December has been busy, it always is, everyone trying to fit four weeks' work into two whilst making preparations for celebrating with family and friends.
And much is happening in the health world, we know now what our budget will be next year and the huge hill we have to climb over the next few years. It would be easy to get discouraged. When you look ahead the future seems impossibly bleak (not a good word to use at Christmas), massive, overwhelming challenges and everything you read spreads more doom and gloom.
And yet, last week we had our CCG Christmas do and it was a very upbeat affair. We know we are making a difference. Now. Those differences are important, they aren’t huge but they do matter. We have managed to improve ambulance response times in a rural area that have been stuck at very low levels (56% eight-minute response) for the last 15 years. How?
Partnership working with GPs and the ambulance service and a series of small schemes that stop patients being transported to A&E when they could be treated locally. In October they were up to 81%. We won’t maintain that during the winter we know but know we have a model that we will continue to improve. That makes a difference to people living in a very rural area, who worry that when they need it most an ambulance won’t be there in time.
We have integrated health and social care fast response at night now. What does that mean? Well in means that if an out-of-hours GP visits a frail older person in the middle of the night who isn’t very well but really doesn’t need to be in a hospital bed we have a service that can keep her at home, even if that means someone being with her for a few hours.
We have increased district nursing teams, which had been salami-sliced down to a skeletal service. And it is making a difference you can feel on the ground and measure as emergency admissions are at least holding steady.
And at the same time we think we can pay off our inherited debt and finally get our health economy into balance for the first time in many years.
What has this taught me? Transformation is incremental. It isn’t some big bang that happens overnight. It involves tiny steps. It is all about hearts and minds. It takes time. But it is possible to change things, if you focus on the now.
I don’t just want to tell people what we are planning to do, I want to be able to describe what we have done. I don’t want to spend all my time planning five years down the line whilst being too busy to change tomorrow. We are a little team and resources in terms of human energy and health are finite. There are choices to be made.
So when I think about those huge greys clouds tumbling towards us all over the next few years, my response is to focus on now. To make things different tomorrow, next week and next month. I don’t want to spend too much time worrying myself and our organisation because the risk is that the worry creates paralysis.
Yes I know it is important to have a vision for where you will be in five years. I remember though that I read an article years ago (can’t find it for this blog but know it existed!) which looked at five-year plans and their accuracy and basically very little of the detail in a five-year plan ever comes to pass because so much changes in the mean time.
What we need is a clear direction of travel. A high-level map that will help us find the way but will not insist we travel on the route we originally suggested if a better road is found in the intervening years. Will we be here then? Probably not. Will the NHS landscape have changed again? Definitely. What we do have is an opportunity here and now to make things better for the patients we serve.
Those of you who have read my blog will know I often write about my mother who is 93 and very frail. She has had a tough year, four falls, three emergency admissions, a stay in a nursing home, rapidly progressing problems with her memory and mood.
She is now in an extra care flat and finally she is doing OK. She is smaller than she was a year ago in so many ways but the consistency of the care support she now has and their infinite patience and sensitivity has meant she is coping, for now. What have I learned as her daughter and an NHS leader? Small steps and realistic goals will bring change.
So, happy Christmas. Let us celebrate. So much has gone well this year despite the headlines. We have much to do in the new year!
