The next big challenge…

Training Primary Care - NHS - GPs - The next big challenge...

News and Comment from Roy Lilley

We are heading for a Pedigree Chum… a dog’s dinner.

The question is; how much of a national health service do we have and how much do we want?

Is it a patchwork NHS? A laissez faire NHS? How much ‘national’ is desirable? How much centralism, undesirable?

To call it a ‘San Andreas fault’ is to dignify the emerging problem. It is more a ditch of indecision. No better exemplified than by the two big policy issues on the front burner.

  • First, the future of NHS staffing.
  • Second, NHS’s digital future.

Both of these two, vital think-pieces, are strategic with a capital S…. or are they?

Trusts are desperately short of nurses. This predicament has emerged because of a failure of ‘national’ planning and the performance of the ‘national’, HEE.

Hence, some Trusts have opened their own schools of nursing and one, a medical school.

Is that the direction. Local solutions?

We have to ask; what is it that can be done from the centre that improves on local solutions? Central solutions that need authority, guidance, in some cases regulation and who struggle with diffusion and influence and suffocate innovation.

NHSI has been quick to stop Trusts spending capital. The cDel is a national imperative that trumps new facilities for patents and staff… Trusts freedoms going down the plug-hole.

Can we tell what is too big to be local or too local to be big?

Maybe the regional training arrangements and the predecessors to HEE, destroyed by Andrew Lansley, weren’t such a bad idea? Are we too timid to go back to what worked?

The woeful state of NHS IT is another failure of central planning.

NHSDigital… another Lansley bright idea, made worse by exasperated Trusts doing their own thing. Timid management at the centre, let them get on with it. As a result; interoperability is years away.

When I interviewed him, head-IT-honcho, NHSX’s Matthew Gould was resiling from centralism. I asked the audience if the centre should be more directive and there was a near unanimous, yes… so what does he do?

Be bold, is probably the answer… and be quick.

Of course, the NHS should act as one to train its staff but, there are 70 places to train as a nurse in the UK and 70 curricula.

Act as one, to recruit from overseas? Of course and it should use the leverage of its buying power to organise our future dependence on technology to manage the use of data and care.

Localism hasn’t worked?

The NHS is an interconnected grouping and that doesn’t help with this tangle because interconnections create interfaces and interfaces are the joins that trip us up.

As NHSI+E prepare to legislate for their future and services are, again, reshaped, it is important the NHS is clear; national, regional, local?

Trusts must be left alone to master their affairs but their affairs often transcend the-local and escalate to the-national.

Trusts cannot solve their recruitment problems alone, neither can they procure complex IT systems. At the same time, they can spend their own capital, to improve services and conditions for staff.

The ‘national’ in the health service is under pressure.

The answer might be to redefine ‘national’ in terms of subsidiarity;

The principle…

‘… that a larger body should not exercise functions which can be carried out efficiently by one smaller and lesser. The former should support the latter …’

The systems we have gives us; lack of sustained management support and commitment, interference, manipulation and buck-passing.

We have regulation, instead of constructive suggestions where they are needed and over-sight where it is not.

It is our taxes and our expectations that puts the ‘national’ into the NHS.

How much ‘national’ we leave or take out, is the next big challenge.

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Reproduced at by kind permission of Roy Lilley.