Whatever that is…

Whatever that is... NHS_Training_in_Primary_Care_General_Practice-01

This is where it gets risky.  Hazardous, fraught with danger.

No matter how much BoJo presents it otherwise, lockdown is over.

Open the pubs?  Forty pages of complicated guidance on how to run a bar with boozy punters, is a toxic cocktail.  Public behaviour, unreliable, fuelled on pints, vulnerable to gossip and shaped by social media, may well take us back to December.

Watching the Valance & Whitty double act, on the BoJo show, on Tuesday, told you all you need to know.  

Their body language tried to put a distance between them and the Prime Minister.  Two meters wasn’t enough.  Two miles wouldn’t have done it.  They are careers apart.  

They want to keep the public safe and BoJo wants to keep the public solvent.  The three men bound by a slender thread of pragmatism.

The only safe way to deal with CV-19, is to stay at home.  Everything else is a compromise, a gamble, a throw of the dice.

Yet, we all know; unless we can reboot the economy, we’ll go broke, take with us jobs and livelihoods.

Re-opening may well be Coronacide but there’s no option.

A manager’s worst nightmare.  What they are paid for.  Managing huge risk.

There are five standard ways;

Avoid it.  Once you’ve figured out what the risk is, can you duck it?  Can you swerve it?  Breathe-in and let it slide by?  Not this risk.

Reduce it.  Easily… stay home.  Don’t meet people and you’ll be safe… and watch the economy crumble.  No good for this risk. 

Share it.  There’s nothing to lay-off, here.  Not for this risk.

Hold on to it.  Accept it, deal with it and budget for it.  For this risk, that’s about all we can do. 

Watch it, review, learn and change tac if you have to… hence the BoJo show and his reluctant double-bill-stars. 

Generally, risk planning is stratified.  

Internal-risks; in the NHS that might be a catastrophe in the operating theatre, bullying behaviour from management, or the like.  These are preventable risks.  The stuff we must learn from.  

Strategic risks; conscious decisions like dealing with overcrowding in A&E, keep the service open, or move to OPEL Four and closure.

External risks; in NHS terms, compliance.  Knowing the national shortage of staff makes a 1:8 ratio impossible and risks criticism from regulators but what’s the option?  Closure of the wards, bigger risk. 

When we manage risks, all the evidence is, we overestimate our ability to manage it.  Overconfidence comes, not from our ability, but generally the capacity of the system to cope.

This is why Nightingale hosptials and their messaging was smart; ‘to stop the NHS from being overwhelmed’.  An example of good risk management.

Shipping frail elderly out of hospital to care homes, overestimated the ‘care’, care homes were capable of.  They could only provide limited care, had poor infection control techniques and skills overestimated.  An example of poor risk management.

An alternative approach is to acknowledge the risks and rely on the opinion of experts to cope with it.  Companies have review boards.  A place for intellectual punch-ups, to push opinions to breaking point.

We’ve had that; ‘making decisions based on SAGE’.  It’s not worked.  It’s clear there’s a rift between what the science is telling, what the scientists are saying and what BoJo is doing.

Governments and public services go to great lengths to create stability.  To avoid shocks to the system and work in functional silos, they are not good at confronting surprise risks.  

The COBRA committee is designed to cope with cross-Whitehall risks but because political implications now take precedence, the Cabinet has taken on the role of COBRA.

Critical to dealing with a crisis… leadership and trust.

We have a showman for a leader who speaks, braggadocio, of ‘world-class’, ‘sent it packing’, ‘whack-a-mole’, ‘get it done’ and put his friendship with Cummings over compliance for the rest of us.

Standard risk management is a poor fit, leadership reduced to soundbites.  

Frankly, we are on our own.  The risk belongs to each of us and shared with all of us.  We are interdependent like never before.  

It’s up to us all to do the right thing… whatever that is…

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