Saturday, July 13, 2013

The future? Who cares..

I work really hard..harder than I ever have. Nope, that's not me but a common refrain from anyone you sit down with for a coffee or a beer with. Every sector says that with conviction. If you had any doubt, then have none. The squeeze is really and truly on. And with the money shrinking, the need to do more clinical work with the same or less money. Spin it any way around but the money just simply doesn't add up any more. We are heading towards an uncertain future where the gap in demand and money available is so stark that crystal ball gazing is fraught with the risks of making one give up. Politicians dodge the obvious or maybe they are just priming the public for what's coming. Rationing is here, no longer one for the future. We have non evidence based pushing of cheaper drugs not due to clinical reasons any more but because each penny now matters.

And the policy-makers wheeze on still doing power points about how it will all be fine, how new technology will transform healthcare. And then they wonder why people are so slow to adapt it. Want an example?..Ok..here's one.

Telehealth...will it work..the evidence is mixed, the jury is out but in an environment where healthcare has been drilled into a financial number, why would you want to adapt a system which reduces "income" for your Trust- and which simply translates into a cut of salary or staff? Lets shed the holistic belief that we work for love..charity and benevolence goes only so far but when it comes to your salary, your mortgage payment being hurt, your kids school fees pressure, your holidays suddenly facing the prospect of Bognor rather than Belize...charity or the penchant of adapting technology flies out of the window. 
All policy makers forget one thing...great to give lectures but all the Telehealth models are based on 1 thing.. the golden promise of saving money...a reduction of costs to the system...ergo reduction of income to the Trust..ergo reduction of staff in the department. Now who wants to adapt something that would compromise their job? No one's stupid, no one's silly...and we go around in a merry go around again and again.

So in a Consultant contract the squeeze has affected that part which never quite brought or will bring much money...and hey the NHS is all about that. Its called SPA...Supporting Professional Activity and in that is included something that Consultants do..teach, educate, be a mentor, be the role model for the juniors to look up to...create the future. And that has now reduced to a minimum...juniors are relegated to folks doing the day job, doing the dementia screen, helping the Trust meet their CQUIN target...who has time to sit down with a junior with a coffee or even put an arm around the shoulder when the day becomes a bit too much for that junior? Problem is I rarely see a non-clinician understand what that part of that job means. Teach?! Pastoral role?! No- go and do some clinical work...who has time for the future when the present is in chaos?

So the responsibility for that or ensuring that this ever decreasing area is protected sits with and must sit with the medical managers. In my department, I fiercely protect it as well as monitor it...what's the point of having SPA if you aren't going to do what you are paid for? And I do it one and only one thing in mind...my own future. When I am old and need to be looked after, I want to have some compassionate, good doctors who have time for me..not ones who tick a few boxes, check whether I have dementia and then chased out of the hospital as their working hours have finished. As ever, doctors have been poor at explaining what they do in the non clinical hours...no we don't all just play golf...but amidst the squeeze, we try and find time to build the next generation. 

For the sake of the future of our patients, as medical managers we must stand up for what's needed and what's not. In the recent GMC trainee survey, our department came up as one of the best in all areas. And there's no non-clinician in this world who will make me change what we do as a team. Yes we are clinicians but we are also teachers. And I leave with you a quote which encapsulates what a teacher means in the words of Paulo Coelho " What is a teacher? I'll tell you: it isn't someone who teaches something, but someone who inspires the student to give of her best in order to discover what she already knows.” And we must not give that up..ever.

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