Monday, September 28, 2015

Reach for the Stars

Aspiration. A word that galvanises many to think of what we could do. It is however a fine line though. Take my own football club..Liverpool. Past glories abound and every year, the hope builds that maybe, just maybe, this would be the year. Aspirations are high but time has been a good builder of temperance. Now we talk about rebuilds, we talk about getting into the top 4...compare that to Barcelona...it's pretty simple...win everything you play in.

The NHS is in an interesting bind of its own. the pride of many who work in it is palpable, any suggestions that you may not be doing to the utmost level ( check any negative CQC report and responses) and we all bristle at the very whisper of it. Inwards, I suspect we all know we aren't doing as much as we can and different reasons are given for it whether it be vested interests, inability to work together, culture...the biggest one which does come through is of course finances.

This is where a dichotomy seems to have emerged with organisations within the NHS. Let's take NICE for example- a respectable body who looks at the evidence and makes recommendations. The problem is the aspiration doesn't quite match the resources or even the ability to deliver. Any think tank or health economists will tell you we are in a financial crunch and struggling to deliver what we have..so how would it be possible to deliver more? Therein lies a fundamental question.
Take for example the recent NICE Type 1 guidelines. One which would be a dream for anyone with type 1 diabetes...but to deliver it, something needs to stop or there needs to be some investments. I absolutely take the point that working to evidence base etc would help stop complications- but in the world of diabetes, that's about 10 years away...so where's the resource to invest to save?
When you ask NICE, their response is "It's not our job to give you the how". That makes it tricky because at the moment, no one quite does either. The problem is that NICE guideline manages to raise the expectation that those guidelines will be delivered- and when that doesn't happen..cue anger, angst..take it out against the HCPs who are the face of the NHS to many...drop in morale...the cycle continues. None of the policymakers, twitter champions etc actually face the patients...its the staff who are the face of the NHS.
CQC is another example. It sets the standards, then judges you based on that. However,when you ask them how with the financial crunch..their answer is pretty similar to NICE. "Not ours to give the how". It's an interesting position to take especially when all these bodies are funded by the NHS itself and not quite external per se.

So what would help the debate? Anything involving the public gets divided along political lines which as relevant as it maybe, hardly furthers the debate. Professionals raising their voice are sometimes branded as being of vested interest- so efforts continue at pace to try and get the public and professionals together. However think of this..how much would it add to the table if organisations such as Monitor, CQC, NICE all did their roles but with a caveat that these are aspirations which needs a financial review to deliver? It would certainly strengthen the focus as well as be fundamentally strong voices? All bodies with their respective roles but working together for a sustainable NHS. Too tricky?

I want Liverpool to win the Champions League...I want them to be Barcelona. But I also know that to do that, we need injection of finances to get the best players etc. and if that doesn't happen, I will learn to be satisfied with a trophy here and there and perhaps a top 4 finish. The question is where do our aspirations for the NHS sit and do we all have a responsibility to reach for the stars? If we do, then it's about time, all national bodies had a think..because if it comes down to the wire, they may not have much to inspect or create guidelines for. Or the crunch of money will shut them down too.


The choice isn't that tricky. If we believe in the NHS a and improving patient care- which is indeed the basic role of all those organisations too- then it's time to reach for the stars..together.

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