Overnight…

primary_care_training_racing_horse

There are some things in life you just can’t change.

You’re not going to live for ever. You’ll never please everyone. You can’t get yesterday, back. Give up!

‘Give up’… two words I don’t use lightly. We all write our own life stories and ‘I gave up’ is not something you’d want to write for yourself.

… but there comes a point.

At what point do you say; We can’t do this and all the effort and energy we are putting in, to making the unworkable work, is wasted.

Far better we put our energies into changing, reshaping, rebuilding, reimagining and reframing what we are doing.

When to give up?

• When the data tells you. Yup, that’s a good start.

• When the people around you tell you. Maybe.

• When your guts and your instinct tell you…

…two powerful voices you should listen to.

Flogging a dead horse is something the NHS can never get its head around. Indeed, in the DH+ there is probably a department of dead horses, with instructions to buy a bigger whip or change the rider.

I think the time has come for us to accept, the signs are there, the data tells us and our guts and instincts are screaming; what we are trying to do to improve A&E performance is just flogging a dead horse.

The four-hour A&E target was, once again, busted wide open; 84.4%, with Type 1 data dropping about three percentage points from 79.3% in December, to 76.1%.

There were 564,000 emergency admissions in the month – up 7.2% the highest number on record.

So far, it’s not been a ‘bad-winter’. Flu and Novovirus rates down but bed occupancy three points above NHSE’s target of 92%. The Royal Colleges say 85% is safe but no one is listening.

Three percent short of a target is bad if you are in the 3% but the vast majority get seen on time… attendances have risen by 85,000 compared with January last year. That means more people are getting through the system on time.

Targets provided a political solution to a management problem. Not any more.

The targets, at first, were part of a supported, collective effort, with resources and a determined effort to share best practice. They’ve since fallen into disrepute. Managers sacked, naming and shaming and the source of bullying and oppressive regulation.

There are three rules about targets. They have to be Specific, Realistic and Achievable.

A&E targets fail on all three counts.

Bundling everyone though A&E, broken finger or heart attack, is insufficiently specific as to the clinical reality.

The volumes of people, set against the resources available makes them no longer realistic.

Because they are unrealistic, they are unachievable.

Looking to increase through-put when our principle partner in care, Social Services, is skint, is not realistic.

There are 900,000 elderly people who once got help from them but no longer do, since the bar for eligibility has been raised.

Is it any wonder they go to A&E?

Throwing more money at primary care, to buy more of, more-or-less the same, isn’t going to work. We once had 8,400 practices, now we have under 7,000.

There are 1194 fewer GPs than in 2015. Based on a rough average of 2k patients per GP, that’s 2,388,000 patients under doctored.

Is it any wonder they go to A&E.

Care homes are now nursing homes and the number of emergency admissions from care homes has increased much more quickly than the number of emergency admissions overall.

There are around 416,000 people living in care homes mostly without permanent, 24hr nursing supervision.

Is it any wonder they end up in A&E.

The Long Term Plan [1.4] sets out 5 major practical changes to sort this out. It’ll take five years.

In the meantime. Forget the targets. Let’s make some promises we can keep;

• We promise; if you’re an emergency you’ll come to the front.

• We promise if you have to wait, you’ll be comfortable and safe.

• We promise we’ll tell you why you are waiting and how much longer.

• We promise you’ll be cared for by people who are important to us, trained, secure and happy to come to work.

… this mess comes from ten years of austerity funding, a ludicrous reorganisation and the dark shadow of Brexit…

…we promise to roll up our selves to sort it out but we can’t do it overnight.

Have a good weekend.

Contact Roy – please use this e-address – roy.lilley@nhsmanagers.net
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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.