This week
North Yorkshire and York PCT (made up of 4 clinical commissioning groups
including ours) announced a financial deficit. It has been there for years and
years but in the past it has been temporarily sorted with loans from the
strategic health authority ( the next tier up) and made up of money from other
PCTs who have under spent. This year there is no “bail out” and so we will
probably finish the year in deficit too.
There is no
easy solution to this financial problem . No Willy Wonka Golden Ticket, no
matter how hard we look for it. The reasons North Yorkshire is in deficit are
complex. I have written about them before but it basically about three things: our
rural geography, the way hospitals are configured and the way we are funded. We
have tried to sort this out each year but got nowhere because of the complexity
of the issues.
I went on a
leadership course years ago. I learned many things that I have used since: lots
of leadership theory, some more helpful than others. One of the sessions that
really stayed with me was the concept of “wicked issues”. These are complex
problems with no easy solution, lots of interconnecting issues, each one
challenging and complicated. These are the problems people talk about often but
put in the too difficult pile because even considering them gives you a feeling
of doom and helplessness. We can all think of examples of these in our personal
and working lives I am sure.
We need to
change our health care system. We need to live within our means financially. We
might all think the funding is unfair (and I believe it is) but I don’t think
it will change much over the next 5 years and spending lots of time and energy
fighting about the funding formula is just a distraction.
We need to re-engineer
our system. We need to keep patients out of expensive hospitals and improve and
strengthen care in the community- more district nurses, occupational therapists,
physiotherapists who can, if required, provide a service in a patient’s home. So that when I see an frail elderly person in
the middle of the night as an out of hours GP and that person is not seriously
ill but not well enough to stay on their own at home I can get them support and
care they need in their own home rather than send them to a hospital miles
away. That means fewer beds in hospital and the money that used to pay for
those beds can be used to employ community staff. To do this we need the
courage to make changes that may initially make our communities anxious and
worried.
We need to
find a way to explain the reasons behind the need for these changes so that
they understand we can improve care for patients and save money. But it won’t
necessarily look like the care we have had in the past. Less time in hospital, more care at home. We
have lots of “evidence” that this is the right thing to do and it is what
individual patients want. Every time I send people into hospital they say to me
“do I really have to go Doctor? Couldn’t I stay here?” We need our politicians
to listen and to understand the problems and the solutions and help us explain
these to our communities.
Maybe that
all sounds straightforward to you. I
know it isn’t. It requires courage,
trust, stamina, commitment, tenacity. Easier to focus on the simple stuff.but
that won’t fix the problem.
Wicked or
what?
