The trees are somehow managing to hang on to the last of their russet and gold…
…the squirrels in the park are on their frantic mission to gather acorns… never to remember where they’ve dug their larder.
The memories of golden sand, soft wine and warm summer terraces are fading. Winter’s almost here.
The NHS began its winter planning in June;
‘… focusing on urgent and emergency care, aiming for faster ambulance response times, reduced waiting times in A&E and quicker hospital discharges.’
In other words; do what we’ve always done but more, and quicker… good luck with that.
The only eye-catching new thing;
‘… pensions regulations have been changed to automatically make additional hours worked by part-time staff pensionable up to their full-time equivalent…’
Graft now, gain later… maybe.
In September plans were ‘stress tested’, because…
‘… [the] health service is predicting … 2025 [is] on track to be the busiest on record for A&Es and ambulance services.’
Like we wouldn’t have guessed.
The fact winter is ‘planned for’ is both good and bad. Good, for all the obvious reasons but bad in the sense it has to be planned for… because there’s very little headroom… meaning…
… every year emergency measures have to be taken… like giving your granny an iPad and crossing your fingers the community people can take care of her.
I get the sense that winter planning comes with the hint of the system expecting to fail… ‘but it’s OK because we had a plan’.
When the people at the sharp end of care internalise the idea that ‘winter is always a crisis,’ the NHS goes into the season pre-defeated.
You hear phrases like:
We just get through it.
This happens every year.
They’ll open the corridors and this year they have screens… like it makes a difference.
People, being resigned to their fate. The collective memory of promises unfulfilled, undelivered or unworkable… more beds, better flow, extra staff …
… everyone knowing; none of it ever quite works.
Winter plans are written as coping plans, not improvement plans.
There’s a pervasive sense of helplessness.
Teams:
Protect their own patch.
Avoid taking risks.
Prioritise compliance over curiosity…
… which stifles innovation at exactly the moment when flexibility and local problem-solving are most needed.
In pressured environments, resignation and despair breeds blame. Managers blame system flow; clinicians blame discharge; Boards blame ‘the system’ and everyone blames social care.
In fact;
Depending on whether the delay is short or long, (and there is a big difference) the social care component is ~30-40%; NHS ~20-30%; with the rest being interface and joint delays…
… all mostly fixable.
Amidst all this, burnout is disguised as stoicism.
Front-line folk keep showing up, long hours, skipping breaks… it looks like resilience but it’s often the last stage of burnout.
People carrying on mechanically, no longer believing things can improve. That’s when it gets dangerous… errors, detachment and attrition.
To prevent winter pressure becoming another season of resignation, leadership has to act before the first ambulance queue forms.
That means reframing winter.
It is a test of leadership, not endurance. The goal; to emerge stronger, not merely survive. That means giving people visible agency…
… empower wards to make small, fast decisions. Local discharge hubs, direct links with community teams and make those successes visible.
Celebrate discharge and cheer the small micro-wins. The Trust WhatsApp group or intranet is the place for that. A daily message from the chief executive.
When a team cuts waits or reduces corridor-care, shout about it. It’s proof that effort matters.
Winter is not the time for remote management. Recently Jim Mackey wrote to NHS leaders to remind them to ‘walk the floor this winter’.
If that has to be said, heaven help the NHS.
For me it is inconceivable that Trust leaders — CEO, nurse and medical directors — should be anywhere else but on the floor.
Personally, I’d lock them out of their offices and throw the key away.
A leader’s job is to replace helplessness with belief. They have to ‘be there’ and listen when people say; ‘… this isn’t working’.
Only if failure is met with openness, does improvement become possible.
Culture doesn’t collapse suddenly. It erodes, winter by winter, under the weight of repeated crisis and absent leadership.
This winter will be for the leaders who can turn limitations into possibilities.
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.
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