Yesterday, I wrote about the ‘new norma’l. Blimey… what a response!
Amongst them was this… from the owner of a domiciliary care company. They do excellent work. If I needed help and I lived in their catchment, I’d look no further.
Here’s what the owner told me;
‘My 95 year old client fell on Saturday at 7 pm. Ambulance called at 8pm, she was in screaming-pain.
It took 12 hours for help to arrive.
She has a fractured right hip so the family couldn’t even get her into a car to take her themselves.
That’s the second time in a month.
My last lady died 2 days later, after being on the floor for 8 hours….
This family have been advised their mum almost certainly won’t survive surgery today.
As well as the patient, the experience is awful for all involved.’
The new normal.
A ‘normal’ that NHSE/I Board seem not to have the courage to address. There is no permanent ambulance representative on their Board.
I am not surprised that Ara Darzi, a clinician, has decided to step down from the new slimmed-down-shaken-up Board. Thank goodness, Andrew Morris, the former chief executive of an excellent Trust, remains as vice-chair. He has a big job ahead of him.
He’ll be the defacto leader.
Patrick Carter, he of the Carter Review, is leaving. If I was Richard Meddings, the incoming chair, I would have begged, crawled on bended knee, for him to stay. He’s the perfect blend of practice, knowledge and drive.
The rest are the same people who got us into this mess. One of them is a donor to the BoJo Boy’s Club… it looks like frail vulnerable ladies will have to get used to lying on the floor for hours.
OK, yes…I admit; this is a difficult problem but that’s what a Board is for. They either roll up their sleeves and find solutions or run up the white flag and look for excuses.
If it were my mum I think I’d have found a way to head for the High Court. If I couldn’t win, I’d at least have a go at showing them to be the home-for-the-bewildered that they are.
To function properly, organisations need three things; people, resources and time. If any one of them is missing you have a problem, but time is often the key.
If you don’t have enough people, you can fix that in time. That’s the issue with the NHS workforce crisis… it’ll take too much time to fix because it takes too long to train people.
The solution is to change who we train and how we train. That’ll take system challenge and courage. The Board doesn’t have that.
Not enough resources? That is fixed by spending less. In the NHS that’s; the time you keep people waiting or changing the levers. Reprioritising what you spend… how you spend it. Shifting money around the system using targets, incentives and tariff. That’s quick.
Ambulances… problems aren’t weapons to blame the past or predecessors. They are fulcrum points to lever change. So…
- Start by admitting there is a problem and it is urgent.
- What is the problem? Avoiding danger or alleviating distress? Or both. Is the solution, the solution to both, or are there two solutions?
- Look outside the NHS… any other system, anywhere in the world, facing the same problem? How are they fixing it?
- Is it an ambulance problem or a whole system problem? Solve that like you eat an elephant… a mouthful at a time.
- Whilst we are talking elephants, what about the one in the room? Covid… if HMG’s broader C-19 policy is causing operational problems, it’s the Chairman’s job to say so, publicly. NHSE is an arm’s-length organisation. Not a subsidiary of BoJo’s Boy’s Club.
- What problem solving techniques can be borrowed from other disciplines – try Takeuchi & Nonaka’s SCRUM.
Get the people with the skills and who can make decisions, with deep knowledge of the issue, around the table.
Include the army, voluntary sector, police and fire… they might be part of the solution.
Lock the door (but leave it open to good ideas), work the whiteboard. No suggestion too stupid, no idea too innovative, no one criticises an idea, no one goes home until there’s a plan. Perseverance.
If the solution looks like it will break rules, targets, system, classifications and ‘the norm’… it’s probably on the right track.
There is a solution to this problem.
I don’t know what it is… but there will be one. We have to find it.
All I do know is… it’s better to leave failed thoughts, half-good ideas and bits of innovation, lying on the boardroom floor, with a few bruised egos, on the way to finding an answer…
… than it is to leave yer granny lying on the kitchen floor with a broken hip, on the way to nowhere.
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.
