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Fixing the NHS for good: prioritising the ‘important’ over the ‘urgent’

Thu 13th October, 2016
Fixing the NHS for good: prioritising the ‘important’ over the ‘urgent’

By any reasonable measure, it is abundantly clear that our frontline NHS is in crisis.

Forget the tabloid headlines screaming as much. Forget too, the more reasoned and balanced view of the challenges facing the NHS as the spectre of ‘winter-pressure’ rears its head as the weather turns colder and the mood greyer.

All you have to do is speak to any doctor, nurse, or healthcare professional working in the service and they’ll tell you in very forthright terms just how great the strain is to continue to deliver the quality of care they provide today.

It’s at this juncture – perhaps the defining one for the NHS – that one might expect, or even just hope, that the powers that be might try to help make things a little easier for those working in, and leading, the Service. At a time when there is a dwindling pool of leaders willing to prostrate themselves at the mercy of the regulators, and an alarming haemorrhaging of frontline staff to Agency working and sunnier climes, its way past time to stop administering the current Systems medicine and look at alternative treatments.

If some of our most renowned hospitals in the past three decades are now so poor that they need to be put in special measures - sometimes, as recently, having had a ‘clean bill of health’ only 12 month ago - something is going seriously wrong.

Turnover rates of up to 15% of staff, vacancy rates of up to 10% of staff, Agency bills that can exceed £9m a month, £multi-million Trust deficits appearing out of nowhere (due perhaps in large measure to the spend on Agency nurses and locum doctors in a vain attempt to ‘keep the lights on’ as a result of staffing shortages) is the result of a set of policies determined by successive governments of all political hues that would make you weep.

The current regulatory regime might, just might, be necessary, given how far things have deteriorated across the system in the past few years. But then, if the system has been working the way it needs to, why have so many Trusts been allowed to get to their apparently perilous state in the first instance? Aren’t the people sending in the regulators the same people who have been overseeing the system for the past decade or more? And if and when it is deemed necessary to send in the regulators and their army of improvement experts and financial wizards, can it be done in a supportive way? Please? It’s not just apocraphyl, stories of seasoned CEOs and their staff feeling ‘brutalised’ and ‘devastated’ and ‘floored’ by their inspections. Is that how we want to make staff who are doing the best they can feel? Is that going to make things better, today, tomorrow and the day after?

Maybe it’s time to realise we’re all on the same team. We’re all on the same side. We all – I think – want the same things: high quality care for all, delivered by professionals who are proud of their work, supported by the system to grow and develop every day, valued and respected for their contribution, thanked at the end of their shift for the difference they have made to their patients and relatives, and paid well for what they do for all of us.

None of these things should be unattainable. None of these things should even be optional. The fact that we’re moving further from these outcomes, not closer, is a serious wake-up call.

There is a better way. It’s very straightforward, and it’s very simple. All it takes is courage to recognise that we keep on doing the same (wrong) things and keep on getting the same results.

The current focus on Five Year Forward View – the strategic imperative around what a future, sustainable, patient-centric and end-to-end joined-up care system looks like – makes a lot of sense.

So too, in the current financial climate, does the current prioritisation of the 44 Sustainability and Transformation Plan (STP) footprints and the corresponding Sustainability and Transformation Funds (STFs) financing it. The trouble is, and has always been, with the latest top-down intervention and ‘tell’ from on high:

• It never works
• It never delivers for patients, or for staff, or for the System, or for the taxpayer
• It never gives the medics and clinicians and healthcare professionals the lead.

We are trying to deliver laudable aims through a system and structure not designed - or with the capacity/capability - to enable it to succeed.

With an Agency spend of £3.6bn last year and a Q1 £760m spend this year, things aren’t getting better fast enough, and there is no real evidence I can see that this modest like-for-like reduction in Agency spend is delivering better, safer, care.

Financial turnaround is not the answer. It’s not the priority. It’s an outcome. And it’s an outcome and bi-product of the turnaround that is actually required: turning around the engagement, involvement and ownership of the solutions to those who know best - our medics, clinicians, and allied health professionals. Recruitment is often quoted as the single biggest challenge facing Human Resource Directors. Wrong. Its retention. If we don’t stop disillusioned, demoralised and demotivated staff from leaving the NHS due to the mounting pressures, lack of support and ‘more carrot than stick’ approach we currently use, we’re toast. The additional work about to hit them with winter pressures and delivering the Five Year Forward View and STPs will, I suspect, be the straw that breaks the camel’s back.

I happened across a workforce transformation presentation last week that contained a slide on the 5 themes from 30 enquiries into major deficiencies in healthcare. The content was produced by Kieran Walshe, Professor of Health Policy and Management at Manchester Business School, and the themes that were the challenge were:

• Poor communication
• Disempowerment of staff and patients
• Ineffective systems and processes
• Isolation
• Inadequate leadership/management.

The study was done in 2002. Fourteen years on, how is the system doing? It could have been written yesterday.

So until and unless we are, individually, and collectively, brave enough to prioritise the important over the urgent, we’ll see the same five themes again in 2030.

Do the right thing.

Engage and empower and motivate your frontline experts to deliver what they know is needed to improve the quality and safety of care.

Support them to do it through a system that is geared to the corporate functions and management layers playing second fiddle to their medical and clinical colleagues.

Take a deep breath, have your bungee-jump moment as a leader, and prioritise the important over the urgent.

Do the right thing. It’s time.

Gordon Forbes (07734 812311)
©Optimise Limited 2016



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