What do we really care about in the NHS?

Another day, another procession of meetings and conversations about structures and processes. Since the publication of the white paper, my days have been full of variations on this same conversation.

There is an increasingly large part of me that wishes that I could find a convenient wormhole so that I could transport myself to the other side of this tiresome galliarde, to find out just whether the people with whom I work all found somewhere in the brave new world. Or, better still, to see whether these changes actually do result in better services for people who need NHS care. To know that it did might make it all worthwhile.

I look back on the past 10 years with a certain sense of pride in the service. The work we have done to improve access to NHS services has been immense. There is still so much to do, but remember when we started to talk about delivering elective care in a timescale of 18 weeks from GP referral to definitive treatment? It was regarded as an impossible dream.

My first referral as a new GP registrar in 1989 was for a patient disabled by hip pain who required a hip replacement. Many will remember that in those dark days it routinely took two years to get surgical treatment - and that was after the lengthy wait for an outpatient appointment. This did not feel like care to me, a naive and idealistic trainee.

This begins to feel like a thing of the past, though somewhere in the system, some will still be having experiences not too dissimilar to this. With our focus on elective access, there is a question in my mind about how clear our collective focus has been on the follow-up of some long-term conditions.

We should have no problem with the notion of “grip” being exerted, if the purpose of that grip is to protect the gains that we have made collectively in delivering access and quality. It is in the interests of our patients, and in the interests of all of us who have worked so hard to achieve these improvements, that those benefits are not lost.

The trouble is that while my world is full of people who care about making the system work, who care about the people who use the service and who are desperate to continue to make a difference, those same people are currently embroiled in profound uncertainties about their personal futures.

No matter how confidently I reassure them about their skills and abilities, their trust in themselves and in the systems around them is weakened.

The challenge of leadership here is to find ways of supporting our people through change, while continuing to support them to deliver. Fundamentally, though, in changing a system which is supposed to be about caring, we seem to be creating, for our staff, a process which feels a long way from care.

Recently I was talking with a friend who no longer works for the NHS, but spends much of her time supporting her friends and family negotiate its complexities. The experience that she and her family have had over the past year tells of a system which may be losing sight of what really matters. Care sacrificed on the altar of delivery.

I begin to worry that in striving for improved access and technical excellence, we have stopped really caring for the whole person.

For that bit - that really important bit which we call “care” but which can’t necessarily be measured - we depend on the skills and motivations of the people who deliver interventions, treatments, therapies, consultations.

In turn, they depend upon the skills and motivations of their teachers and trainers, and upon the skills of the people who make it possible for them to improve, and yet there is little collective focus on how the system recognises, rewards and delivers improvement.

As a system, we are not focusing on all the right things. How we care for people is every bit as important as improving access. How about, next time round the dance, we talk properly about integration, connectedness, relationships, shared values, learning and leading together, and about the real meaning of care. Make it our focus, not just an assumption.