"Do you think you are ready to go home?"....a cursory question on the wards whilst on the quest for early discharges was met with a mumbled "Yes, sure". Something wasn't quite right...a few more questions dug up the once proud police officer now living in a bungalow looking after his bed bound wife, riddled by stroke. This was his fourth admission over the last few months.."just a fall" murmured the elderly gentleman....adding "I am really trying, honest"...as his eyes moistened, at the sharp end of the NHS, all those powerpoint presentations seemed a million miles away..all those evangelical, buzzing leaders who told us that things were getting better seemed all a bit..false.
There had been no lack in this gentleman's care...multiple involvement from multiple professionals of multiple qualifications...just nothing joined up, all working in their silos, trying to meet their organisations targets and satisfaction surveys. Was he happy with their services? Of course he was..but no one had asked him whether society had repaid him, no satisfaction survey with the system.
It hurts me, especially as I am one of those who tries to live in optimism, tries to create a bubble where at least for a bit it seems ok..and then you walk into the daily grind and the bubble evaporates just like one of those recurring dreams of El Dorado.
The system needs boldness, the system needs big decisions..we all know it,we all talk about it..and then we walk away from it. The debate about the NHS always seems to degenerate into an idealogical sparring while honest conversations rest in the background.
So you know what...it's time for the CCGs to step up to the plate..I have met enough to know that these bodies are filled with honest, caring people who want better care..so I suggest go for it, be bold. Commission services which patients need, make providers work together..you have had your time to bed in, be the nice guy..and by now the basics of what healthcare needs should be apparent.If not, go and find out what works where and stop reinventing the wheel. Beg, borrow or steal a pathway, a specification which has or is working, make local tweaks if needed, genuinely involve patients in it and then ask the local,providers to deliver. If they don't want to, ask them to explain to patients why they can't or won't.