Tuesday, November 3, 2015

Bigger Picture

An email pinged into the inbox today..."Have they got to you?"...was the heading. With intrigue I opened it to a query why my blogs had stopped- had to assure that it was down to something more basic...my parents were visiting- and simply put- was just enjoying some family time- and as ever, was warm, fuzzy and simply...lovely.

It did make me think though about the culture we live in- where in spite of multiple conferences, hashtags, "Francis", self styled defenders of patients safety etc etc...such an email does come along. Either way, to reassure, nope, no ones muzzled me- and to be fair, none in management have never ever asked me to tone things down or stop writing.

So to this blog...and I must talk about Pete Deveson- and I must say the fella did make me sit up and listen. It was at the BMJ Big Debate- and in the middle of all the fun and laughter, the jokes and banter, Pete talked about "Learned Helplessness". Delivered with panache, fun but with a striking message underneath, he talked about how many had forgotten the art of speaking up when needed. Many a times,  I am told how its about the "Bigger Picture"..how our leaders can't say things openly because the bigger picture is more important- and I must admit I am starting to struggle with that. What does that actually mean- a bigger picture for the person themselves or a bigger picture for healthcare?

Keith Willett recently spoke at  Kings Fund conference- Director for Acute Episodes of Care or the Emergency Czar in old parlance. I watched on twitter as he spoke about the challenges, spoke about recruitment, spoke about working differently...and I waited..and waited..waited for this clever intelligent leader to utter one word about recruitment crisis, low morale, junior doctors...but nothing came along. What does that mean...he thinks the emergency care crisis is solvable without improving morale or tackling the recruitment issue...or is there a bigger issue at hand I am not aware of?

Sir Bruce Keogh recently spoke at "Agents of Change"...he spoke about leadership, challenges, issues to tackle..and I waited..waited..waited for 1 line, 1 word about junior doctors, waited for something about mortality issues- and I kept waiting. Let me get this crystal clear- read my previous blogs- I actually hold him in high esteem- I suppose it sucks even more when one of your heroes let you down. So what's the message for budding leaders? Keep quiet or is silence tacit admission of support?  Or is this all a form of learned helplessness? Or is there a bigger picture?

Recently I wrote a blog for CQC- and on balance I still felt it had a role...and then it goes and commits the most spectacular own goal ever. Hike your price up in an environment where money is gold dust- hike your price up for which evidence is still flaky, hike your price up in a tax funded system when patient care is stalling....CQC says it isn't their fault- but the DH that they are passing on the costs. What stops an "independent body" from publicly pushing back- learned helplessness or some nebulous big picture which escapes mere ordinary mortals?

We have exposes being run by HSJ- like the Daily mirror and Sun into NHS gaps- honestly- don't have to do anything fancy- just pop along into your local trust and you will find gaps. What stops from collectively raising the question of prioritisation or funding? A bigger picture? I can raise a national campaign tomorrow showing gaps in diabetes services bigger than "safe staffing"- what will it achieve if you haven't tackled the basic question? A few kudos for a few, a few blogs and then we move on to the next gap or crisis. Bigger picture anyone?

We criticise others about silos-we ourselves live in our own- and till we collectively ask what needs to stop, its all futile- and a circular debate in an echo chamber at best. Ask yourself this: You want safe ward staffing- fancy stopping screening for diabetes to do that? You want access to insulin pumps- fancy stopping funding shinier CCUs? That, ladies and gentlemen, is what the bigger picture is about for the health of people. Beyond that, the bigger picture is one of individuals and their ambitions.

In Sanskrit there is a saying .."Maunam Sammati Lakshanam"...it means "Silence is Half-consent". Have a think of the Big Picture tonight, won't you?

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