A wicked problem?

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?