row about closing down Lewisham A&E.

 When Will There Be Good News?

Well Kate Atkinson has published another book – sadly not about Jackson Brodie – but good news nonetheless. In our world, there were some cheering signs of commitment to patient and public engagement in new CCGs. They want to do it differently, they want to do it right and they hunger for ways of understanding how well they are doing? Good luck to them. If they are looking for some principles to underpin the way they do their commissioning, take a look at the elements outlined here taken from the continuing narrative for integrated care devised by National Voices for the NHS Commissioning Board:

  • All my needs as a person were assessed and taken into account.
  • My carer/family had their needs looked at and were given support to care for me.
  • I was supported to set and achieve my own goals.
  • Taken together, my care and support helped me live the life I want to the best of my ability.
  • I was in control of planning my care and support.
  • I could decide the kind of support I needed and how to receive it.

And from there to our latest thoughts from integration to partnership.


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