At a time of challenge and difficulty in the system where should our ambition be? To simply survive day to day? To keep our heads above the flooding torrent’ or do we at the same time as treading water and keeping going aim to do something different to re-route the water, stop it from washing away everything in its path and leave behind a soggy mess? When I was young I went to a college where we provided beach life saving patrols to our local area in the summer. So I learned to swim in the sea. The number one lesson was don’t rush to swim towards the calm bit of water you can see ahead because when you get there it will be just as choppy as the water you are swimming in right now. Learn to swim in choppy water. To make progress when the waters are cold and rough you need to be resilient, skilful and keep your eye on the destination.
There is so much turbulence now…. An election coming that is too close to call and likely who ever takes the helm to mean changes for health.. because somehow there always are…Services under pressure…recruitment right across the system in crisis..
Primary care and the staff who work within it have choices to make…about whether they are architects and builders of something new or simply allow themselves to get washed away ….The response from primary care to my October blog about my Mums care has been fascinating…. Those who felt it was a call to arms to fight to the status quo, build something better.. and those who are simply too tired, too worn down to do anything but reply that my mother’s care was safe at least…safe in the smallest sense.. on that day sending her into hospital was the most risk averse decision…. And that is true if you don’t factor in the risk of hospitalisation for a frail elderly woman.. the risk of infection, falling, a steep worsening of memory…but in the end that is her risk.. not theirs… Is it wrong to want the best rather than accept the average? But it feels like the energy to change is being sucked out of primary care..and a cold hopelessness is creeping in.
It made me sad… I have never accepted the hopelessness argument ( it is all hopeless and I can’t do anything to change it) and have always wanted to make it better. I am a striver.: for every problem there is a solution. Whose job is it then to fight for primary care? The “ Forward View” describes a compelling vision for primary care, who designs the road map to get us all there? Will we in primary care expect this to be done to us? For us? In spite of us? Do we embrace change or abdicate our responsibility and then blame those who make the changes?
Will CCGS DO IT? Co-commissioning primary care. Is that the way forward? Well it seems to be the only option around. CCGS seem keen as do GPs but is that because we will be good at it or because of the lack of capacity in areas teams to do anything? We as a CCG have struggled with the idea and whether it is right. We can talk about conflicts of interests policies to make it safe and I am sure they will help.. but the public don’t understand the NHS Architecture and why should they ? It is absurdly complex… and they see Federations of GPs providing services, CCGs of the same GPs commissioning care, and we can tell them it is all governed and transparent but when I do that I see blank looks and disbelief on peoples faces. I see risks to the clinical leadership in CCGS too because the easiest way to deal with the inherent conflicts are to simply reduce the influence of the GPS within CCGs, but I believe doing that risks a return to PCTS. Our strength and success is built around the real partnership between managers and clinicians and the public working together to change things….
The vanguard initiative ( this is central NHS money being given to "pilot" sites around the country to try out new ideas) will be interesting. To succeed it must allow local areas to work to their own agendas, and resist the temptation to impose structures and timeframes to meet national and political imperatives. The changes envisaged are huge and to be successful it must be clear to everyone participating what the task is.. what the challenge is.. what the future should be before we talk about structures and payment mechanisms… lets get it right for once please…we should know how to do this….function first then form….time to get the buy in from the people who are actually doing the caring first… hurry… won’t help.. people need time to understand and be willing to change..We know this.. Let’s hope that the Vanguard money will be spent to support local development of new ways of working and not a straight jacket of central control as so many of these initiatives have been in the past… a good idea that gets lost in translation….
Most importantly we have to develop a system that safeguards quality and continuity for those who are frail and have complex problems, provide timely and accessible acute care and creates an environment that will attract doctors nurses and other health professionals to choose it as their career into the future…because it is rewarding, challenging but not exhausting and is fun… ambitious enough? I think so!…time to keep swimming…..
