Sunday, May 19, 2013

Great Expectations

There comes a point when it will have to be said. Duck it as much as you want, avoid the issue as much as you want, try and twist the media as much as you like, there will come a point when some one has to put their hand up and dash the great expectations of the public. The great expectation that as things stand the NHS will continue to provide everything and more; the great expectation that errors will cease, the expectation that communities will be equipped to keep people at home away from the cold corridors of emergency departments, the expectations that GPs can do more, junior doctors can work harder, specialists will do one point, someone will have to let the cat out of the bag. That there is no more money to give everything to everybody at the highest quality possible.
And it doesn't matter how many conferences you attend about "working together"; how many meetings you be a part of exhorting the "servant-leadership model", how many flyers you read about integration of health and social care. At the end of it all, any economist worth their salt will tell you this..unless there is more investment, it simply, is not do-able any more.

The latest drive within hospitals? 7 day service. Any dispute it needs to be done? None whatsover. Skeleton staff over weekends compared to weekdays have been known to harm patient care. So have no doubt that 7 day cover is a must. But we have forgotten one simple does one move to 7 day service when even the 5 day service isn't sometimes good enough? We want Consultant reviews over 7 days a week...but a great idea only when they do so 5 days a week. Many a places this doesn't happen- either because they are busy with their other scheduled work or are doing something not quite within their job plans. their respective managers know that to move to a 5 day service review, something will have to give, something will have to stop. We decide not to...ergo we can't do 5 day cover in a uniform basis...but we are having conferences on 7 day cover. We are looking at workforce implications...we are talking loudly as to how we are about to universally embrace 7 day working...but no one has any answer whether it will get blocked at the financial stage or does something else stop. A good example? I can do 7 day cover but that would mean me also taking time off to compensate for my week day work..which means cancelling my type 1 diabetes clinic. Something suffers, something gives.

All this while the expectations keep getting fuelled. Politicians of any colour or even commissioners need to be honest, need to be bold to engage with the public to say we have no more money left to pour in. Funding has flat lined ..and yet we keep talking about how we are going to make it happen. The thing with visionaries is that they rarely do the implementation- and the NHS is now in a bind. Nurses have kept on saying they are short on the wards..but its evidently all about working differently, cutting waste or some other speak which sounds clever but increasingly means little to departments and staff who have no other "waste" to cut or cannot work any more differently.

So please- some honest conversations please with the paying public. As a Consultant, I get paid to spend 46 hours per week at my work, my average runs at about 70. And I am not unique either. yes, there are the bad apples but the majority of staff whether they be GP or nurse or specialist are exactly doing that...working far and beyond what the pay package is...trying to bridge that gap, trying a bit harder to meet the great expectations.

A good jockey knows how far to push a one point, the whip ceases to work..and the race is lost. I am a born optimist and our department fizzles with pride, passion and the desire to make a difference. Not so unfortunately everywhere. Most places have folks over worked, over stretched, resorting to black humour to fend off the tide of media diatribe against the whole profession...and still we don't do much to calm the levels of expectations fuelled. Instead we jump from one bandwagon to another. I am passionate about making a difference to people's lives but let us, please, be realistic. In an era where cost cutting is such a huge drive, in a era where every department has to show examples where they have to meet a Cost Improvement programme target every year...please..lets be realistic, start to have honest conversations about what's achievable and what's not.

I will finish with the words of JFK.." The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest but the myth, persistent, persuasive and unrealistic".

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