Blair Mcpherson's Comments
I had to double check the date on this article to make sure it was 2014 and not from the archives!
One definitation of a fanatic is someone who redoubles their effort when the cause is lost. When will policy makes recognise inter gratin of health and social care is a lost cause? We have had a requirement for joint strategies and we have tried pooled budgets before always with the same disappointing results. Is it really worth all this time and effort which only serves to distract and frustrating senior managers? Originall it was that better co ordinatination and less duplication of health and care services would benefit service users/patients. Perhaps you remember being urged to share records and computer systems so people only told their story once. We had jointly located community teams but the acute Hospital trusts weren't interested. Now we have the push for joint commissioning because it will be more efficient but any gain is likely to be in the long term and has been overly optimistic. So rather than big national policy changes why not just focus locally on making hospitals take more financial responsibility for services that get people out of hospital with minimum delay and prevent unneccary admissions.
Comment on: Talking dirty to the public
Why " Talking dirty"?
The phrase "longstanding " is a classic piece of understatement. In far too many parts of the NHS a colour blind approach is still the norm. There are still senior managers who say ," we treat every one the same".and they do. And they see nothing wrong in this approach.
In a recent article in the HSJ a chief executive refered to leadership as a contact sport! Whilst senior managers think the syle of management should be more like boxing than basketball not much good will happen.
It's a hard lesson for chief executives to learn but the reality is they don't make a lot of difference to how services operate day to day. Which means they can't have much impact on quality in the short term. They can of course make things much worse by imposing reorganisations which disrupt services, demoralise staff and distract managers. They can reduce staffing levels, change the skill mix to have more unqualified staff and cut back on training in an effort to be more "efficient". So I am heartend to read that this group recognises that they should not believe their own propaganda and that the emphasis is shifting from the previous focus on the money.
There is nothing wrong with recycling ideas and "empowering staff" is certainly not knew but there is a big difference between going under cover to find out what its really like and implying that simply by listening to staff managers will be able to deliver on budgets, performance and care. Empowering is more than listening it is giving power, sharing decision making. "Empowerment" is overused, discredited and a bit of a con. It usually means we will inform and we will listen but we will still decide. I am all for informing and listening but I thing to talk of empowering is to imply a shift of real power which on past experience is if not dishonest then misleading.
Commissioning is part of a tighter budget control process with in the NHS, a process that is not driven by an assessment of need but is finance led, it's about what we can afford, economies of scale and encouraging the private sector where they say they can do it cheaper.
Comment on: Happy staff mean a healthy business
In the long term particularly in the carding business then happy staff may well lead to a healthier business but in the short term in a climate of budget cuts, redundancies and proposed mergers fear seems to be effective. Of course that is assuming you regard health care as a business.
There are a lot of questions the NHS has yet to find answers to. Should Commissioners continue to use a Trust that is in special measures? If they withdraw their support the Trust is no longer financially viable. If they continue to commission services from the Trust despite a damming inspection report then what was the point of introducing a commissioning led NHS? How does a Trust get put of special measures? Is it inevitable that the chief executive, chair and most of the board have to go I order to restore confidence? This looks like another case of balancing the budget and making the efficiency savings at the expense of undermining the confidence of staff that the Trust is genuinely committed to providing even an acceptable level of care. But is this increasingly an impossible ask? What does the government really want the CQC to do , light touch resulted in unacceptable and dangerous care in depth tell it like it is reports seem be equally unwelcome and problematic! Are Trusts to be run as business or should the NHS be practise led rather than finance driven?