Back on the road - BP motorway petrol-station toilets haven't got any better...

Anyway, from the looks of it I would say the NHS is in the grip of a fever, a contagion.  It's running through the Service like a bush fire.  There is a plague on the loose.  It affects conference speakers.  They must get contaminated by touching the lectern or from the press-button-thingumajigs that move-on the PowerPoint slides.

The origins of this disease are uncertain but it is destructive and damaging.  It is spread by carriers and comes out in a rash of five words.  They occasionally throw away the words, others will big them up; centre stage, the pivot point of what they are talking about.  The words?  I'll tell... but I warn you they are contagious... I am not responsible and seek medical help immediately.  Here they come...

The NHS has to change... Everyone is saying it.  The NHS has to change.  But, no one can tell me from what, to what? 

Change from the most admired healthcare system in the world, free at the point of need, comprehensive and there, 24-7, when you need it.  Rich or poor, young or old, whatever race, creed, colour... it'll take care of you.  Which bit of that don't you want?  Which bit do you want to change?

If we said the NHS needs to embrace the use of technology, be more efficient, better understand and deal with patient flows, multi-skill its workforce, redesign patient pathways and be more nimble - I'd go for that.  That's called modernisation, rejuvenation and overhaul.

Do we want to change the basic tenets of the NHS?  I don't think so.

If the NHS were to 'change' it would have to have the buy-in of the public who fund it.  Do they want to change from a tax-funded system with one with top-ups and insurance?  I don't think so.

How many of the 1.3m staff want to change their employer to work in the private sector?  All the evidence I've seen is that staff come to work with a strong sense of vocation and calling.  From managers to medics, cleaners to clinicians, they share a deep sense of public service values.  Where staff have ended up working in the private sector, most of them tell me they wish they could find a way back to the NHS.

If the case for 'change' is being made around the issue of running costs and austerity, how much more money would be wasted on change.  Isn't 'change' code for cut, shrink or diminish?

Most people will admit the Andrew Lansley's reforms have taken us in a �3bn loop to get us back where we started and have delivered nothing.  If the NHS 'changes' again (into what I have no idea) won't it strip morale, dilute effort and distract everyone's focus?

If the NHS is to alter what it does there is only one person that can be the guide.  The patient.  If we deliver what patients want we are half way to success. 

What do they want?  My guess is, The Five Gets; they want to Get-in, Get-diagnosed, Get-fixed-up, Get-out, Get-on-with-their-lives.

How difficult is that?  Very!  But, it is a vision for the future and an image we can hold in our mind and we can all work towards.  The problems the NHS seems to struggle with are access, outcomes and technology.

Access is about managing flow... largely we don't, everyone gets herded into the same funnel and we don't measure enough to know if what we are doing really works.  The public, the patients and staff use technology in every nook and cranny of their lives but the NHS works in a gas-lamp world.  We don't need to change what we do, just invest in how we do it.

The redesign of stroke and cardiac care across London, now admired and copied elsewhere is an example of innovative redesign.  But it hasn't 'changed' the NHS.  It just made it made it more proficient at what it does.

The NHS has to work smarter and that means it has to be nimble and that means it has to be freed-up from the tedium of business-plans, scoping exercises, strategy, top down policy, daft targets and all the other clunky-stuff. 

It has to be free to give-it-a-go, try-it-and-see... now that would be a change!

Have a good weekend and if you are working over the Bank Holiday - thank you.   

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