Come in useful

I have a present for you. A little gift to cheer you up. Bring a spring to your step and a smile to your cherub-like face.

I haven’t bothered to wrap it. I don’t need Amazon to deliver it. I’ll give it to you now… it’s a word.

‘Boondoggling…’ mark my words; it will come in useful.

What does it mean? It’s an archaic term for ‘doing meaningless work’.

It originated in the 1930s in the US to describe make-work projects or tasks that were perceived as wasteful or unnecessary, particularly during the Great Depression.

I have list of people, here and now, who have been boondoggling.

They are nineteen of the great and good; members of the £walled, Times Health Commission who have spent the last year, a far as I can see, boondoggling…

… looking under the bonnet of the NHS with the aim of telling us how we’ve all been doing it wrong and what we should be doing to put it right.

They’ve cogitated, ruminated, pontificated, examined and given us ten things to do that will save the NHS.

One of the basic rules in innovating and making change is to ask; is this really innovative, have we, or someone else, tried it before and the killer questions…

… if we have tried it before; where are we doing it … go and see if you can do it better.

… if the answer is, we’re not … ask why, what can we learn.

The Nobby-Nineteen are too Nobby to get their hands dirty to ask the basics.

Their ten ideas are;

1 Create ‘digital health accounts and passports’ to book appointments, tests, letters-n-stuff.

This is low-level and simple. Spain, Singapore and Denmark do it.

Not here because of the lack of investment in basic IT and held back by feral systems and poor interoperability discipline in procurement.

Joe Harrison, who is running the development of the NHS App will tell you… he’s all over this, right now.

What’s missing from this nobby-brainwave is patients owning their own records, granting clinicians access as required. There are too many doc’s on the panel to be this radical and transparent

They do it in Australia. The funny thing is, the person who made it happen in Oz, tried to make it happen here. The ebullient, indefatigable Tim Kesley was actually defatigated by gutless politics, poor DH comm’s, a hostile press and inadequate budgets.

2 High-intensity operating lists. Much is made of the Guy’s and Tommy’s conveyor-belt approach to surgery… which was a triumph.. not of surgery but of PR. It’s about as new as a white fiver.

The John Radcliffe was doing something similar years ago. Lewisham, Meadway, Kings are doing it.

In fact Geoffrey Robinson’s 2007, TV series, ‘can I fix the NHS’ pioneered some-such in Rotherham.

The limits are on the procedures, the suitability of the patients, the building design, staffing and money…

… and getting it wrong. It is an error to focus on the gains made by a single surgeon, rather than viewing total productivity across two operating theatres.

3 Convert the GP contract to focus on outcomes… as GPs cannot be responsible for what happens after they’ve made a referral, forget most of that….

… encourage more super-practices… fine, bring money, sort out social care, fix commissioning and bring more money. What happened to the Vanguard initiatives? They didn’t bring enough money.

4 Write-off student loans. Yup I’ve been banging on about this for ages. Biden is doing it. But… brace yer-self for the other students in other disciplines, who’ll want the same treatment.

5 Non-blame compensation… a-la Sweden and New Zealand. However, to make it work patients would have to be barred from seeking recourse through the courts and that infringes the EU Convention of Human Rights… Brexit having locked us into compliance.

6 Establish a national care system… it’ll take ten years and is impossible without a consolidation of the care supply-side.

7 Four week guarantee for children and young people requiring mental health support. MH is in such a mess. This is well beyond the NHS to deliver.

8 Tackle obesity with what the The Nobby-Nineteen call a ‘sugar-tax’ approach. It’s not tax-based, it’s a levy and works entirely differently to taxation. Banning advertising for fatty foods and what-not… blah… it doesn’t work.

9 Incentivise NHS consultants and seniors, with 20% protected time, to take part in research… one fifth of their working week… really? The Times Commissioners must be living on Planet Nobby.

10 A ‘healthy lives committee’, cross party working and catching flying-pigs. More jobs for the Nobbies. Gimme-strength.

The Nobby Nineteen might just as well have spent a year grinding water for all the good any of this will achieve…

… we all know this stuff, like we know night staff can’t get a decent meal or make a cuppa… apparently a Damascus Road moment for the Nobbies.

If asked, you’d have done this job in half an hour, with half a dozen recommendations on the back of half an envelope;

  1. A carefully trained, curated and cared-for workforce
  2. A serious attempt at sorting social care, right now
  3. Vertically integrated primary-care
  4. Ring-fenced funding for a digital first NHS; IT interoperability, face recognition log-in, and investment in data analysis
  5. A clear revenue and capital, 10 year funding programme
  6. A cradle to grave focus not on health but on wellness

It seems to me, the further up the tree you get, the further you are from reality and yer feet on the ground.

The NHS isn’t short of people with ideas, examples and answers to the daily puzzles and problems. The question is; what stops them, slows them up and why do they give up.

The Nobbies might have usefully concentrated on that. Instead, what have they spent a year doing?

I’ve given you the word for it… I told you it would come in useful.

News and Comment from Roy Lilley
Contact Roy – please use this e-address
Reproduced at by kind permission of Roy Lilley.