What have we done to our NHS?


What am I learning from the Patients in Control project work?

A lot.

I am still a teacher at heart, still the person who enjoys working out how best to facilitate learning and the changing of minds.

I’ve learned that I know a lot about the NHS, about structures and processes, and about how those in the NHS think. Though it’s never predictable.

I’ve learned that there are lots of people working in and with CCGs around the Midlands and East who “get” the proposition about designing services that enable and empower people to be in control of their health and their day to day lives.

And that there are some people, less, who don’t get it at all, and see healthcare as a paternalistic model where they are at the top of the hierarchy, and patients way beneath.

I’ve learned that a lot of people are waiting for someone else to take the initiative, to provide leadership, to “give them permission” to do things differently. They want to but they don’t think they can. They see existing structures as barriers, tight finances as handcuffs, contractual processes as how we have to do things.

And of course there are plenty of people whose enthusiasm is carrying them into innovative territory, where ideas are welcomed, nurtured and brought up into real, transformative projects. People who see opportunities, not blockages, reasons to do things, not reasons not to do them.

I’m seeing people who seem to be in a state of bewilderment and apparent fright, who are staring into headlights at…what?

And I’m seeing people who know that things have to change, and that only they can make this happen, locally. That they cannot going on doing the same things and if they want to get different outcomes.

I’m meeting very few people who say they know how effective the services they commission are. Most readily admit they haven’t a clue. So when we suggest decommissioning the ones that don’t produce good results they don’t know which these are. How can they change the way they spend money to co-design new ways of supporting patients and carers when they don’t know where funding can or should come from?

I’m learning that some CCGs want to get straight on with some small, ground breaking projects that will address specific areas of ill health. Like high amputation rates in a geographical diabetic population.

And I’m learning that some CCGs only see the big (often financial) picture and don’t know what the small things are that are happening in their own patch.

I’m learning that there are some CCGs where senior members appear unengaged, perhaps tired, perhaps fed up, perhaps unable to see any solutions to apparently intractable problems not of their own making.

And there are others where everyone really interacts and discusses ideas, listening and challenging each other positively and constructively.

I’m learning that sometimes great ideas come from unexpected places. Like the finance manager who really understands what patients in control is all about and why it is important to do it. For the people as well as the finances.

I guess these organisations are no different from lots of others. Except…

These people have been thrown together to manage the spending of hundreds of millions of pounds, and the health care of hundreds of thousands of people. Few are entrepreneurs. Few are strong leaders. Most are managers and clinicians. Some are lay members who bring different skills and experience but who don’t have organisational knowledge of how to make things happen in the NHS and can be understandably naive.

And now all these people are running very large businesses which have frozen or diminishing income, rising numbers of ever more demanding customers, and a shortage of trained people to produce the “work”.

Is this really the way to ensure efficient spending and great outcomes for people?

I find it easy to be encouraged when I meet the enthusiasm and energy of some groups. But this can turn to despair at the turn of a calendar page.

What have we done?

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