Saturday, April 29, 2017

Brave enough?

How bold are we? How much do system leaders actually mean when they talk about having clinically led systems? It's like a moment in time when the sheer rhetoric of all that chit chat starts to grate so much that most folks lose interest. More to the point, how much do politicians or for that matter, even managers trust clinicians to deliver what's needed? The intriguing answer to that - after all my years of management at different levels? Absolutely no idea.

Clinically led organisations do goes the saying...yet how many organisations are actually clinically led is a matter of dispute. But on the flip side, there is no better time than now to perhaps road test much are managers actually ready to cease control or do they genuinely see themselves as part of a team with their job to deliver the clinical priorities as outlined by clinical teams? I am keen to test the theory so over the course of time will indeed share the experience. The problem is the more clinicians feel rebuffed when their plans or suggestions are rejected or ignored -the more you disengage how do you square that circle? How do you get the prodigals to return? Even with my role in NHS England, I am bemused by how many non clinicians I sometimes have to spend time explaining why Type 1 diabetes needs focussing on. The evidence is there, the need is there...yet..somewhere the trust isn't in a clinician.

Let's take diabetes. Many separate pots of money...let's make it simple. How about we forget all the nonsense of widget based system for a long term condition, add in all the present expenses in acute and community providers whether it be outpatient based activity on a payment-by-result for an acute Trust OR block contract to as community provider)  and look at a 10 year contract to deliver for the region some basic priorities? Let's say you give that system 10 years to improve amputation rates, improve safety, improve education, improve pregnancy outcomes....well tested principles which has benefit for patients and economic return for investment.
Stop micromanaging, give the clinicians the onus and responsibility and the task to live within that budget. Doable? Give them the onus to improve those simple markers, not blue print every single detail as to how to do it.
Get it done, learn from others...your area, your money- deliver the outcomes - engage with primary care...prove your salt as a clinician- and make sure you have a fantastic manager and financial person to help you do it.
I can guarantee you that most clinicians would relish that challenge...that is the essence of why doctors went to medical school- to improve outcomes...not to lessen referrals on a spreadsheet. Stop going for surrogate markets, let's give a timeline, a budget and the markers. Everything focussed on those markers, networks helps to amalgamate good ideas...stop branching off and doing some vanity focus only on a few key priorities.

Brave enough? And more importantly, do the system leaders trust enough? If you are a manager...go on...ask you? Are you brave enough? Does this excite you? It works on guarantees, it works on many assumptions but it does energise the clinician to deliver.

You want to change care? You want to improve outcomes? Time to be bold, time to change funding structures, concentrate on outcomes that matter. We from NHS England can certainly outline the priorities and support in delivery....but no amount of power points, articles or lectures can deliver or excite clinicians enough till you have the faith in them to deliver. Bold enough? All of these structures...vanguards, STPs etc etc give you all the structures you need. If you want to cease the moment, then as system leaders, the time is now. I can assure you there are plenty of clinical leaders in diabetes who would pick up that gauntlet.

Is the system?


  1. Please also take Patient Leaders who support you with change and most of the care also is done by patients and their families/carers

    1. For sure!! Always been the way I have at least tried to work!

  2. I regularly see clinicans stepping up and becoming great leaders. Courses such as the Mary Seacole course run by the NHS leadership academy are helping.
    I think old fashioned professional hierarchy has much to answer for in keeping good aspiring clinical leaders down.

  3. I would suggest that sometimes it is the clinicians who are less than enthusiastic about service redesign and change and, indeed, sometimes block service change, based on my experience of working within a number of primary, secondary and specialist community NHS services over the past 30 years.

    1. Fair enough- so- if I bring to the fore clinical leaders ready for a budget like stated, the system is ready to support? If so, let me know- and can always get the ball rolling in my NHSE role