Thursday, January 19, 2017

Lost in a maze

Do you have days when you wonder whether you are lost? Days when you look at the latest email and wonder who the senders are? I do not know what is going on in the NHS but I do know there are so many organisations. bodies, people that I am utterly confused. And frustrated- as it seems they have now become barriers or yet another body- who needs to be involved- and whether unwittingly or otherwise, are now halting progress. They all seem to mean well- yet…

My recent experiences are not unique- every clinician I have asked say the same thing. Wrapped in a tinge of self importance, a title of some relevance, the many many layers of structure are simply annoying- and to the patient- they mean nothing. I am pretty sure this blog won't make me popular- but I frankly am at a stage of my career, where I am now in a "don't-care" mode. My job is not to make everyone happy, it isn't to win a popularity contest- it is to try and improve care for patients who responsibility sits with me.

Lets take Vanguards- in a politically toxic environment, where every single initiative and venture is seen with suspicion - we forgot what its role was supposed to be. At the core of it , it was pretty simple- to try and get people together. Do something basic- like work together. Vanguards were the structure established- come to think of it- what does it say about us that we aren't capable as adults to do that ourselves- that we need permission, we need a structure- to exhort us to think beyond our titles, beyond our affiliation. Many moons ago- a manager sternly pointed out to me that my allegiance rested with the acute Trust- as they employed me. My response that day- stands to this day- I am employed by the NHS- the Trust was simply a means to pay my salary- my responsibility sat with the system.
I always make jokes about the Super six model being the fore-bearer of Vanguards- we did one simple thing- we didn't wait for permission- we treated our primary care colleagues with respect- thats pretty much it- and oh yes, fought tooth and nail with every layer of management to get the plans approved. I do smile when I see the very people who blocked all attempts of this model now go around talking about it- or even "try to spread good practice"

Too many bodies, too many layers….trust your clinicians, whether you be part of a network, Vanguard, STP…think of it…all you are is a structure or an attempt to get people together- which in my book- can be done in a pub, in the drawing room of my house or even over a meal at the local curry house. Trust yourselves- and believe me, you don't need any permission from any structure or body. If you belong to a new fangled organisation, don't obstruct- think of whether you are now just yet another layer which is doing yet another meeting to discuss yet more plans.

CCG, Vanguards, STP, local providers, Strategic networks, Academic networks…what chance is there of any progress if all of them want to do more meetings? Stop talking, planning- go do something. Do anything- even go and fail- but just do something. Trying to fill in local transformation diabetes bids have been simply mind boggling- let along use of words such as mystifying- while trying to understand who the heck some people are- or their roles are. The irony has been stark when some of these folks have taken time to read documents written by me- back to me….stop this Monty Python circus- and let the clinicians do some work.

Final note- all these roles are on public tax payers money- at a time when we are crying out for staff at all quarters. Its time to see what the return of investment is on some of these quangos- and if there isn't, get rid of them. Because frankly, now some of them are now standing in the way of delivering patient care.


  1. Hi Partha I completely agree. Over the years instead of tackling issues head on we simply apply another layer, each more isolated from clinical reality. Good luck with any changes. Paul

  2. Hi Partha I completely agree. Over the years instead of tackling issues head on we simply apply another layer, each more isolated from clinical reality. Good luck with any changes. Paul