Friday, October 6, 2017

Maze

Tenacity. How far do you take it before you say...you know what...this isn't worth it? The NHS tests you, doesn't it? The groups, the bodies, the approval process, the multiple committees...its enough to make your eyes water. At one point, you are just happy to do your day job, pick up your salary- and go home. And therein lies a lot of the inertia in the system. Its not simply the lack of trying from individuals, its the incredibly byzantine process that sometimes makes you go..."Ah well".

Let me give you an example- recent release of diabetes transformation funds (41 million £ across the country for 2017-2018)- and its been absolutely fascinating to see it from two polar opposites. One- from the central team- giving the money out- and hoping /expecting folks to get on with using the money to improve diabetes care...(after all, we keep getting told, if we only had some money to "transform" the system, all would be better- so surely, the system is now adult enough to use the money when it arrives?)- and secondly from a local level. I don't hold any management roles anymore in diabetes at a local level- but the intrigue of the process made me decide to get involved- perhaps also to get a feel of "how IS it going on the ground?" When clinicians voice their frustration, are they actually meaning it..or making excuses?

And you know what? It has been one of the most fascinating, character building, frustrating as well as eye opening things I have ever done. Without going into too much details (you have to save something for your book after all) below is a list of organisations I have had to contact, seek approval from, inform, cajole, send snappy emails to, chat with to get the money moving to actually deliver care:

Local Sustainability & Transformation Plan Board
Local CCG X 3
Acute Trust
2 community provider trusts 
Podiatry department
Orthotic department
5 GP leads with interest in diabetes
NHS England South team
Clinical Network
Accountable Care System

I suspect I have missed out a fair few- but at last count, to free up the money which we from NHS England allocated- it has taken me 187 emails, 17 meetings, countless conversations and many many hours spent doing something I am not even paid to do- apart from that tenet of "we are here for the patients".Towards the end, I was doing it simply to find out how far this trail would go, how convoluted can we make the process, perhaps even just for my own entertainment...and in a nutshell, why even money can't solve the problems the NHS has. It's given me insight and perhaps food for thought as to how we should use money in future, if at all.

All the fault of Lansley and his creation of the maze or just a convenient excuse to absolve us of our roles too? I suspect there is a mixture of both. I recall negotiating in the Pre-Lansley era too. Multiple PCTs, Trusts firmly entrenched in their bottom lines, GP discussions at individual surgery levels, if you ever want to know how easy or difficult it was to ensure there was one diabetes team across 3 providers in 2010? Buy me a beer someday....it was perhaps just a tad less folks to negotiate and barter with- but the atmosphere was as much stifling....the financial crunch at present has perhaps forced previous siloed players to come a little bit more out of their entrenched views-but that's about it. Lansley didn't help but it wasn't a land of honey and manna either before the Health & Social care Act.

The NHS and the varying roles I do keeps teaching me valuable lessons...and one of them very simply is that it's easy to slip into a zone of thinking "why aren't they doing their job?"- whether it be from an NHSE perspective..or from a clinician on the ground. This maze and byzantine process needs to stop if we are to have any hope of progressing care- let's put it this way, if I accepted all the meeting requests sent to me, I would have zero time to do the work I am actually supposed to do- look after patients. 
The even greater irony is that none of those bodies are actually deliberately trying to stymie care or filled with villainous characters....they are doing their job, as asked by the system, following a process set up by ourselves over the years- though there probably as ever is a jostling for position. Whenever a new structure or body emerges, the previous ones perhaps feel a bit threatened, want to justify their presence, make their authority felt. Whatever it may be, it doesn't help those for whom the NHS has been set. Of that 41 million £ earmarked directly for patients with diabetes, how much will actually end up directly helping them? I wish I could give you a confident answer at the moment- from my experience of local devolution, the variability seen etc? Let's see.

So where to next? I suspect some of the legal issues come in the way...but some, if not a lot of these bodies need to go if we are to entangle the mess we are in. We can dislike STPs, rail against  ACS because they come from the land of the free...but whatever it is, we must and have to stop this merry go round with multiple organisations before anything can happen. Clinicians don't have the time, energy to "keep at it" all the time..its soul destroying, disheartening and not something that helps any of us. What I find fascinating is the number of conferences and meetings say exactly this very thing, attended by these very folks...and yet- when it comes down to it? The process goes through its churn- it's as if the NHS cannot unlearn something it has been accustomed to do.

You would think this blog is written in frustration- it actually isn't. The end product of all that has been that "we have finally got there". Its written to showcase the challenges we have created for ourselves. This one particularly is to exhort anyone who reads to think how their role in any management body actually helps, what sort of "power" one must cede to allow patient care to flourish and think beyond the narrow tramlines of "process". We must do better than this..we must have the ability to sit around a table, streamline organisations and be quick, nimble and get to the actual business of delivering patient care quicker. We need to make our way out of this maze. And quick. 

Otherwise, all the money in the world won't improve care- it will simply be more of the same. Here's to  a good weekend but please, do take a moment to think. How actually does the maze help any of us? Or the population for whom we are the appointed vanguards of using taxpayers money. Have a think, won't you?

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