I’ve been my ‘saying’ for years and some of you will have button badges with it on and there’re probably still a few T-shirts.
When you plan improvements or changes there’s no way you’ll get services for young mums, right… unless you’re a young mum.
Services for older people? Not older… don’t even begin. Same for kids, kidney patients and care homes.
Ask the people using the services.
I don’t care if you do have a Masters in business-what-not or a Phd in fiddly-do… you can’t be a mum, an older person, a kid, a kidney patient or live in a care home… all at the same time… so talk to the people.
Ask them, get it right, step back and take the credit.
Don’t ask, get it wrong, step forward… take the blame.
Simples.
Managers get nervous about asking. They worry that expectations won’t be met or demands undeliverable. Don’t worry, the public are much more sensible than you think…
… and if they do want something you can’t deliver, no better time to explain yourself than at the beginning.
Start with them and work backwards.
It was the quest for patient satisfaction and the assumption it would be linked to efficiency, that prompted John Major’s, Conservative government to set public targets for the NHS in the ‘90s.
He guaranteed a maximum two-year wait for non-emergency surgery and reducing death rates from specific diseases.
Tony Blair arrived… we ended up with more targets than a shooting gallery.
Targets have a mixed history.
In A&E they forced the pace of innovation. Same was true in the early days of ambulance services.
Since, targets have become routinely missed through a combination of not enough people, capacity and overwhelming demand.
When HMG steps in, to rejig a target… everyone smells a rat.
The target that all patients should see a specialist within two weeks of an urgent referral for cancer tests by a GP, is to be scrapped.
NHSE are streamlining, meaning…
… three-quarters of patients should have a diagnosis, or an all clear in 28 days.
… and once diagnosed, patients should receive their first treatment within 62 days from referral or 31 days after the decision to treat.
Is this good news or bad? Well, it’s the difference between inputs and outputs.
The new standards (note, not target) replace 9 cancer targets, including:
the two-week wait between a GP referral and first consultant appointment;
a one-month wait for care, once a decision has been made to offer treatment, such as chemotherapy, radiotherapy and surgery;
and a two-month wait from the urgent GP referral to a first treatment of cancer.
They’re all inputs, set no expectation of when patients should receive test results or have a confirmed diagnosis... the outputs.
Bully-Boy, on the BBC, said;
‘… changes will be those where it’s been requested by clinical [cancer] specialists … in consultation with leading cancer charities …working with consultants, clinical leaders… what drives best outcomes… [how to] get the best survival rates.’
Are we moving the goal posts, our thinking or our ambitions? Fine-tuning or fiddling?
Ask the patient and work backwards?
If I had sinister symptoms I’d want five gets;
get in,
get diagnosed,
get fixed up,
get out and
get on with my life…
Note, they are all outcomes. Targets are input measures and broadly useless.
A target to see a doctor in 14 days may not do it for me. I might need tele-dermatology, or an endoscopy… now.
…. I want to get a diagnosis and get treated.
There’s been a 28% increase in urgent GP referrals for suspected cancer. HMG say there’s an investment in 160 community diagnostic centres at just over £14m a piece, but…
Over the past five years 33% of CRs were recruited globally. Over a third from India… in 2021, 25% from outside Europe.
The shortfall of 207 whole-time equivalent consultant clinical oncologists (19%) is predicted to rise to 318 (26%) by 2024.
Macmillan Cancer Support says; 37% of the current workforce is over 50 years old. By 2030, almost 4,000 additional specialist cancer nurses will be needed.
Are the new ‘standards’ easier to deliver?
Dunno, ask a cancer specialist.
Are the new ‘standards’ safer?
Dunno, ask a patient safety expert.
Are the new 'standards' better for cancer patients?
>> I'm hearing - Private equity firms have bought up dozens of healthcare companies including ambulance fleets, eyecare clinics and diagnostics businesses over the past two years. They hope to cash in on spiralling NHS waiting lists.
>> I'm hearing - Sarah Dugan stepping down as Herefordshire and Worcestershire Health and Care Trust, CEO.
>> I'm hearing - Almost a third of GP practices have been forced to stop offering routine appointments in the past year owing to overwhelming demand.
>> I'm hearing - Pharmacies to be paid £17.12 for co-administering COVID and flu jabs.
>> I'm hearing - it's taking months for an employer here to get a PIN, from the NMC, for a highly experienced nurse from Europe.
>> I'm hearing - GPs could be asked to take part in 'coordinated actions' as opposed to engaging in full scale industrial action this autumn in a bid to secure improvements to the GP contract, the new chair of the BMA GP committee in England.
