Tuesday, December 19, 2017

New Kid or New Clothes?

How much more change can the NHS take? Or are some changes absolutely necessary? Or are some changes needed to correct the wrongs of the last change? I mean...the only thing constant in life is change, right? These are the questions which -as ever- plagues the NHS- when anything new comes along- and based on our bias, belief, ideology or indeed even cynicism, we tag the latest change with a brush which fits the best description. Talk to senior enough folks- and they will nod sagely - the circles of change have left their mark on them...each cycle bringing something new, rehashing old wounds, bringing some fresh. Factor in that, in essence, we are a bit adverse to change in general, throw in the religion that the NHS is...and what a fascinating cocktail it indeed is.

In the context of all that arrives the latest version...the ACS (Accountable Care Systems). Or ACO. Or depending on your view- the Saviour of the NHS. Or the End of the NHS as we know it. There's been enough commentary on it from well known campaigners, political commentators etc so I won't bore you with that- but will give a personal perspective on it. I couldn't really care less what you call it, you can call it Mickey Mouse for all I care- but if anything purports to get organisations together, beyond their individual Key Performance Indicators- or indeed their bottom lines, then perhaps it can only be a good thing. Now I am not as clever as a lot of folks, perhaps even naïve, can't understand the politics of it all...but a vehicle which says get all your money in one place and work backwards for the benefit of the patients- seems like the ideology to which the NHS should be aspiring to anyway. I mean..I don't care what your Service Line Arrangements are- or how gleeful you feel about doing that extra coding to get more money- at the end of the day, it comes from someone elses bottom-line...Left Pocket, Right pocket, same bloody trousers, isn't it?

For years, I have sat and marvelled at the potential for organisations upping the ante at gaining that extra pound- off each other, off each departments...and after a point? It feels like monopoly money. I could give example after example from my time as Clinical Director of an acute and later community trust- where the arrangements could only be described as...cynical. Efforts to balance your own siloed bottom-line while the whole system tanked.

Anyhow, so what can ACS do? Well, very little to be honest- without the belief of the folks involved in it. Or their ability to convince the majority. Its not about convincing all- heck, we didn't manage that even with slavery or racism- so why try anyway. Its more about inspiring others to believe. A structure is as good as the players involved in it- a bit of a footballing analogy- but it doesn't really matter what sort of Tiki-Taka or False 9 you play with- if you don't have the folks to execute it. Or the belief they can. Or...more importantly- unlearn years of behaviour ingrained in them. As regards the scrutiny of the process, if the Healthcare Select Committee is looking into it,maybe the process will give some assurance- maybe it won't. I don't know- all I do know is this...it really doesn't matter even if all the money in the world appeared- the raw fact is we are still a fair bit away from having the ability to work together-as a system. We are still...primary care, secondary care, community providers....and so it has been for ever. Can we unlearn that? Can the system leaders switch their way of thinking? Or is it time for a fresh generation to try? To me, the structure gives the foundation- whether we can build on it, boils down to our thinking and approach

In short,  as ever- who knows. As Christmas approaches and we enter a period of bonhomie, maybe its time for us to save the NHS - just by gaining the ability to work together- from one pot of money- as well as developing the ability to argue for a bigger contribution to the pot-as a collective. Maybe we could. Maybe Santa may bestow that gift upon us all.

Or at the very least, one could always dream. I wish you all a very Merry Christmas indeed x