Creeping Policies

Rarely does a week pass without me being required to absorb and react to some new policy or other. The variety is bemusing and the volume is breathtaking. Being an awkward sort of sod, every now and again I ask:

"Why?".

If an answer appears (sometimes), and if it makes sense (rarely), the usual justification is "Standards for Better Health" which is a government White Paper. This justification is almost inevitably unfounded. Here's a typical example: Last year we were instructed by our PCT to obtain Criminal Records Bureau (CRB) checks on all our employees. "Its a new policy".

"Why?"
"To protect children and vulnerable adults and anyway, it's part of Standards for Better Health. We're checking all our staff; it's best practice."

"Please show me where it says that."
(Six months later) "Um, er, it doesn't but it's good practice and that's why we're doing all our staff."

"These checks cost £36 a pop. Why should I do this for my caretaker and the lady that hoovers reception?"

(Three months later)"Please answer the last question"
"Um, actually we've stopped checking everyone because we're short of money and it doesn't make sense to do everyone."

"Now please tell me what I do if someone has a criminal record. Your policy doesn't mention that!"
"Well, it all depends"

I won't go on. It's too painful but it is the typical approach of our so-called managers. They are quite happy to spend the best part of £20,000 of someone else's money rather than think something through. When challenged, they waffle on about putting patients first when what they mean is avoiding acting like a competent manager and making sensible decisions. If there is a micrometre of doubt, they'll spend the money. After all, it's not real money, is it? It's certainly not theirs.

Good for You Patricia

The dust has settled and they've swept away the debris from the annual conferences of Nurses and Unison (the health workers' union). The Secretary of State survived her "ordeal" of heckling, jeering and slow handclaps. Everyone can be pleased and none more so than Her Secretaryship. Frankly, anyone who has shimmered her way so far up the greasy pole would find being politely heckled by nurses about as awful as not having the correct change for a newspaper. In the meantime, her Macmillan-like "best year ever" attack served its purpose.

Imagine that it's you sitting in Health HQ, knowing that the nurses and the unions are going to make, and the press will be delighed to print the headlines about how bad it all is. Attack is still often the best means of defence and that's exactly what the Mem Sahib did. She set the agenda and no matter how much ridicule her attack generated, it still took the wind out of the sails of her opponents. Now that's what I call effective senior management!

The Deputy Prime Minister's troubles also wiped the debate completely from the public's low-capacity consciousness too. Who say's "It's an ill wind ..."?

How Many - Deja Vu?

I thought I would get ahead of the game. Everybody tells me that the Avian Flu pandemic is a matter of when and not if. Some time ago those that carve the stone tablets sent me a sample "Flu Pandemic Information Pack" containing a range of publications. Some were aimed at clinicians, some for patients, and there were nice big posters inviting patients to "ask for further information". Well, thinks I, since I have 14,000 patients and a "churn" of 20% in our transient community, I'd better ask for 5,000 of the patient stuff and enough of the clinical stuff for our fifteen health care professionals (a new Labour phrase that always leaves me wondering who are the health care amateurs?).

On to the NHS order line.

I want 5,000 of these please.
maximum order is 1,000.

I want 15 of these please.
maximum order is 2.

I want some of these and some of these
both out of stock. contact us at a later date.

The "how to communicate effectively about the pandemic " recommendation is to "let the patients know early". Someone, somewhere is Healthquarters is sitting back thinking that they have got the information flowing. I think the word trickle might suit?

I'd swap a tonne of management

It is fashionable to complain that the NHS has spent much of the extra funding provided over the past few years on recruiting loads of managers. Like most "well know facts" there is some truth in it. I should know since I am one of 'em. Irrespective of the 'new vs old' chestnut, one feature of most NHS management that does get me down is how little leadership they provide. It is a difficult time in the NHS. This government says it is transforming the way everything works through its major Payment by Results and Practice-based Commissioning programmes. There is a veritable avalanche of new stone tablets coming down from the Department of Health mountain. Changes and budget restrictions, new ways of working, breaking down established pathways from primary to secondary care; all these challenge staff at every level. It all cries out for positive leadership; someone who can inspire the team to rise to these challenges and achieve these ambitious goals.

From my lowly position, I can see none. I don't mean "not much" or "not enough". I mean NONE.

I'd settle for a few kilos of real leadership. Oh, I get lots of memos. I get loads of papers (usually cut and paste jobs from a DoH circular). I get deadlines and funding floors. I suppose I ought to feel pleased to be consulted (usually about how I feel about a decision that has already been made) and yet I'm not. Instead I feel that those that should be inspiring, motivating and making it happen, are behaving like any dictator worth his salt. They're hidden away down in the bunker sending out orders with no real idea what their troops are doing or if they're succeeding or not.

One thing's for sure; if we get it wrong, it won't be their fault. After all - they didn't get involved.

No it isn't difficult. It's simple.

Gaby Hinsliff is a journalist on The Observer (a UK Sunday newspaper). She was told to ring her hospital to arrange an appointment to see a consultant. Read how she got on here.

Don't think that this is unusual because it isn't. Whenever I challenge our local hospitals over their appointment booking telephone facilities (from the latin facile which means "easily, without difficulty") they patiently explain that it is very complicated and they receive lots of calls and they're awfully busy. It is delivered as though it explains why the service is so awful. Well actually Mr ever -so-patronising hospital grandee, it isn't difficult at all.

Lots of calls is lots of demand.
Lots of waiting equals no supply.
You're in charge of supply so do some.

If you don't know how, then get yourself a clipboard and (a) count the calls; (b) measure the average call duration and divide (a) by (b). Tweak the number for holidays and assumed sick leave and abracadabra. This is how many people you need answering the phones at any one time.

Drip by drip

In my current role, I am for the first time responsible for maintaining a fairly sizeable building and surrounding land that isn't my home. Looking after 'bogs and drains', fixing dripping taps and redecorating is time-consuming, fiddly and, not to put too fine a point on it, dull. Even worse, occasionally I have to deal with the Scarlet Pimpernel of English tradesmen - builders ("They seek him here ... "). It is ever so easy to do something more interesting, more intellectually challenging and involves finding or making money rather than spending it. Maintenance can so easily be deferred, ("if it ain't broke. don't fix it") especially when the same work will cost double the price that would be charged for"domestic" customers. But I buckle down and do it, reminding myself that the building is a huge financial asset and the cost of repairs will eventually come to those who wait.

Then there is the question of the appearance of the place. It may not need painting to maintain structural integrity, but high-use buildings soon start to look shoddy and tired. Aesthetic priorities are almost certain to be ignored when the finance director comes a'prowling to balance his books. These matters always come down to "balance".

What does frustate me greatly though, is the lavish expenditure on capital projects. When a new building is constructed, there is plenty of money for landscaping and stocking the gardens. There is no minimalist cost approach to fixtures and fittings so it seems fair to assume that these things are of merit. After all, there is plenty of second-hand furniture and office equipment around from whatever was closed to make way for the new build. Yet it seems that only new stuff will do. Clearly, "balance" doesn't quite extend this far. There is no money for flat screen displays for the waiting rooms in most of the estate; yet all the new build gets them.

"Ah, but that's Capital" say the wise people. "Ah" say I. In a commercial world, a company's freehold is a significant part of its capital and an important one to keep in good nick.

Look around next time you're visiting your local health facility. The state of deterioration is a straight-line function of the years that have passed since it was built. It needn't be so but bogs and drains just aren't the sort of thing that gets the local MP to cut ribbons or Chief Executive's their OBEs.

How Many?

For a year or more, the Department of Health has been touting Choose and Book as a good thing. In many ways they are correct. As a patient, I too would be impressed that, on being told that I am being referred to a consultant for a specialist opinion or for specialist treatment, I could "leave the surgery with an out-patient hospital appointment convenient to me". This post isn't about the merits or otherwise of "Choose and Book". It will happen and it's all our responsibility to make it work. To help us to do this, our local "lords and masters" have published a handy booklet for us to give to those whom we refer using the new system. It's jolly nice, informative and comprehensive. It will be a great help to patients. We are supposed to give one to each person whom we refer. For us, that's over 4,000 booklets each year. How many did they send us?

Ten.

Can't get any more: out of stock... No idea when there'll be any more... Not sure who ordered them... Try again in a month or so.

Can You See Me?

General practitioners (or GPs as we say in England) are some of the most advanced users of software to support them in their day-to-day clinics. Many practices use their computer-based medical record as the primary source of information about the patient sitting in front of them. An ingenious system of coding every sort of ailment, disease and unfortunate event that can befall man means that all sorts of useful data can be extracted and used to help better manage each patient's health. In fact they're so good, that our lords and masters want us to do more and more with them, mostly more good stuff. As with so many good things, there is a trade-off. Your doctor can't be looking at you if he is busy typing in his consultation notes and looking at patients is still an important part of any consultation.

My son had to visit his new GP for the first time recently. On being summoned, he entered the consulting room and held out his hand to shake that of the doctor. The doctor never looked up from the screen on which he was reading my son's summary. Instead he asked: "how are you?". Luckily my son was in one piece. Nothing was hanging off, exuding pus or bleeding over the floor so he didn't look as foolish as my son felt.

We should all remember that it is as important to look as to listen. Body language can tell much about the person that the words won't reveal on their own. If a patient limps in and sits down with a grimace, it wouldn't take much medical skill to see that there is something amiss, even if it isn't what the patient has come to talk about.

Then there is the question of plain good manners.

More of the Similar

Yesterday we reviewed with a number of your performance directors and choice leads, the best means of assuring readiness is genuine and reaffirmed the expectation that this is captured in a written form, practice by practice.

or ...

We met yesterday to decide how to make sure that you were all ready, and to agree what written evidence we will ask you to submit to prove it.

You couldn't make this up

Extract from a report by a Strategic Health Authority into progress made in implementing "Choose and Book". Ready?

"The key concern is that the added resources funding implementation teams expire this March, while local communities need to move from 2% electronic booking to the December target of 90%. Communities are at various stages of identifying funds to continue implementation, but credible plans for managing the trajectory have not yet been submitted."

For those of you who aren't quite into "healthspeak" I add this translation:

"We've almost run out of the extra money we were given to do the work although we still have a great deal of the project to do. We're looking for more funding to enable us to plan and complete the project but haven't found any as yet."

I think I will go and sit in the corner for a while ...