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There is a word that once was quite useful and sensible, now it seems to me, has become the first word in the lexicon of the snake-oil guru-come-politician.
Think-tanks who’ve stopped thinking, use it a lot and it's a word that has been weaponised.
Sharpened to a point, to make its insertion into a sentence, a paragraph, a book, a report, a policy document… deadly.
Somehow the word has been re-purposed to imply all previous work has failed. A past that is stupid, lazy or neglectful.
A word that has the power to induce Nystagmus in anyone in earshot.
The word has been burnished and polished in such away as to bathe the user in a glow of superiority, a know-all-ness. To use the word is to claim the moral high ground.
The word? Reform.
We hear it all the time; ‘the NHS must be reformed’.
Rich or poor, granny or gangster, the NHS will; scoop you up, fix you up and get you up and about the best it can, as soon as it can… no charge.
Which bit of that do you want to ‘reform’?
One of the problems with being around for a long time, apart from arthritis and general cussedness, is...
... I’ve lost count of the ‘reformists’ who have come into the NHS, turned it upside-down and changed nothing… and gone.
To add to my excess-irritability is; no one ever learns from the past.
Now we have to put up with that stupid-boy, who’s never run a chip-shop, parading about, telling us the NHS needs ‘reform’ and he is the crusader who will do it … may your god help you.
I’ve lost count of NHS reforms.
Here’s the four ‘L’s of why, right now, 'reform’ is wrong;
1 Lucid thinking - clarity, what problem are we trying to solve... and 'all of them' is not the right answer.
Principally the NHS is clunky and struggling with too much demand.
Demand issues need long-term resolution.
Sixty percent of people turning up have lifestyle related issues… totally outside the purview of the NHS.
The biggest users of A&E are babies under 1yrs... largely because local government doesn't have enough money to run proper health visiting services.
No amount of ‘NHS reform’ will fix that. It's a societal issue and all about funding choices.
2 Leadership - the cat’s-cradle of No10, DH+, NHSE, regional apparatchiks, newspaper headlines and MPs push and pull the NHS in different directions, daily.
Everyone is in charge… no one is running the show.
What exactly do we want the NHS to do? Apart from... more for less.
If the national imperative is fixing waiting lists… say so and get on with it. Targets, guidance, diversions... all the time leadership and direction is fudged…
... no amount of ‘NHS reform’ will fix any of this. It is a clarity of thinking, planning and management issue.
3 Looking isn’t doing. Spending time looking at the problem isn’t going to fix it.
The woeful state of NHS IT, data-analysis capacity and incompatibility is probably the principal impediment to improving productivity.
Stop looking at it... fix it.
Richard Granger, Christine Connelly, Katie Davis, Tim Kelsey, Matthew Swindells, Matthew Gould, Tim Ferris and Uncle Tom Cobley looked, but couldn't fix it...
...because…
… none of them had the power to go out and buy something on Monday, deliver it on Tuesday, plug it in on Wednesday and have it working by the weekend.
Health Service IT procurement rules need changing to put the National back in the title. Simple.
No ‘NHS reform’ needed to fix that. It's a one-line-regulatory matter.
4 Liaising with staff.
Understanding that staff do not work for us. The trick is, working with them… to find out what actually does need to be sorted-out.
You can walk the distance from the board to the ward a thousand times but if you can't influence the five inches between the ears of the people working at the sharp end, their thoughts, hopes, ambition, motivation and attitude... you've travelled in vain.
In some parts of the NHS, workforce conditions are appalling; rota inflexibility, 24/7 fresh-meals, car-parking, creche... you know all that.
No amount of ‘NHS reform’ needed to fix that.
Improving the way we do things is simple… for example;
Ward Councils (pioneered by the Good Governance Institute) working right now in the fabulously well-led Peterborough (The Posh) Hospital, where I visited last week...
... is a shining example of how to make services efficient, safe and evolve into better, every day.
No amount of ‘NHS reform’ required, thank you. Just a determination to listen to the people doing the job.
External pressure, disguised as reform, comes couched in the language of ‘we know better’, bagged-up with silent criticism and delivered with all the vitality of Monday's wet-washing.
Reform always comes focussed backwards.
Looking to its origins… ‘Labour’s reforms’… with no thought to its impact or legacy.
When ‘reform’ is hijacked as a noun it loses its real meaning of ‘restoration’, and ‘returning to its best’ and to do that..
... all the NHS needs investment in its systems and TLC in its workforce.
It does not need 'that word'.
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