First class…

First class... NHS_Primary_Care_Training_GP Staff

My view of the world, my barometer; the park next door.  Who’s there, how many, what are they doing?

From rainswept days, lone runners and solitary dog-walkers, to the here and now.

My latest report.  The weather is blissful.  Lockdown appears over.

People are in the park, doing their thing, two meters, forget it, life, with all its intimacies is back to normal.

Later today a dishevelled BoJo is expected to announce more messy, policy confusion which, people will ignore.  

Altering posters and stickers from two meters to one, will be a nice earner for the printers… good luck.

He seems not to understand human nature.  The reverse of give an inch and take a yard.  

Say two meters and you’ll get an arm’s length.  Say an arm’s length and you’ll get whatever the hand, on the end, can touch.

The nation is heading for the pawn-brokers.  We have to breathe life into the economy, whatever the risks to life.

All focus on what’s next and how willing leaders are, to stray from their comfort zones and change the shape of things to come.

I recall a similar optimism, following the world banking crisis.  We were promised austerity would be the mother of invention.  An era of ingenuity, efficiencies, innovation and leaner ways of working.

What we got was debt, shrinking public services and insolvencies.

Key, this time; workforce.  As global governments look to rebuild their health systems and create resilience, the scramble for staff more frenetic… and there’s a global shortage.

The way people were attracted to a career in the NHS, trained and motivated wasn’t working before the pandemic.  It’s unlikely to work any better in the aftermath.

Investing in people and recognising that the key change, that got us through Covid, was teamwork not hierarchies.

We’ll need some game-changing strategies. 

A host of innovations have been welcome but there’s something missing and probably, the most important.  One of the gaps created by Lansley and his lunacy, in the 2012 Act.

He axed regions.  Regional health authorities were not universally popular.  They were often run by bullies but as part of a management structure… invaluable.  Big enough to get traction, small enough to be in touching distance.

Without regions;

In the early days, pandemic testing was attempted on a regional basis but with no structures in place, managing it from the centre was impossible and it folded.  

To manage a local shortage of testing-reagents HMG tried to replace ‘local’ with a web-page and a telephone number.  It struggled.

The invitation to make ventilators left hopefuls hanging-on to central phone-lines, specifications were changed and once again, a collapse of ‘central’.

Workforce; a national HEE strategy, has failed.  A people plan based on regions would make a lot more sense.

PPE?  Local, willing and able manufacturers frustrated by the central supply-line, gave up and problems compounded.

A central fiasco over supplies from Turkey.  The gown-and-glove Tsar, sucked the work done locally, into the centre and there are still shortages.

The App?  There’s an out-of-the-box solution that would work regionally. But, the centre wanted national data.  To save lives, all we really need is something to tell us who’s been exposed to whom.  It’s good enough and good enough, is good enough.

The R number.  We’ve learned, national R numbers are useless.  But, the more local it is, the more valuable it is.  A shift to regional R might have got parts of England moving a month ago.

Schools; local people knew which schools could manage social distancing but the centre insisted on knowing they all could.

Track and tracing; after a huge effort to create a national service, we are realising, it is local authorities who have the best chance of making a responsive system.

After Covid there will be changes.  My fear; change invariably means more government, when we need less. More centralisation when, we know, decentralisation works better.  

Despite BoJo’s bravura, nothing that has been created centrally is ‘world-class’ but a lot of what has been achieved locally, is truly first-class.

News and Comment from Roy Lilley
Contact Roy – please use this e-address
Reproduced at by kind permission of Roy Lilley.