On the one hand we have Polly Toynbee, every leftist commentator I can find, and a massive number of ill-informed passionate souls, saying the NHS must not be changed, just better resourced.
On the other hand we have Jeremy Hunt, every rightist commentator I can find, and a number of ill-informed passionate souls saying that the NHS must be forced to compete harder, like a cyclist doing extra training, in order to win some plasticised gold medal.
To claim it is “my NHS” and defend it is not my goal.
(It is our NHS, and we should understand it).
Claiming that both sides in this debate appear to be as lost in the idiocies of performance management, arguing about techniques for changing targets in a “caring for people industry” they do not understand, is more like it.
How many of you have an elderly relative who has been through/in the hospital system in the last 10 years?
Where I work, every colleague appears to have this experience, and every one of them has a sad story of blatant failure in the system that they had to work to overcome.
I use the word system advisedly. The hospitals are, each, one group of systems within a system, within a much larger system that includes GPs, Community Nurses, Social workers, Occupational therapists… therapists of all myriad hues, and all the back up staff that go with them.
At the “head” of all these myriad providers of health and social care services sit “the commissioners”, and those many local and area commissioners are currently going through enormous changes brought about by the almighty commissioner that sits “above” them – the UK government.
At the heart of all this lies you, the patient/citizen,
or it should do.
In fact, despite the oft repeated and rephrased mantras about patient-centred care, or customer focus, the poor bloody citizen is regarded by the whole system as a passive widget in the almighty machine.
Another question:- Ever heard the phrase, “non compliant patient”?
It is not that citizens always know best and should be running the NHS, though of course they generally do know best what they want and need for themselves. It is more of an issue that front line professionals should be supported to do their job in helping citizens to achieve their better life, without hideous and multiple half-hearted tweaks and experimental built-on projects in a bureaucratic system. This is a system that thinks the committee that designed the camel should have included more measuring systems and been much more closely inspected before it was allowed to run in the 2.30 at Aintree.
So our professionals, our nurses and doctors, therapists and admin staff, managers and politicians, are all fiddling with the camel, those who specialise in hump enhancement believing that bolting on a third hump will make it run longer, while those who just do camel toes……. believe that carefully trimming its toes will help it jump the high fences.
A thorough analysis of what it is that NHS front line staff do will show you just how much they have been pushed to meet targets, pass inspections, fill in forms, cover backs, seek the money, hand off the problem, comply with policy directives, stick to tight specialist professional guidelines, obey the rules, absorb the new rules daily, go through mapped processes, review all of the above and not jump out of a high window screaming…
Did you see the words, “listen to, and care for, people” in there?, no, of course not.
None of this is the “fault” of any individual person.
No one is trying to kill the NHS.
But in trying to manage its performance and modify design for exception elimination, to manage down costs, set targets, beat deadlines, grab monetary incentives, and more, the treatment may be succeeding in killing the patient.
Ask any sister in charge of any hospital ward, how many of those patients actually have a clinical need to be in that ward at any one time, and you will possibly hear the truth, that it is never more than 50%.
Ask that same sister how many forms she has to fill in for each patient. (it can be 10 different paper care plans for just one person, never mind other paper work.)
An amazingly large number of people are admitted when they do not need to be.
This is often seen as a precautionary approach, which sounds reasonable. But when it is an elderly person who has a troubling pain in the gut, who has been waiting 3 hours 58 minutes in the ER waiting area – alongside fifty or more others who also mysteriously wait 3 hours and 58 minutes, something begins to smell a bit fishy…
and that is just one front door to the system.
When you want to see the GP, what do you expect?
If you are an average working adult with what you believe might be more than a minor problem, my guess would be that you will expect to be able to make an appointment, see a GP you probably don’t know, and have 6 minutes to tell him your one problem. After that you will expect to either receive a course of antibiotics, or (deep fear) be referred to a specialist for tests.
The time rationing system seems acceptable to you (They are busy people in demand).
The limited times of available appointment slots may be annoying, but is similarly acceptable.
Since it is a free service you may decide to just skip that appointment if you are feeling better now five days have passed from when you booked it…
The system doesn’t like this.
There are signs up about it, for you to obey, and systems in place to try and prevent this “bad patient behaviour”.
You may be a non-compliant patient.
If you find your way to a social service help-desk, feeling unable to cope with caring for your sick mother, curious as to whether she might be able to get some help from the council, what will you expect from this front door?
(It is all part of the one huge system)
There are some criteria that you may need to meet straight away…
Has your mother got savings of over £23K? what are the details of all her various forms of income? How severe is her need? Is it life threatening? or only might be in a few weeks if nothing is done (in which case, better wait a few weeks)
the system is set up to restrict access,
to prevent those below a certain threshold of need from accessing a rationing system of service provision that is probably not suited to the needs of that person anyway.
Inside the health and social care system we like to think that we are the wondrous professionals who provide the health of the nation, we see ourselves as more than an emergency service, the backbone of British social society. We secretly feel we may be part of a system that has increased our population’s average life expectancy so brilliantly over the past sixty years.
We buy into the fear that we cannot afford to help all people who need it, that we must ration and constrict services so as to keep down costs. We also see professional service provision as our proper goal, and specialisation a great way of ensuring people get the best possible service…
It’s a great, big, failed lie.
Managing down costs and increasing standardisation, inspections and targets, is exactly why Ford lost out to Toyota way back in the 80s. It perversely achieves the opposite of its avowed aim.
Dear NHS system controllers: – If you redesign the system around tailoring your responses to each person as they first come to you, the “magic” actually does happen. They get the life they really wanted, when we listen and understand what they really want.
You get to do a great job, when you escape the safe office and sit alongside the professionals at the front door, also doing a great job, seeing first hand how simple listening ears and helping hands can prevent multiple professional referrals and total dissatisfaction in “your patient”.
The beauty of doing this is that people achieve a massive boost in quality of life while saving the care system millions of pounds. Because 90% of the demand from patients is repeat or “failure” demand, i.e. when you get it right first time, this demand disappears.
Due to confidentiality issues, I cannot cite the real life examples of where this has been proved, but it has.
The trick will be for the frustrated managers and directors at ALL levels to stop trying to tweak the wrong things righter, take a step back, and see exactly where all the failures in the system are occurring (everywhere) – and why they are occurring (three-humped, toe-trimmed, massively inspected camels) and then commit to joining the extant revolution that says,
“The citizen shall define what will make their own life better,
we will stop doing everything that does not support this happening”.
(this has massive implications, the elimination of a million forms, the throwing away of 98% of all rule books)
It turns out that family and community support provide 97% of any individual’s care and support throughout their lifetime. The first job of the statutory sector is to support, and not to belittle and take over, the roles of those care givers.
When we get this right, the specialists can be called in only when they are really the best answer to the citizen’s problems.
When we get this right we will see that everyone has strengths, links, assets and desires – and is not a bag of needs that we should hastily fill with statutory “care”.
When we get this right the NHS may well be so efficient, we actually can smile and assure critics from home and abroad that we have the best system in the world.