I know I’m supposed to start the week with some sort of inspirational message. Help you spring into the next few days, whistling a happy tune.
I would if I could.
Alas, I can’t. Over the weekend I plunged into a slough of gloom. The cause of my despond? I read some of the care-home trade press.
Take my advice, don’t. If you’ve a relative in a care home, don’t read it. If you’re thinking about a care home for someone you love, don’t read it. If you’re thinking of working in the sector, don’t read it.
It's wall-to-wall gloom. Care homes are hanging by a thread.
The sector is up to its oxters in problems. I read an article that quoted a director of six care homes in the West Midlands. He said;
“Our staff can move into the NHS on a band 2 rate at over £10 an hour, and it’s a pretty identical job function… existing staff can move into other higher paid jobs and are now less interested in coming to the sector because of the pay…"
Staff vacancy rates, in care-homes, have increased from 6% in April 2021 to just over 10% in September 2021. At that rate it’ll be 13-14% by Xmas.
No proper pay scales, no career structures, ad-hoc recruitment…
… on top of that, another problem.
Staff are obliged, rightly in my view, to be vaccinated. In consequence unvaccinated care-staff are moving to work in the NHS, where they are not yet required to be vaccinated.
They’ll get paid more and they won’t have to be vaccinated until the spring of next year… by which time, anything could have happened.
No19 is expected to set the NHS vax-deadline in April.
Which leaves us with the inevitable question; if it’s such an imperative for us to be jabbed and booster-jabbed, now, why is it, NHS staff, in the maelstrom of infection and vulnerability, can put it off to next year?
Of course there is no reason, other than No19, who has already put his foot into relations with the GPs and their unions, is not up for another fight.
It’s the wrong decision.
All decisions have consequences and the biggest problem of all, the unintended consequences.
The US inquiry into the Titanic disaster obliged all ships over 100 tons to have enough life boats to carry every passenger, in the event of an emergency.
Sensible? Yup and the SS Eastland obeyed the rules. The extra weight of the life-boats, on its decks, turned it into an unstable deathtrap. She overturned, yards from her moorings in 20 feet of water.
When the British Army, in India, replaced muskets with rifles, it was alleged, cartridges were greased with pig and cow fat.
Indian soldiers, some Hindu, regarded the cow as sacred. The Muslims believed pigs to be unclean. Neither groups would use the rifles.
To make an example, the British imprisoned a small group of soldiers who refused to use the rifles.
The discontent boiled over into a rebellion and sparked a war of independence and year of fierce fighting.
The unintended consequences of decision making… how to avoid them? You can’t.
Strategic planning, scenario planning… there’s always the unexpected.
Straightforward solutions, at first sight look simple enough but what will they look like three, six, twelve months from now.
An alternative way of looking at problems is, the OODA loop.
Conceived by a military strategist John Boyd, there are four steps;
observe,
orient,
decide
act
It’s pretty much common sense: awareness,
figure out what’s happening;
control events by understanding the data and information you have;
respond, make a decision and
take action.
The key is not in the steps. The trick is ‘the loop’.
Repeat the steps, staying nimble and be prepared to go through the cycle again and again and make changes.
OODA tells us...
... inconsistencies in vaccination requirements have caused a migration of the workforce. Variability in terms and conditions in care homes have exacerbated the problem.
Every town has care homes and almost everywhere has a hospital, that pays more.
The solutions are obvious. In the short term, bring forward NHS vaccinations and mid-term, require care homes to mirror NHS Agenda-for-Change, pay-scales.
But, yes, you’re right. That has its own consequences.
>> I'm hearing - about problems with the NHS covid-pass part of the NHS app. Second vaccinations are recorded as the first dose. records are showing people as having two, first doses. Problems are reported to the data resolution team who take 2 weeks to respond.
> I'm hearing - Sir Jonathan Michael, the former chief executive of both Oxford University Hospitals and Guy’s and St Thomas Foundation Trusts, will look into what lessons can be learned from the Fuller case and his final report may include recommendations for the wider NHS. This inquiry was set up by the Trust but No19 has stepped in and Sir Jonathan will now report directly to him. This may go someway to appeasing the local MPs who have called for a public inquiry.