Inconsistent and Incongruent Messages

The King’s Fund have just released an excellent video to help explain how the NHS works and some of the complex things going on in it at the moment. It doesn’t shy away from making it crystal clear who is in charge of the money, nor the difficulties we’re facing in staffing and resource allocation. Have a watch of it and then keep reading!

 

 

What is particularly important to understand, especially where we are learning to work in new ways together, like here in Morecambe Bay, is just how inconsistent and incongruent the messages are that we receive from the leadership structures of the NHS.

 

So, here in the Bay, we are forming an Accountable Care System, which brings together different health & social care commissioners and providers to work more effectively together. We are forming great relationships, breaking down walls and barriers to work together, whilst tackling significant budget issues as we try and ensure that we deliver care in the most excellent, safe and sustainable way for our population (whom we are trying to include fully in the co-design of the services we provide).

 

One might think, as we are being actively encouraged to reorganise ourselves in this way, that the Department of Health, NHS England, NHS Improvement and the CQC would all be pulling together to support these changes. One might presume that they would ensure the various contracts and ways of paying and assessing us would enable us to do this important work – the opposite is in fact the case!

 

On the one hand we are encouraged to ensure we work more efficiently and “cut the waste” out of our system, but when we do so, the contracts in place are working against us!! we literally being told to work one way and then penalised if we do! It is an entirely schizophrenic existence and creates an extraordinary amount of wasted time and energy.

 

I’m not exactly sure what it is that is causing the disconnect between the different regulatory bodies. However, as they require of us a new collaborative way of working that ensures greater efficiency and improved models of care…..perhaps it could be better modelled and enabled by those in the “centre”. This would give the entire reorganization a great deal more integrity. Cultural and behavioural change is talked about a great deal and we are enacting it despite the perverse drivers working against us. I wonder if the same is true at HQ, Elephant and Castle. This mixed messaging needs to stop and those of us leading systems, working with great complexity, need to be given the permission, support, and enablers to really flourish.

 

 

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Learning from The Well

The Well is an extraordinary community of people. I respect them deeply and learn so much from every time I have the privilege of being with them, listening to their stories. They are all people on the journey of recovery from drug and/or alcohol addiction. They are welcoming, non-judgmental, caring, embracing and kind. Most importantly of all, they offer hope that no matter how far into hell you have been, there is a way out and no matter how badly you have messed up, you are lovable and worthy of a new chance. There are countless stories of those who have gone before, through the “12 steps”, and found transformational grace and and the chance of a new life. The support they give to each other, especially at times of trouble is based on openness, honesty, trust and a genuine love for each other that holds through difficult battles for a better future.  Every story I have heard has humbled me, and each time I am with them, I go away changed and filled with fresh hope. I am so grateful that I can now count several members of the community as my friends. I feel we, as the medical community have much to learn from them.

 

 

After my last meeting with The Well community, which was in Barrow In Furness, I then spent some time with an excellent Diabetologist, Cathy hay, who is employed by Cumbria Partnership Foundation Trust, but works at Furness General Hospital (another example of how we are breaking down boundaries and working more effectively as part of Better Care Together). I was learning from Cathy about how she and her amazing team are transforming how they care for and work with people who have diabetes. Like me, she believes that hierarchical behaviour gets in the way of building good relationships across teams, playing to each other’s strengths and working effectively with patients. She has worked hard to break down the ‘need’ for consultant follow-up clinics, putting the power back into patients hands. They have had a much more proactive approach at working with patients to really educate them and empower them about their own conditions through the fabulous work of the Diabetes specialist Nurses and Dietitians and a team of Psychologists, lead by Elspeth Desert, who help patients learn how to face up to and cope with physical health issues.

 

Group programmes (such as DESMOND, DAFNE or the X-PERT courses) enable patients to build supportive relationships with one another and networks form in which patients are rightly able to become the experts in their own conditions, supported by a team of people who they can draw on, as and when needed – determined by the person with the condition. This cuts the need for outpatient appointments drastically and releases the team to work far more effectively. The ‘Walk Away from Diabetes’ programme encourages those with the earliest warning signs to try and avoid lifelong medication altogether through exercise, dietary changes and accountability with one another.

 

In some ways, the approach is similar to what I have experienced of The Well and it got me thinking about just how transferable this approach could be across health services, in an extremely timely and cost effective way…..(which although sounds potentially a little mercenary is actually really important – we do actually have a responsibility to use the resources we have as well as we can, and our previous models are no longer deliverable, given our financial and staffing pressures, let alone the increased numbers of people accessing services). What if, once people are diagnosed with a long-term condition, we give them the option of a self-directed, learning approach to their condition, in the context of community with others and a supportive network around them? We could save an inordinate number of unnecessary outpatient appointments. It puts people back in charge of their own bodies and conditions, far more empowered to make informed choices and enables care to be available in a more efficient, cost effective and timely manner. Communities of people, facing up to their conditions together, learning together, helping each other, supporting and resourcing each other and finding improved health and wellbeing at every level as a result.

 

Many people across the UK have at least one long term condition. Many of these people also struggle with a mental health problem at the same time, often linked to the condition they live with. A more cooperative approach can break down some of the barriers and enable people to connect, which will improve both their physical and mental health at the same time.

 

We are beginning to see an exciting redesign of our respiratory services along these lines, lead by Pat Haslam, Farhan Amin, Tim Gatherall, Shahedal Bari and the team……I wonder how brave we can be across the board and how much better our care might be together if we did?

 

 

 

 

 

 

 

 

 

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