Perhaps you will allow me to take a liberty with a metaphor. I’d like to change the Bermuda Triangle into a Bermuda Square.
The NHS has somehow ended up in the middle of a Bermuda Square; public opinion, politics, reorganisation and overwhelming demand.
The four corners of the square are feeding a powerful under-tow and all we can do is watch and fear the good ship NHS is not consigned to the same fate as HMCS St. Laurent or the SS El Faro.
It’s easy to see how the undercurrents will feed a bow-wave of demand and create a rip-tide of negative opinion, as more and more of the public, or the people they know, wait for treatment.
Public opinion and a hostile press will create a whirlpool of political demands. MP’s worry, as an election draws nearer, about the prospect of their seats being washed away and will demand more ‘performance’.
With the resources available; workforce, buildings, equipment and reading between the lines of the NHSE Board papers, there can only be marginal gains in performance, which will fuel demands for reorganisation as if, in some way, it’ll ‘change’ performance.
A look at NHSE/I January board papers hints at how desperate the situation is.
It’s made plain to the Board;
‘Workforce remains the biggest risk to service delivery…’
… yet, there are no solutions on offer.
The Board papers tell us;
So far, ‘1,800 call handlers and clinicians have been recruited for NHS111, since September 2021’.
It’s not clear if these are additional, to replace leavers, or how much more capacity this creates.
It goes on;
‘…an additional 400 call handlers have been recruited to 999 services’.
We are left in the dark about what this means.
Pressure-off in the call-centres or better responses to the public, who have been facing delays of hours, waiting for an ambulance?
The point is, faster responses will shift demand along the supply chain and could deliver more congestion at the doors of A&E.
The Board noted;
‘Community Diagnostic Centres have created an extra 365,000 tests, carried out since the first CDC became operational in July 2021.’
Very good, but that will shift demand along the corridor to outpatients.
The pivotal information;
‘…total elective activity for November 2021 was at 89.2% of 2019 activity levels.’
Heroic, yes… but gets us nowhere along the road of making a dent in waiting lists and doesn’t tell us what elective activity was in 2019.
What’s the latest position? Dunno…
The Board only meet monthly. You’d never think they are handling a national emergency.
Perhaps, next month, they’ll ask why stressed NHS staff in England are quitting at a record 400 a week.
No one seems to understand the NHS is a giant supply chain, interdependent and entwined.
Where does this leave us?
A lot has been made of the positive effects of Covid. I’ve done it myself. Writing about the legacy of a more nimble, innovative service.
But, when you come to think about it, why did it take a pandemic, exhausted people and death on an industrial scale, to tell us, in normal times, NHS management was out of touch, overbearing, bureaucratic and in many places superfluous.
It seems to me we have to change the geography of management.
I get no sense NHSE is close to the front-line. In fact, the evidence tells me they are just about as far away as they could be.
The HSJ are reporting;
‘Trusts which miss their elective activity plans will be subject to higher payment deductions than were previously planned…’
The background is; NHSE initially proposed that waiting list activity, above plan, would be paid at 75% of the tariff rate, with a deduction of 50% for any shortfall against the plan.
It has now proposed to increase the deduction rate for activity that is not carried out, to 75%.
Why? It’s the old story…
Kissing up, kicking down.
Yes minister, we are sorting out waiting lists. Kissy-kissy.
Trusts! Sort out waiting lists, or we will cut funding off at the knees, give you a kicking and put the boot in…
This is insane management. Totally bonkers. Amateur, pathetic, inept. I have a dread fear, the NHSE/I Board are out of their depth and drowning in Bermuda.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
