Friday, January 12, 2018

Lost?

You can sense the despair in the air...you can literally reach out and perhaps even touch it. Enough has been documented about the sheer incessant pressure within hospitals, the ramp up of the noise in the media, the chatter on social media...you can't escape it. And with it has come a sense of inevitability about the cycle- yet perhaps a bit more tighter each year. The tough times brings forward a discussion of "how do we solve this problem?" along with the sharp divides of opinions, the same rhetoric of what may or may not work, the health care professionals saying "its the worst ever" and some sticking to smart alec comments about what should be done.

I mean...is it the worst ever? Or do we healthcare professionals harm our own cause by saying so each year- and we get to the "crying wolf" phase- where we get ignored when it actually is the worst ever? I don't know- but facebook posts from former years can be educational...it appears most winters, we struggled. Personally, how bad is it? Let me just say after a long, long time, I was reminded of my days in Kolkata...the sheer volume, the look of desperation in the poor doctors or nurse face...the annoyance that they couldn't do better. Heck, I even discovered places in the hospital I didn't even know existed- or at the very least, never expected to visit as a Consultant Physician. Problem is caught in the sheer white heat of social media, the message does get the counter of "here we go again"- albeit unfairly. Or at least it certainly feels so. It feels different for sure- something has to give soon.

Then there is the inevitability of the debate of "What next?". Take your pick. Hypothecated tax? Immediately appears a raft of idea why its a daft idea/scourge of the world/an evil plan to destroy Bevan's legacy. How about a cross-party commission? Well, that isn't good either- not all parties like it- because lets be honest, why get rid of a political football that has served many so well for so many years? Ok- lets ramp it up- how about a Royal Commission? Pfft, they say- it takes too long- long grass issue. Well, that's really funny and makes me smile. About 2 years and a bit ago, was part of a group which asked for it. Response then? Oh-it would take 2 years- and the NHS "doesn't have 2 years!!" Looking back, it seems we have had a lot of chat, a lot of political commentators have opined, but what has happened as regards funding the NHS question? Fanny Adams. I don't know- maybe, just maybe..if we had done something 2 years ago, we may have had something to discuss, implement, debate etc. But nope, heck, some tin foiled hat people even said we were pushing privatisation. Well, blow me over. 2 years later, welcome to GroundHog Day.

Then we have the debate about structures and funding. The main opposition-for example-to an Accountable Care System seems to vary between- oh its American- that's all evil OR we possibly can't integrate services as it opens the whole service to privatisation. So are we objecting to the structure, the concept or do we want to ban private companies from bidding? Who knows- but integration / working together sounded like a good thing. I have an idea- lets give it a different name...how about National Health Service?

Then we have the "appeal for funding". An ask which each year gets even more....well...peak bonkers. We all know where extra money "should" go- social care, primary care, better prevention health, better community support....where however it does go to? Acute Trusts bottom lines, PFI bills, locum bills, anything to do with improving "flow" with a few hand downs to the other areas which would be more useful longer term....total net effect of using the money? A big zero. A plaster- till next year- when "its the worst ever ever ever...so can we have some money please?" To make it peak W1A season, the ask is led by NHS Providers- the same organisation which was one of the few bodies to support imposing a contract on junior doctors. I may have missed their apology for getting that wrong- but all the money in the world is no good if you don't have the staff. The junior doctors issue was far more about money, it was about morale- it was about the future- it was about a workforce we could ill afford to lose.  It was about standing by your workforce, not disrespecting them...it was much bigger than a pay dispute.Combine that with Brexit, the uncertain economy, an opposition which is level in the opinion polls with the ruling party...and we are a bit...lost,aren't we?

Normally, I always like to say something upbeat, something positive. I am not sure I do about this whole mess. The narrative seems to be lost between - we need more money/ Corbyn will save us/We are the best in the world/Stop Privatisation/ACS is the Devils spawn...all of this means very little when you are standing in the middle of a Medical Assessment Unit and thinking..."This can't be right"- or looking at your duty hospital manager and thinking ..."Dude, you need a hug".

So please- all you clever people- try and come up with a coherent plan- because I am not aware of one- and neither can I see anyway out of this rut- unless we try and get our heads together- and perhaps, just perhaps be open to suggestions beyond our firmly entrenched position.
I don't care what system it is- but I would like to provide a better service than what we are starting to at the moment.

Till the next year.