Wednesday, August 5, 2015

Ask the question

We must be able to do what we preach. No- really, we must. How many courses, events, conferences have we all attended where we talk about importance of being transparent? We must be able to- shouldn't we? We have an issue of patient safety- and quite rightly, it is top of the agenda. The CQC- for whom I actually don't possess negative feelings - (as frankly, seen enough occasions where the "fear" of CQC has worked far better than any data, any debate, any business cases to get appropriate staffing) - quite rightly tries to flag areas of poor care; poor staffing and asks the question of Trusts- and Trusts have to respond to that. 

What sticks in the throat of then Monitor turning around and saying- well.. actually staff appropriately. So we come back to a question. There actually isn't one question only. I know many want the question to be simply - where's the money- whether that be due to personal experience, whether that be due to political leanings, belief- so for many- that indeed could be the question. The efficiency evangelists say - there can't be more- which is also fair- in which case the question could be "Ok- so what isn't essential?" 
We could talk about value based interventions- but the interpretation of that is individual- who's bold enough to say "We think safe staffing on wards is most important, so we will stop providing pumps to type 1 patients"? Sorry- did that offend you? Is it by chance that you are someone or know someone with type 1 diabetes or does that not matter to you- as you are don't interact with people with type 1 diabetes? Ok- don't get angry- I will keep it- shall we then take away community rehab for heart failure? Outrageous did you say?

So what's the question? Well it could be many- the problem? All believers, evangelists are tainted by their own experiences, their own confirmation bias. I would like to ensure psychology services are available to all- that's because of my interaction with patients who would need that...would it matter to a Gastroenterologist..or a Radiologist? Maybe it would- but would it matter above their latest tech or whatever that would "improve patient care"? 
Let's take patient safety- the loudest supporters are the ones who have gone through pain personally or been at hearings listening to harrowing tales..their drive and passion is understandable but they didn't ask the question. They didn't ask one simple thing: Can we afford it? Or if we can't, what else is going to be sacrificed? Does it mean they care less about say the need for a pump in a type 1 patient? I don't think so- but question is would they rather sacrifice it to get better patient safety or improve patients they see everyday? 

It's tough, isn't it? I have been on the other side of the NHS  a few times  too- and before #hellomynameis became a movement, I never even felt the need for something like that. Why? Because every GP, Consultant, junior I met was polite , introduced themselves- and no, they didn't know I was a doctor. Kate's experience shaped her views but it still has been her views- which resonated with many...the difference? She knew the didn't need the basic question answering- what else gives. This was a simple human interaction- nothing else had to give.

So we are now here. I do not know what is non essential staff. From my experience,a manager isn't, a dietitian isn't, an admin person isn' I don't know who is. But I would like to ask the question- Who is? I would like some to ask the question- what gives? I would like some to ask: How? If it isn't about money, what do you want me to stop?

If we are in a state where we can't do everything- maybe its time to do a few things of highest quality- and maybe top of the tree is nurse staffing. Then lets be adult and say we will stop other things. I am ready to have that conversation in the world of diabetes- with patients. Let me finish with a question...
Are you?

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