Give us a chance

It seems as though the NHS is never out of the news… and so very little of it is ever positive. So much of it though is rehashing things that have already hit the press in the past. This week we had the Select Committee report. It didn’t tell us anything we didn’t already know and we are working on it all. I sometimes want to shout.. please give us a chance.. .we have been here for 3 months… we know the issues we are trying to sort things out but the issues are complex and don’t get solved overnight and actually CAN’T be solved by centrally driven solutions. Each one is complex, multifaceted so you have to take each one and break it down in to all the little bits that don’t work, fix each of them and build it all up again into a service that works seamlessly. And that isn’t easy. Which is why is hasn’t been fixed before. Yes it is true that A&E is a pressure valve for the whole NHS ( actually so is primary care ) anywhere with an open front door is. But the reasons it is under pressure are complex…. A mysterious rise in the death rates of older people over the last 12 months, changes to the GP urgent care front door because of the introduction of NHS111, and general increase in demand across the service, more frailer older people, yes we need to change primary care, community care, GP out of hours care, how the ambulance service works, how social care works, and that is before we get to the A&E front door. WE are on the case. Changing things though actually means changing how people work and that isn’t like designing a new form it is about behaviours so it takes time. It doesn’t help then to have lots of structural things built over the work we are doing that require reports and attendances at meetings. Each of those requires someone who would otherwise be doing doing to be doing reporting and thus less doing gets done. Not rocket science is it? Maybe people just need to try to trust the system they have so recently designed and give us some time ( well a little more than 3 months) to get on with making things better.



And then there was the Keogh Report which I thought was brilliant. Simple. Succinct. Sensible. Coherent. And yes I believe described a way forward we could all sign up to and follow. So then came the recommendations from the new Inspector of Hospitals basically using that structure. Great I thought! But No! Why? Where are CCGs? We commission local services. We work every week with our acute trusts we know the details of every SUI, every never event, every case of hospital acquired infection. We discuss action plans and monitor compliance. We see trends. We live here. We hear from our local GPs and from our patient forums about their concerns and we feed them back to the hospitals and expect and get action. It is new and we are all just finding our feet but surely any new inspection regime should be co-hosted by the local commissioners, the ones who were there before the inspection team arrives and will be there when they leave… surely, surely we should be there too? If we really want to make this different we have to join up the dots. I don’t want to be in a focus group or submit a report I want to be there with the inspectors contributing with all the knowledge I will bring to the discussion and debate. WE had an NCAT review when we were considering reconfiguring our maternity and children’s services, the CCG with the NCAT reviewers worked together. It was good. It was obviously much smaller than a full inspection but as a model it worked really well. We will be the ones who work with the hospitals after the inspection to make things better, surely we should be round the same table. Why aren’t we? Are we invisible? Do people think we aren’t capable? Does everyone think we will be gone before this gets off the ground? Does the central NHS not think we are interested? WE are ALL about improving quality and safety in our service, our NHS. Please give us a chance to do our job.