|
On the Tube…
… in my carriage the seats were taken. A handful of us were standing. A young lady stood up in front of me, smiled and offered me her seat.
It was the first time it had happened to me. Previously, I’d given up my seat… but today was the day, my pride, youthful conceit, aspiration, hubris, met reality…
… I looked old enough, frail enough and probably miserable enough for a woman old enough to be my daughter, to offer me her seat.
What to do? My brain-box went into overdrive. Should I decline? Harumph and say no?
Would I upset her? She was gracious and polite. All I could do was to be gracious and accept her politeness… I smiled, said thank you and sat down.
Slumped. Welcome to old age.
There are few benefits of running down the clock but there is perhaps, one.
Experience…
…not experience in terms of conceit, some faux wisdom but the experience of having been around, having seen things and events that have gone well and those that haven’t…
... it’s probably the one benefit that compensates for creaking joints and postprandial somnolence.
When a reader sent me a copy of the £walled Times interview with Penny Dash, the soon-to-be redundant chair of NHSE…. (it is reported on here, but not in its entirety)…
... a loud bell rang and my memory went into overdrive.
Dash has been infected with the virus that’s sweeping through the upper echelons of the NHS… the insatiable urge to traduce the service with gratuitous insults about its performance but offering no solutions except to sack people..
In the article Dash lists the 'failings';
-
Empty buildings not being used but still costing money to run… generally they’re bits of buildings that are impossible to rent
-
NHS wastes too much money… she doesn’t tell us how much is too much or on what.
-
Hospitals have already spent more than £2 billion above their allotted budgets, which Dash said ‘was staggering’… it’s spending more because it is doing more work than it’s paid for. Overtrading.
-
More doctors and nurses, but we haven't seen an increase in activity… probably something to do with ‘more’ not being ‘enough' and working with clapped out IT, in crumbling estates might have something to do with it.
-
Shift away from small GP practices to groups with 20+ GPs who can run neighbourhood health centres… they are called Darzi centres and failed back in the naughties.
-
Teams that can keep patients at home… the community nursing workforce is in decline.
-
A single national quality board within the department will oversee safety and a national care strategy… we all know only GIRFT really works.
-
Variation in GP practices… is that variation in practice or patients?
At that point, in stepped the bell-ringer, the aged Mr Memory.
Dash is ex-McKinsey and I remembered, 25yrs ago Big-M produced a deck of PowerPoints that, in-terms, told us what they thought was wrong with the NHS.
Guess what, I kept a copy! Oh yes!
Here they are and in summary they say;
-
Cut the tariff to make places more efficient... effectively taking money away
-
Deal with the variation in GP productivity
-
Stop ineffective procedures
-
Reduce outpatients
-
Increase nurse patient-facing time.
-
Increase day cases.
-
Reduce prescribing variation
-
Cut procurement waste
-
Don’t waste estate space... that again!
Think about this.
For twenty five years the NHS has been struggling with pretty-much the same things.
It tells us the forces of change, the levers, the influence, consultancies, the leadership, the systems are somehow completely out of whack.
The M’s of this world, politicians and our present leadership never analyse ‘why’. Get to grips with the root cause of problems so they can change the right things.
It’s too easy, lazy and idle to identify faults… it takes brains, courage, memory and experience to change things.
The NHS struggles to modernise because its complexity outpaces leadership capacity. Short-term political cycles undermine long-term reform. Finance and workforce crises drain transformation energy.
If only 'the leadership' understood the five S’s that defeat meaningful change;
-
Scale and complexity; layers of management and regulation
-
Short political and leadership cycles; Health Secretaries rarely last more than 2yrs and Dash will be gone in 14 months
-
Short-term funding; instead of long-term investment. Capital raided for revenue
-
Staffing pressures; professional silos and tribalism. No proper workforce planning
-
Same-old-same-old; like Darzi centres… brings on change fatigue. People roll their eyes and give up…
… the Service and its leaders fail to learn from their own history.
That’s the point.
The NHS is still standing but it needs to sit down and learn from its experiences.
| 
