Hospitals that are full of people who really shouldn't be there. Staff working at the limits of their capacity. Overburdened bureaucracy and regulation. Political indecision. An ageing population. Management struggling to find the balance between culture and attitude.
The feeling that top-down burdens make change impossible and the working environment is a oneway street to more pressures.
Systems that are saved, by the hour, every day by the people working at the frontline of healthcare.
People whose decisions and outlook and mindset, dig deep into their repertoire of human invention, vocation and training to make the experience of illness, accident and happenstance bearable, successful and memorable.
It's how it is. It's how it's become. It's the work-a-day. It's what happens.
When organisations are under pressure, when what they do is mission critical and when their appetite for money drives policies into safe-places and innovation become a risk too far. An environment were more means nothing, because more is not enough.
A system that tries to push patients to where the treatment is cheaper not really knowing if the true costs-in-flow support the idea that bespoke care close to home really is cheaper than the wholesale care in the production line of a hospital.
Pretty well every observer of the health scene could write about this. A narrative that is so familiar that our eyes gloss over the page. We scarcely read it any more. The territory is so familiar. Like the mark on the wall, in the hall, by the front door, we noticed it once but now we walk by and don't see it. Oblivious.
The difference? I'm not writing about our-NHS.
I am in Australia were, apropos nothing, Sunday was the hottest day of the year so far and the view from the top of Sidney Harbour Bridge was dazzling. Sparkling water; the ferry and the pleasure craft mark the azure water with the white mare's tails of their progress.
I understand it is been snowing on the Albion. Good luck with that!
The climates may be worlds apart. The healthcare systems are struggling with the same problems.
Our healthcare systems are just too good at fixing-up people.
The public's health has changed gear with a better understanding of risk and law and health and safety. We know more, can do more. Our clever people are cleverer. Our talent more talented.
Our sense of mission still as focussed but here are two hospital systems, a hemisphere apart, very different in their funding models and history, that struggle with identical problems; demand and funding.
Whilst Our-NHS was struggling with frail elderly and exacerbations due to the cold and snow, Oz-NHS was struggling with the impact of heat and dehydration.
And yes, it's true, everywhere you go in the hospitals who have been generous enough to open their doors to me, you hear English accents, a Scot, Ireland, Wales... a home from home. But, they don't have enough doctors, UK managers find a welcome and great jobs and yes, they have a shortage of nurses. Without migration their system wouldn't work.
... and no, they don't understand Brexit any more than I do...
This is an eyeopener. The same problems. Solutions... yes. Bright people always find a work-around, a new idea, innovation. They get it; if you show people what good looks like they will get on and do it, better.
There is a lot to learn a lot to share and a lot to understand. We are not unique. We nudged the Australian healthcare system into second place in the Commonwealth Fund analysis... only because of their access to primary care... where geography defeats them.
We don't have a monopoly of excellence. What unites successful systems is an open mind.
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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.