A Web Mishmash
A Web Mishmash
Last night the conference kicked off with a dinner for delegates sandwiched between addresses from two prominent speakers. The Secretary of State John Reid was to have been one but unfortunately was unable to come at the last minute, but the helath minister John Hutton steeped into the breach. His well crafted speech was apparently his own doing, not the civil servant-authored version that John Reid would have given. He was suitably (and I think genuinely) effusive about the key role that medical managers need to (and are) playing in the NHS as it goes through change after change. There was nothing particularly new or controversial; BAMM, the Department of Health and, of course, the government all came out smelling of roses. The NHS did pretty well too, having been pulled from the jaws of disaster by knights in shining armour, and all that stuff. Well done all!
Sadly, the meal itself came a poor third in the evening’s agenda, and we were rescued eventually by our Chief Medical Officer, Sir Liam Donaldson (minus charger). Liam had wisely guessed that powerpoint would not go down well at this juncture and spoke unaided by this—and his reading glasses. He recalled Alan Langlands’ metaphor Can the elephant dance? and gave his own view of the challenges facing our favourite elephant (the NHS) as it is forced to change over and over, much of it being a rant about the dangers of devolution. He stressed 10 points:
The death of deference. The post-Bristol NHS climate together with the rise of consumerism have led to a decline in the deference which the medical profession has traditionally enjoyed from patients and public whilst, conversely, indignation about poor care standards is increasing (for example, failure to respect dignity in the elderly). Liam feels it important that the profession itself buries deference.
Can we get to grips with the safety issue, and can we match other industries in this respect? One in 10 hospital patients suffers some kind of medical error.
Will the NHS, in its re-invention of earlier policies of devolution, become too interested in outcomes of care without being able to measure them? Infrastructure is important: can we afford to do away with [central] planning? (We had similar discussions during the big devolution revolution in our own hospital 10-15 years ago, and concluded that whilst highly desirable for many reasons, devolution without a framework leads to anarchy.)
Devolution of responsibility. The government invented NICE to end ‘postcode’ prescribing. Sereral years down the line the cancer ‘tzar’ Mike Richards can demonstrate an 8-fold difffernce in presription of anti-cancer drugs.
Adaptability and the capacity to adapt. Emergency capacity, Sept 11th, terrorism etc are challanges for an NHS with devolution away from central command and control, which is crucial in emergency situations.
The IT revolution: can the NHS get it right? The stakes are high: we are embarking on the largest and most expensive infrastructure project in the history of the planet against a background of spectacular failures of previous large projects in both public and private sectors. The potential benefits are enormous. Indeed, the NHS reforms depend on it. Richard Granger is the ‘electrician’ of the project; Aidan Halligan the ‘benefits realization’ man.
Public health. The NHS is and historically has always been primarily a sickness service that is not good a prevention and education. Liam’s view (unsurprisngly) is thar public health is not an option; we must do it.
Chronic disease management. Now a buzzword, but how do we do it? This is becoming a new government priority and one which will cut accross traditional service boundaries (which is why its difficult) but has great potential to improve the lives of many, and reduce unnecessary spend.
Younger people want a different work/lofe balance than previous generations of professionals. Currently, 60% of NHS staff are from the post-war ‘baby boom’ generation and will retire in 6-7 years. Those from later generations will probably not be so workaholic. (Or be allowed to be).
How do we define ‘greatness’ in health care. Greatness is an attribute of human endeavour, not of organizations or institutions. (Nevertheless, Liam, humans work for institutions and organizations and are often inspired to greatness by them, and their history.