Sunday, July 5, 2015

Happy birthday my lovely

67..depends on your view really whether it is close to retirement age or not. Has it served its time - has it got life yet in it..again, a perspective or which prism you want to view it from. On this day, the birthday of the NHS, let me be honest- I have never been in the tub thumping camp that the NHS is the best thing humanity has ever produced, nor pandered to the shroud waving camp that anarchy is around the corner and zombies are about to inherit the earth. Mostly because its pretty nigh impossible to have any sensible conversations with folk from those camps- eyes bulged, muscles straining, each camp tries to outshine each other- leaving us all wondering what exactly needs to happen to make things evolve.

Some have been let down by the NHS and mostly their anger and frustration has been fuelled by the duplicity, the effort to hide, the need to keep the truth away..some have used that as a force for good (step up Mr Titcombe), some have been bitter, angry...understandably too as the NHS has failed to appreciate the angst the loss of a dear one left behind. On the flip side, I have seen some absolutely stunning care, compassionate, way beyond the call of duty which makes one believe the old lady maybe still has life in her. Anecdotes shape our view, personal experiences mould our thoughts.

I was born in the NHS and I had the fortune to come back and meet the midwife and Consultant who delivered me.My parents always talk about the amazing care they received. Since then, I have been trained by the NHS, I have worked as an acute provider, community provider, done management roles, leadership roles, been part of quangoes, think tanks....you name it, I have dipped my toe in everything the NHS can offer..and on its 67th birthday, all I can say is that it is neither awesome, nor awful.
It is good, with its warts, with places to improve...caught in a financial crunch..perhaps in an idealogical maelstrom..struggling to keep up with all the challenges thrown at it....this wasn't what she was built for but over the years, has adapted, depended on its workforce to deliver. And it still will. Will the NHS continue to exist? Yes. Will it deliver everything for everybody? No- and perhaps rightly too. We all want the best for our patients and as a patient, I want the best for the pathology I have. I am a diabetes specialist and I want the best care for every single diabetes patient I have or anywhere. Is it possible..the answer is no as I also do appreciate it competes with the care of frail elderly, mental health,social care...it's now about priorities.

So on its 67th birthday, if we all want the NHS to adapt, then it's perhaps a time to reboot, time to perhaps think outside our own prisms..as ladies and gentlemen, there is only 1 pot. When you want to generate revenue off the back of something, it will only come at the expense of someone else's need. So think- and be honest. We all had an understandable fit of apoplexy at the thought of charging patients...how many of us would go to work and stop the 1 DNA  is instantaneous discharge rule. We know why we do it...financially a repeat referral generates more money...one pot as I said. And also spare a thought for the patient whose letter had gone to the wrong address or the GP who has to do the referral again in times of crunch. There is no point in making pledges or being energised by conferences if you can't bring back that compassionate or even system wide view to work. None whatsoever.

So on her 67th birthday, just think that to keep her going, the pot of money is one. The need to be honest is high..whether it being open to patients about what is possible or it to colleagues as to what needs to stop. Let me give you one example...another squillion GPs or Consultants won't do anything for type 2 diabetes care..but upskilled HCAs, better supported Practice Nurses and unshackling pharmacists? One budget across providers? Now, you are talking.

The million dollar question however sits with one basic thing...do you believe the NHS is worth it? We can blame all politicians for years to come...but let's never forget our own egos, our own views and vested interests also stop us from doing what's needed. Brave enough...or simply aiding the NHS down to a 2 tier system? History will judge the politicians in their own rights...it will also ask what we as professionals did too.

Happy birthday, my lovely x

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