Sunday, July 12, 2015

What gives?

The plates are shifting...slowly and surely, they once again are moving to a head. Some sterling work by Shaun Lintern has shown that NICE are ready to publish nursing safe staffing levels -which undoubtedly will put pressure on NHS England to either adapt or reject. A political hot potato- this will indeed be a difficult one to juggle as one either runs the risk of ignoring NICE..or there has to be pretty good reason to ignore it- at a time when mid Staffs etc have highlighted the importance of safe staffing and the impact on patient safety otherwise.

So it comes to a head..and before progressing any further with this blog- let me make a clear statement- this is NOT about debating whether safe staffing is important- it is. Simple as that- no debate. Patient safety is paramount and safe staffing to achieve that isn't one to be debated. HOWEVER the question is if we have 1 pot and an efficiency drive to achieve, what gives to achieve that? The finance directors around the country have shifted uneasily with the safe staffing issue- not because any of them have any issues with patient safety- but because they appreciate the financial impact of it. Commissioners -for sure- have felt that uneasy feeling for its them who now have to decide what gives.

If we want to tackle the area of safe staffing- whether it be via NICE guidleines or whatever means- that requires front end investment OR robbing Peter to pay Paul. Did I hear someone mention about the 10 billion extra? I won't rehash the argument made eloquently by many others- but thats something that primary care needs and is about using that money innovatively. So if we use that pot, does primary care take the hit or do innovations stall? I have said many a times- this is the era of prioritisation-and the quicker we start having that discussion, the better for us all.

So let's say that safe staffing as per designated ratio is paramount- the fundamental what isn't? Is it about perspective? Is it about evangelism? Is it about personal experiences? Julie Bailey has been nothing short of admirable (ok tenacious if you aren't a fan) at her drive towards making this a national priority..what would happen if we had someone as driven, as focussed , as media savvy pursuing the agenda of let's say, health education? Would that be of a higher priority? Would that be a fundamental core- or would it be in the second rungs while safe staffing is the core issue? Its magnificently tricky.

Then we talk about evidence and investment or even opportunity costs. Lets take NICE...depends, again, on your experience and perspective. Type 2 diabetes guidelines- 2 drafts- a significant amount of money invested- as a diabetes specialist, the first draft was simply a group of individuals making a fantastic pigs ear of the data. Cometh the protest from the whole community..a fast turnaround and we are getting somewhere. Trust the organisation to look at data properly without prejudice or cost being the issue? What was that about sacred cows and our need to challenge them?

So the time is now. If safe staffing is the priority as per whatever evidence base, then lets start discussing at community and hospital level, what isn't the priority? There is 1 pot- in which there is only X amount of money. To make 1 side of that investment go up, another side will dip...what is that? Community care less important? Funding 7 day GP service less important? We need to discuss this rather than giving our views that our own area of focus is the most important.

In my eyes- type 1 diabetes care is optimal, can be improved and shame on you if you say you can't afford all. But there is also a realisation that something has to give to achieve that...which is exactly the conversations we have started with our local folks. Think what you wish for- and if you get your wish for- also spare a thought for those who haven't had their wish granted or who haven't been able to make their case eloquently enough.

We all aspire to world class care.The fundamental question in a world of finite budgets is simply....what gives? Or can you convince the powers that be to invest rather than divert.

1 comment:

  1. The NHS is facing some hard choices in the coming years. Governments need to be realistic about what the NHS can offer with its current level of funding.