It seems to me the NHS is doing quite a bit of stuff that it doesn’t really know why.
Perhaps I could put it another way… doing stuff force-majeure. Obliged, out of necessity.
For instance…
... no one is going to persuade me that looking after yer granny in a virtual ward is preferable to looking after yer granny in a real ward.
Yes, I know all the arguments about the best place to be is home. Safer at home. Familiar circumstances at home. Deconditioning, mobilisation... yup, get all that.
But, I’m not convinced yer granny with a nurse on an iPad is safer than your granny with a nurse in the same room.
They're called community nurses.
You can manipulate the budgets however you fancy but you will never persuade me that virtual wards, done properly, are anything but more expensive and more consuming of high-end skills.
How have they become national policy…
… because we don’t have enough real beds or real community nurses.
Force-majeure.
We rationalise our thinking and attempt to justify something in a seemingly logical or reasonable manner, often to make it appear better than it actually is, even when the reasoning isn’t entirely valid.
We try to find logical justifications for decisions that might be based more on;
emotions (granny is happier at home),
biases (they are doing it ‘there’ so it must be OK to do it ‘here’), or...
preconceived notions (it’s new and new is good).
This creates cognitive dissonance, where there's a conflict between our beliefs and feelings and what we end up doing.
To reduce our discomfort, we unconsciously distort our reasoning to align with the decisions we've already made or want to make or...
... are obliged to make.
NHSE says this policy works so we all have to try and whistle the same tune. Then come the targets, the gaming...and the rows.
Virtual wards have been successfully implement in some places, in specific circumstances, therefore we persuade ourselves they’ll work everywhere, in all circumstances.
Rationalisation can also involve cherry-picking information or focusing on certain aspects while ignoring others.
This selective perception leads to an incomplete or skewed view of the situation and results in some dodgy decision making.
Once entrenched in policy, admitting that we've made a mistake becomes well-nigh impossible.
Think about food retailing.
Tesco, Sainsbury and all the rest, coalesce their best stuff in supermarkets. Bigger means more savings in running costs, delivery, oversight on quality and staffing. Overhead costs are lower and that feeds into prices and that feeds into competition.
Now think about the NHS.
Our supermarkets are the Trusts and right now we are spending a good deal of energy and effort in trying to unpick the services Trusts offer and reposition them in primary care.
‘… most analysts agree that one of the keys to the future of the NHS is a re-balancing of activity between primary care and secondary care…’
Who says so?
Ten years later in primary care, staffing problems are crippling, overhead costs are bankrupting, lack of IT connectivity and a restricted estate are still not resolved and there’s been little or no shift.
Yet, we continue to rationalise all this by telling ourselves it is more convenient and better.
Probably it is but we still can’t do it because of the intractable problems of people to do it and places to do it in.
Primary care will welcome new things to do because it will increase their income. They become enthusiasts, for all the wrong reasons.
Any objective look at the direction of policy-travel would tell you we are kidding ourselves.
Biases have crept in. Virtual wards are fashionable. Management by fashion creates policy-fads and fad-policy is bad policy.
We’ve come to recite;
‘moving care closer to where people live, is better’...
... without really knowing the impact disrupted service interfaces and funding might have, capacity, practicality nor what ‘better’ means and …
... neither is it possible. If we haven't learned that in ten years, what have we learned?
Covid bounced us into remote care...
... we’ve just carried on with it. No one has considered the longterm impact on staffing, service quality, cost and no one is going to admit a mistake.
The main challenges facing the NHS, are staff-retention, bureaucracy, lack of digital technology and obstacles to sharing patient data.
>> I'm hearing - Sherwood Forest Hospitals FT chair, Claire Ward has become Labour’s candidate for the first East Midlands' mayor, to be elected next year.
>> I'm hearing - the free flu jab for most 50-64 year olds is definitely scrapped.
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>> I'm hearing - the Covid inquiry verdict on the impact Tory austerity had on preparedness for the pandemic is set to be delayed until after the next general election.
