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Conference Special- Brian Jarman an exclusive presentation and in conversion with Roy on data, HSMRs and what's safe and what's not.  
  London 22nd Jan 2014  More details here.

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News and Comment from Roy Lilley

If you read this at 0715 you'll probably be listening to the speculation and the leaks.  If you read this mid-morning there will be gossip.  By lunch time, 1pm, you will know.  Later today the DH publishes their response to the Francis and Berwick reports.


We can guess... a new this and a beefed-up that.  A duty of this and a responsibility for that.  Rules obliging Trusts to publish how many nurses are on this ward and that.  The CQC, with more to check and inspect with tools, benchmarking and calibration.  More of this but no more of that.  It's all government can do; rules and rationing, bullying and bungs.  They have no other leavers to pull.


The start of all this?  Mid-Staffs, in pursuit of FT status.  They cut corners, cut staff and carved their name into the history of the NHS, defined by geography; Bristol, Leeds, Alder Hay, Mid-Staffs and now Colchester.  The solution; stop pushing for FT status, the brand is irreparably damaged plus, fund the front-line properly and make it fun to work there.  Problem solved and you can dump the rest of the paraphernalia.


Do we need to ask how situations develop where colleagues think it is better to construct lies about patients not getting treated than to actually build services where patients do get treated?


We know, don't we?  We know that the fear of criticism and the fear of explaining to a line-manager can be greater than the fear of having to explain to a patient.  Board; more scared of the regulators than the relatives.  They all end up doing asymmetric, mental calculations; the loss of face and the prospect of more pressure appear much larger than anything to be gained from the truth.


The likes of the TDA, increasingly identified in my post bag as bullies, Monitor with their obvious disdain for the realities of the front-line and the CQC, more and more like the Vatican, seem to be oblivious to the damage they inflict.  The pompous CQC huff and puff but has made us no safer, Monitor complicates and obscures common-sense, the TDA persist in trying to make 2+2=5.  None of what matters to them matters at the front-line.


Between the three of them they have frightened administrators, managers and Boards half to death and turned them into liars, crooks and counterfeiters.  In turn Boards have bullied staff and turned them into liars, crooks and counterfeiters.


System weaknesses, fault lines, failings, mistakes and mishaps hidden, driven underground, covered up.  The very organisations, set up to keep us safe have made the NHS a more dangerous place.  All three; a menace to the public's health, a danger to staff morale and have made a patient's journey through the NHS more perilous.


If there are too few nurses on a ward to provide enough care what are the nurses supposed to do?  Tell the manager?  They know, they're the ones who cut the rota.  Tell the Board?  They know, they cut the budget.  Tell the press and get the sack.  Tell the patients in a moment of candour?  What are the patients supposed to do? Ask a relative to come and help?  The nurses could tell each other, have a whip round and hire an agency nurse themselves!   Faced with a charge of 'wilful neglect' they'd do better calling their lawyer. 


This whole paradigm needs rethinking.  Just how do we get the best from the NHS all the time, every time?  The answer is in the question. Look for the best.  Find, promote and celebrate the best.  A new organisation; the NAfFS.  The National Agency for Fabulous Stuff.


Yes, I know, a Naff idea but, think for a moment.  When Colchester fell behind with their cancer treatments, they had two options.  Confess or lie.  How about giving them a third option. 


Just suppose they could have called the NAfFS and said; we have a problem treating cancer patients.  Tell us; who is doing it well and will you ask them to help us, please?  Just suppose the Trust with the solution was paid a consultancy fee for helping.  Wouldn't that simple investment be cheaper than special measures, less costly than the damage to the NHS's reputation we have now and a sensible start to doing things safer and better?


If the staff, money and resources devoured by the Kerberos that is Monitor, TDA and CQC, were diverted to front-line care and sharing good stuff, the NHS might just be a lot safer place.


Alas, I fear by teatime we will all know there will be more of the same.  The politicians will do what they always do and we will end up with more of what we've got.

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