Ask nicely

There are sounds that only a dog can hear.  There are mathematical theories only a computer the size of Croydon can fathom.  There are things only Einstein could dream of and achievements only Olympians can attempt.

The rest of us, mere mortals, rely on the distant memory of a 2:2, or common sense cultivated on the compost heap of years of mistakes...

... so, I have to confess, when I read it, I thought the mighty HSJ had made a mistake.  How dare I doubt them.  At the very thought I'm banished to the naughty step, typing this in the dark...

I checked the date.  No, not yet April.  Then it must be true and it is beyond me to understand.  Dare I say, beyond the wit of any of us to understand.

The HSJ is carrying a report that NHSE is abandoning its plan to publish a forward view for community services.  The report is here.  It is £walled.

The HSJ wish to protect their market edge, this is a leak of an internal document and I get why they are doing it.  Absolutely I do.  However, the document is a public document, that is to say, funded by the taxpayer and in theory, belongs to us all.  

It is such an important decision from NHSE, that I hope you will all subscribe to the HSJ and read it, or that the HSJ might relent.

Fundamentally, the leaked document says, in terms; there isn't going to be a plan for community services.  Beyond rational thought?

There are an assortment of thoughts...

There's no point planning for a service that is dwindling to nothing.  There is no point planning for staff we have forgotten to recruit.  There is no point planning for a service that has no identifiable national lead.  

There is no point this Cinderella scrubbing-up as no ball is planned.

We can argue from here to kingdom come why the nursing profession has let this workforce get into this state.  

How it has been so neglected:  

At the end of the PCT days, to comply with EU competition palaver, community services were given away to the likes of Virgin or cast-off, under the flags-of-convenience called social enterprises.  Mostly against their will and mainly out of the reach of GPs.

It's all gone wrong from there...

Somebody, somewhere, should have a head, hanging in shame.  In the meantime we have to figure this out.

I'm prepared to accept, there is a strand of thought that runs; configuration is now on a system-wide scale, predicated on population based, capitated budgets.  We are talking whole systems.  Not bits of systems.  Whatever the bigger plan, so will it encompass a plan for the moving parts.

Yeh, well... as the Dutches used to say; if pigs could fly, bacon would be a lot dearer.

Let's be realistic.  Let's tell each other the brutal truth.  

The shift in policy, to look after people in their homes, get them out of hospital quicker, have the GPs doing more stuff and use the patient's bed and not one of ours... is a noble ambition and works on a laptop.  Not many other places.

I know there are examples of gargantuan efforts, shaving bed-stays, holding back admissions.  These are health heroes and we can't all be heroes.

A policy isn't a policy if it's only for heroes.  We all have to be able to do it.  A plan isn't a plan if it is based on exceptional people doing exceptional things because exception is not the rule.

We have to do things, as a rule.  As a rule, if you show people what good looks like, let them copy it, they'll get on and do it better.  As a rule good people can do great things if you let them know what you want them to do.

As a rule, dumping stuff into the community isn't working.  GPs cannot keep the tide of complicated elderly patients out of hospital.  As a rule, social care can't jack-up care packages fast enough.

As a rule we know strong, well staffed, highly trained community services work. 

Buurtzorg works.  If you want a plan for community services, Buurtzorg might give you theirs, if you ask very nicely.

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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.