It’s been hot where I am.
Dunno what it’s like where you are.
London gets 1410 hours of sunshine a year. Believe it or not Manchester gets six hours more. Paris has 1662 and Malta is off the scale.
Moving swiftly on…
… the NHSE’s plan for recovering urgent and emergency care services.
There’s a bit that caught my eye…
‘… ahead of next winter we will offer more joined-up care for older people…
…including scaling urgent community response, frailty and falls services …
…meaning the right people help you … without needing an admission to hospital…’
By a curious coincidence I’ve been reading John Lister’s excellent article berating Labour for becoming the Tory Party. It’s well worth a cuppa-builder’s.
In making his case John gives us the following facts;
- ‘… we have seen a 42% reduction in District Nurses,
- a 30% reduction in health Visitors,
- a 12% reduction in nursing home beds
- and a 16% reduction in residential home places…’
He hammers the nails right out of sight, with;
- ‘… 3,500 English GPs left primary care in the last 12 months…
- since 2012-13 England has had a 7% increase in population,
- a 20% increase in GP workload
- and a 12% decrease in real terms funding for GP services…’
Put all that together and it seems a fair question to ask; just who is going to deliver the promise in NHSE’s plan;
‘…[better] joined-up care for older people living with frailty, including scaling urgent community response…’
The plan makes the point;
‘… even before the pandemic, pressure on urgent and emergency care had been growing…’
By now, I’m sure it will be occurring to you, squaring all that with Lister’s list, is… well, impossible.
There is nothing really wrong with the plan. It is perfectly respectable plan.
If it were a piece of furniture it would be a nice solid sideboard. The sort of thing yer granny had.
What’s not arranged nicely on the top is in the drawers or neatly on the shelves.
A repository for everything. Old photos, grandad’s medals, a box of party poppers, the crystal salad bowl and the best cutlery.
‘Where is the so-n-so?’
‘I think it’s in the sideboard…’
What do we do about the ‘W’ word… winter? ‘It’s in the plan.’
Planning fails because of;
- Inaccurate information
- Inflexibility
- Overlooking opportunities
- Biased decision making
- Communication issues
- Planners worried about their credibility and bash on, regardless.
You’ll be familiar with all that… and you will know, plans also fail because of… unrealistic expectations.
The trick is to know when expectations are unrealistic.
We can’t plan a winter plan on the basis that there aren’t enough people to do what we’re doing now.
Doing more is a non-starter. So is doing nothing. We’re in the ‘we have to do something’, territory.
It would be tedious to turn this into another tirade about workforce shortages, as tempted as I am.
The plan’s authors do acknowledge ‘growing the workforce’ and ‘supporting staff to work flexibly’… how?
Dunno… but we do know…
… admissions start to ramp up in October, which, give or take, is about 90 days off. What can we do about workforce in about twelve weeks.
The plan seems to pin most hope on deploying staff to virtual wards, to keep yer granny and people with longterm conditions at home.
Good luck with that.
Those with long-term conditions, who have the greatest healthcare needs, account for 50% of all GP appointments and 70% of all bed days.
All we have, to wrap around us this winter would seem to be the threadbare blanket of virtual wards.
Experienced people will tell you, (as they did in this IHSCM roundtable discussion) patients with a clear diagnosis or disease trajectory and a good history, do best, in virtual wards.
Remember, the older you are the more complicated you’re likely to be… go figure.
The uptake of virtual wards seems to be a reflection of the appetite for risk among clinicians.
Outcomes are mixed. In some cases up to a third of virtual patients end up in hospital.
Evaluations are fairly small scale and the one thing that stands out is…
… they must be run by people, good people, experienced people, who know what they are doing… and we all know the problem with that.
Enjoy the summer…
… the warm beer, the elderflower cocktails and the smoky Bar-B-Q’s. Have fun on the beach, sand between your toes. Watch the crimson lozenge, that is the stetting sun, dissolve into the emerald sea…
.. and I’m sorry I mentioned the W word….
… but it’s virtually here.
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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