Monday, March 16, 2015

Optimism...with caution

It's a world of fascinating dichotomy at the moment, isn't it? The colleges have asked for political parties to commit to the 8 billion the NHS needs to survive, no main stream have agreed to it..while on the back burner sits the issue of having to find 22 billion of efficiencies. Even if one finds that 8 billion with the appropriate political will, the eye watering efficiency number would make most finance directors reach for their bottle of Gaviscon. Then we have a presumed crisis of leadership as the right leaders potentially would find the money, only if they knew how to lead. Parallel to that we have the "shiny" brigade...striving to improve the emphasis on empathy, trying to spread the feeling of doing good, while at the same time, we have Kirkup suggesting silos, professionals turning a blind eye to poor care..dichotomy all around us.

One more bit in the mix is the fascinating situation of the makes me smile when people rail against those who do private someone explain to me what PbR has now become? See more patients,turn the wheel, for each activity, you generate money for your Trust..did you say we were all in this together? How many trusts do you know who have made a profit and then handed it to primary care or social, they rather invest that in developing maybe another wing or an IT project to improve "their" services, not necessarily the system. In between all that, an institution like Barts is now on its knees...leadership and shininess won't sadly help what actually is's the injection of cash. Who's feeling confident about that 22 billion efficiency savings now?

So as a clinician who has spent a significant time in management, looked at enough balance sheets, it's darned difficult to be overtly optimistic, believe that a solution is around the corner...but having said that, there always comes along a few things to lift the spirits a bit, give you a bit of hope that we aren't sliding inexorably towards a health system where availability of quality will be dependant on your wealth. It's tough though..the world of healthcare in the UK is already having encroachment of companies putting their products on the market, outside the NHS, creating a 2 tier system..those who really need it, can't afford there much to arrest the slide?

Thus it's with a degree of optimism, I have looked at the Vanguard projects..a new and interesting development. Am also fully aware that this already has had its cynics but with the challenges mentioned above, we need some major game changers...could this be one? The trick as ever is to implement the clever words, the glossy power points into reality..and then the toughest bit, to sustain. Can the vanguards do it? Time will tell but certainly it's something new, something different.
In American football term, it's as close to a Hail Mary pass as it gets...we need to decide as a community whether we engage with that constructively or simply sit back, criticise and just ask for more money. I am an optimist and I want to see how this works, how it can be sustained, how theses can work without breaking the local trust or imploding primary care. Whether right or wrong, it's different, it walks away a bit from silos and it's worth a try for sure. Best of luck to the ones who lead in's not easy to put your heads above the parapet..for that to be's now about implementing and sustaining..and maybe also know when it's going wrong and being big enough to stop. It's not about your local trust expansionism or even a GP cohort taking control of the system...but about whether the patients are served best..whatever garb it maybe in as.

The other bit has been the recent Diabetes UK Annual conference..maybe one of the best I have attended in recent times and I won't spend much time talking about it ( Read a great piece here) but what struck me was the change of mood...there seemed to be more of a mood of optimism, a more stronger willingness to improve care, a better mood to work together..I loved mingling with the patients amongst all the HCPs...but the best bit for me was the energy I saw within the up and coming trainees. I am enthused by their views, their desire....we, as a community, must let these guys flourish..they are not uncomfortable in mingling openly with patients, having a debate about care....I like that..I really do.

Meeting so many people I knew via Twitter (Anne, Roz,Mike etc) was fabulous..talking about what we have done over 4 years in Portsmouth was proud, trying to share the importance of SoMe to many was fantastic...but mo than anything, it was the desire to share, interact as well as say to many HCPs...please do go and engage with patients..beyond what you can learn. Share with them our frustrations too, the issue of the finances, what choices we have to my experience, people understand, people have time for being honest and in the main, appreciate the work we do within the tightening constraints

So, times a changing...we need realism..we need to understand the finances aren't stacking up and all we can do is to collectively raise the voices loud enough for the politicians to listen. Till then, we must and I stress, must, work collectively. We must look at efforts of new working with positivity but also be a friendly critic. Let's not shun the ones who are trying the Vanguards but let's try to be constructive..we are all trying to do this for the let's try..while at the same time, keep the open dialogue with the patients about challenges we face. If our politicians can't say due to whatever reason the problems the system faces, the. It becomes our role to do so. Yes, we have much to learn from patients but at the same time, it's a 2 way street and opening channels gives us the opportunity to share with all our issues too.

Times a changing..approach it with a degree of optimism, shall we? Cos without that, what else do we have left?

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