Thursday, January 1, 2015

The mirror of Galadriel

1st January's that day of the year when you think of what's ahead, what could be, what may become. In the world of Tolkein, there existed such a device..a basin of water used in the Elven realm by Galadriel that could possibly show things that were, things that are and things that yet we dare to have a peak? Do we dare to have a look at a possible future and either batten down the hatches or do we step up to the plate and try and change what we see- beyond 140 characters, a vent in a blog or pledging on a wall? We shall see, won't we?

Let me have a peak though..let me see what I think may happen - if not over the next 12 months, but over many more..

1) Hospitals- unscheduled care will continue to swell, flow will become even more difficult, realisation will set in that all across the land the 4 hour target is unachievable. We shall all seek for the one who bears the ring- many pretenders will arise- alas, it won't change. It will no longer be about flow, it will be about acuity. ED staff, acute medical staff, ambulance crews will continue to buckle. they will step up to the plate one more time, one more day, hospital status alerts will stay at black mostly...the age of Sauron is upon us. Within hospitals, apart from those taking the heat, plenty will pay lip service, we will have a few stepping up to help, the rest will continue to do their specialist work. Social care or lack of it will be the critical reason why hospitals stagnate - the managers will look that bit more battered, a bit more frazzled- pushing the staff for a bit more while in their heart of hearts knowing there isn't much else to give.

2) General Practice - the pressure will ramp up- times are not going to change. They will ask for reinforcements but this time, the reinforcements may arrive to Helms Deep- perhaps a bit too late. The entrepreneurs will make hay- take over neighbouring surgeries, start employing Consultants, be innovative- the rest will get angry, distraught..go to work one more day- asking for one more effort. The natural instinct will be to lash out..hospitals, specialists, politicians, patients...the mood is dark, the forces are restless but there isn't much to stop the heat. A few rebellions will erupt- countered by the few entrepreneurs while the majority will go to work- one more day, one more effort to bring. One leader to unite them all, one Aragorn? Not quite visible in the mirror, yet.

3) Specialists - have been mostly quiet in the ensuing chaos but this maybe the start of them - either by choice or force, being asked to explore other avenues of work. Those who do private practice will CCGs cut off or restrict certain procedures, they will do more of those in the private sector. A few will rise to lead hospitals taking control of a system where primary care is rudderless and without will be the age of the Trusts..otherwise known as PACS. They may will become vital commodities- as entrepreneur GPs and Trusts battle for their services- whether doctors or nurses.

4) CCGs - Purse strings will will be all about relations with them. Payment by results will continue to drop and evaporate thus forcing Trusts to look at different ways of doing things- some silly, some fantastic. CCGs will become more powerful as they come into their own- look at working together with organisations like Public Health etc to form ideas..some silly, some will be up for grabs..entrepreneurs will flourish, Trusts will either join hands or take each other over. The time of the Entrepreneurs is here.

Finally, there will be an election...and irrespective of colour, hue or whatever, the above will stay the same. Next 5 months will be silly season, making promises which will be unachievable. We have rejoiced at Stevens ask for £8 billion...we have forgotten the £22 billion of efficiency savings we have been asked to make. No one has the answers, no one actually knows the way out of this...and no one has even breathed a word about increasing taxes...there is a tacit understanding that this efficiency savings will need to come..from us.Ladies and gentlemen, there is no white  wizard coming post May- there is no game-changer in the offing.

So...keeping to the Tolkein references, remember this..what Frodo saw in the mirror of Galadriel didn't come to pass in the end..we all know what he did to stop that happening. The key however was needed folks from different, elves, hobbits, dwarves to come together to make it happen. The question is whether we, as a whole, can come together, beyond the " I am special" argument and make it work. Singularly, all those visions in the mirror will come to pass. Together? We may just prevent it.

Time's ticking, ladies and gentlemen, Make any resolution you want..but better include the one to join hands with another beyond your own "clan". As Gandalf says.."The board is set.The pieces are moving.We come to it at last, the great battle of our times".

Have a lovely 2015, won't you?

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