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Got a to-do list for today? This week, maybe?
How many items on the list are hangovers from last week?
Oh dear… why don’t things get done?
Too busy, too ambitious, too much and the list too full of stuff you don’t want to do?
Here’s a tip, do the thing you least want to do, first. The rest will seem a doddle.
You’re not unusual. Not out of whack. Things that need to get done, don’t. It’s the same for HMG.
Right now, our great leader's aspirations for change. Three things;
- Shift care out of hospital into primary care
- Analogue to digital
- Stop people getting sick in the first place
None of it is new. Have a look at this, Tombstone City of what's happened to policy in the past…
Moving more care into primary care
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1962 Hospital Plan; emphasised the role of general practice.
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1990, NHS and Community Care Act; GP fundholding, giving primary care more control over budgets to manage patient care outside hospitals.
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2000, The NHS Plan; stressed expanding primary care services and shifting care from hospitals to GPs and community settings.
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2014, Five Year Forward View; promoted integrated primary and community care models to reduce hospital admissions.
Digital Transformation in Healthcare
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1968, NHS Computer Strategy; yes really, the first formal policy push for computerising NHS records.
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2002, National Programme for IT; a major attempt to digitise NHS patient records and infrastructure.
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2014, Personalised Health and Care; pushed for a paperless NHS and expanded digital patient records.
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2019, NHS Long Term Plan, Emphasised AI, digital consultations, and data-driven healthcare.
Health Prevention as a Priority
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1976, Health and Prevention Act; focused on preventive health through public health measures.
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1999, Saving Lives; Our Healthier Nation; aimed to tackle major causes of ill health… smoking and obesity.
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2010, Public Health Responsibility Deal: A shift toward partnerships with industry to promote healthier living.
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2018 – Prevention is Better Than Cure: A policy paper explicitly emphasising prevention over treatment.
… yup, some of this stuff goes back sixty years. The only thing that has been properly achieved and working, making a difference is… smoking legislation. As for the rest?
We have;
- a threadbare system with no properly interoperable IT systems
- an overweight population with life-expectancy falling and people enduring a miserable old age
- no way to fund the double running costs needed for care-shifting... secondary to primary
Plus a dozen or more think-tanks and consultancy firms, who have charged a fortune for their advice and work, yet nothing gets done.
The principle problem? The lack of accountability for failed policies and the public memory is very short.
Politicians get away with it, or end up in the House of Lords and there is never enough money to do the job properly.
You don’t need me to spell-out the NHS is a massive, multi-layered organisation with a complex web of local trusts, independent GPs, ICBs and regulatory bodies that have failed.
Implementing policy across such a vast system means new stuff arrives at places where some are more ready than others.
Hence, come succeed and some fail.
Governments operate on short electoral cycles, whereas healthcare requires long-term strategic planning. Frequent changes in leadership and priorities mean policies often shift before they can be fully embedded.
Changes get dumped on people and seldom get buy-in from the people who will be making the changes.
Change, often complex change, is heaped-on management, on top of the day job. The capacity for change is overestimated; workforce shortages, operational pressures, and infrastructure limitations.
The NHS is frequently in crisis mode, dealing with winter pressures, staffing shortages, funding gaps, making new policy implementation secondary to firefighting immediate issues.
I haven’t seen the Ten Year plan but we know it can do nothing other than duplicate the existing long-term plan, repeat the mistakes of the past and end up another headstone in the Tombstone City of past failures.
Is there a better way?
Yes...
... a modular, incremental approach will deliver faster, more meaningful improvements without massive failures.
- Pick one region, set a realistic time scale.
- Embed some change-makers to get behind the existing management and help with the implementation of the plan,
- enabling change and the day-job to be done properly.
- Learn from mistakes.
- Celebrate success.
- Create a shop-window of success.
Invite others to come a look. Success creates change-envy and an appetite to get on with it.
From the population, create diffusion-ambassadors, disciples and evangelists. Use them to create a social system to facilitate the changes in subsequent regions.
It ain’t what you change… it’s the way that you change it.
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