Whatever you are about to do, ask, is it kind, is it necessary and most of all, is it helpful.

A bit better

All power corrupts but powerlessness corrodes.

I’ve never seen the NHS so short of staff. Never seen it so busy… so up against it. 

Never seen it, with its back to the wall, quite like this. Never really sensed an attitude, so universal, nothing quite like this.

There’s a general feeling of helplessness. 

Nothing, people doing the job, can do about rota gaps. 

Nothing, about the surge in demand.

Nothing, about the waiting.

Nothing, about the erosion in public confidence.

Nothing, about a dangerous, wide-ranging feeling of… ‘we just have to get on with it’.

Dangerous, because, ‘Just have to get on with it’… can easily turn into… ‘Why, am I just getting on with it’… and transition into… ‘I’m done with getting on with it… I’m off’.

Powerlessness… corrosive.

What can we do?

Everyone is sick to the back teeth with listening to politicians saying; ‘You’re doing a wonderful job’. 

The answer to that; ‘I’m just trying to do a job, made a thousand times worse because you didn’t do your job.’ 

It’s true. If you don’t plan workforce and you neglect social care… this is what you get. A system that silts up. August is going to be horrible.

No one really wants to give up. There’s a strong sense of vocation and although vocation doesn’t pay the rent, it does give a sharp focus on doing the job, deep down, people love.

There’s no magic solution to the mess we’re in…

… more people will be recruited, over time. It’s a five year roll-out for nursing and at least ten for doctors and, you must stem the flow of leavers.

Expanding capacity? It takes people and money… there ain’t none. 

In the meantime, somehow, we have to think about productivity. 

Talk to a nurse, just off a 14hr shift, with no breaks, about productivity, you are likely to be facing a serious assault! 

The narrative must change. Who benefits from a productive working environment? Find ways of enabling productivity…

… making it easier, for hard-working people, doing a hard-job, to do the hard-job easier, quicker, safer and right first time.

Here are three things to think about.


At the end of your day, when you sink into the sofa with a glass of something lovely, you are entitled to say; ‘I’m knackered and I’ve done a great job today’.

Maybe… maybe not. There might be someone, down the road, across the county, at the other end of the country, in another country, doing your job… better.

Maybe… you might be doing your job a hundred times better than anyone, anywhere. 

We’ll never know because the NHS, from Pritchard’s desk, down, is focused on targets, penalties, finding fault and things that go wrong. 

If they were focused on finding success and things that go right… and sharing them… we would have a much better NHS.

The problem? We are not curious about success. Most senior leadership is defensive and not curious, at all.


The health and care workforce is full of skilful people, but we could change gear.

If a physio, or OT is helping a patient who complains of sleeplessness and joint pain, the usual solution… a chat with a doctor… adding a service interface, delay and cost to the patient pathway.

If the health professional is a prescriber, there may be no need for that. 

It’s called non-medical prescribing: 90,000 of them in the NHS; nurses, pharmacists, optometrists, radiographers, physiotherapists, podiatrists, dieticians and paramedics; since 1992, the UK led the way but has since stalled. 

Ninety thousand in a workforce of a million gets nowhere near the productivity potential. 

If we said to every member of staff, everywhere: ‘what one skill is there that would make your job easier, enable you to make your own decisions’… and then we made it happen… how much more productive would we be?


There’s a question that everyone, everywhere, from ward to Board, can ask themselves. How helpful am I? 

Leaders writing policy… MDT’s working together… how helpful are we… ICB’s scaffolding their future, if it’s helpful, do it. If it’s not… why bother. 

Whatever you are about to do, ask, is it kind, is it necessary and most of all is it helpful.

Three things that won’t up-end the NHS…

... but might just shift the fulcrum point, tip the scales, give bit a nudge, to making it a bit better. 

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.