Second best…


News and Comment from Roy Lilley

The art of the possible is, strictly speaking, the art of the second best.

There are things we’d like to do but can’t, because they are not possible, so we have to do what ever is second-best.

We are seeing that played out in Westminister right now. The art of the possible becomes the art of compromise and trade off.

In a more positive context, much of the Long-Term-Plan is the art of the possible because it is full of examples of good people already doing great things… if only we’d known they were possible!

As important… we can do things now, that perhaps as recent as five years ago, were not possible. Now, the art of the possible becomes the art of the ‘can-do’.

Chapter 1 of the LTP sets out five ambitions of which, I think, the fourth might turn out to be the most important;

4. Digitally-enabled primary and outpatient care will go mainstream across the NHS.

A digital-first NHS is now not just the art of the possible but is a can-do and probably, must-do. Must do, with care.

Three things;

• Going ‘digital’; without a clear strategy is a road to nowhere.

• Planning ‘digital’; if you don’t start with the patient and work backwards, you’ll walk into a disaster.

• Doing ‘digital’; move too slowly and the benefits of change will be overtaken by the speed of events.

Thinking that solutions are as simple as doing a percentage of outpatient or GP appointments on the phone might be seen as reengineering a service but it is not reimagining it.

It overlooks questions like; where will the clinicians be?

• Do they have to be in a hospital or a surgery? In which case how does the health landscape change?

• Who employs the clinicians? It may not be the hospital or the practice.

• Hence, the workforce changes, and if the workforce changes, training changes, reimbursement and skills change.

Starting with the patient and working backwards, challenges the assumption that, going forward, a digital service will work for everyone. We will all be comfortable and capable with technologies. Patently wrong.

However, to deny progress on the grounds that some may not cope and the fear we’ll create inequality, ignores the fact that using technologies to care for those who can, creates the headroom to care better for those who cannot and of itself, defines a new equality.

The NHS has a problem with moving quickly and diffusing ideas. Hence, without the rigour of central direction, creating a procurement strategy, finds itself in a no-man’s land of indecision. Trapped in a world of pilots, trials, duplication and dither.

We have 100,000 gaps in our workforce.

The art of the possible defeats recruitment strategies making up this ground.

Work-redesign, sorter training, reengineering conditions of employment and recruitment, reimagining work. Possible but not inside the time-scales we need.

That is why the management of patients by the use of technology is no longer an option. It is all that is left. It is all that is possible.

The art of the possible creates a new horizon of care. There are sufficient reliable technologies available, now, to speed access, reduce travel, costs and carbon footprint.

There are technologies, now, that can undertake routine tasks and decisions, forecast demand and highlight pressure points… creating a new ability to plan and precious time to care.

The art of the possible does not need us to look around the corner and see what technology is coming. We just have to look around us to see what’s here, now.

Digital-first commands we audit everything we do and ask what can be safely done without a human intervention.

A deliberate policy, with the intention of creating the time and space for the human interactions that are the precious moments of care and compassion that are so often crowded out by shortages of people, often distracted by repetitive, manual tasks.

We talk, casually, of staff as a ‘human resource’. Better; an asset and an expensive and increasingly hard to find asset.

Getting a return on ‘the asset’ is to make it possible for people to do the things that machines and technologies cannot.

The art of the possible is possible. Driving change at scale and quickly… that calls for determined leadership and a clear plan.

Without it, we could well end up with second best.

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Reproduced at by kind permission of Roy Lilley.