I've visited eight adult social care departments this year, and talked with front line staff in all of them.
From the kick-off I’d like to say thanks to Aintree University Hospital FT for showing us how staff engagement is driving pride towards ‘getting it right for every patient, every time’. It was a great way to start day one of the NHS Confed Conference 2015. Listening to the opening speeches at the conference the theme was repeated; harness the power of staff and uplift the social contract that bonds all of us working in the NHS. Culture and confidence in the changes ahead are key to delivering systems change. Balance of relationships and motivations is vital along with alignment of risk and incentives. During the day I began reflecting on a number of group and individual conversations I’ve been having recently as to what this really means in practice. I’ve deconstructed it down to four key paradoxes:
- More is not best
It’s not enough anymore to say the more patients the system is dealing with, the better job we must be doing. Accepting an ideology of busy is best puts the NHS on a rollercoaster to cost. If we’re only treating more sick people the system is failing. Statistics today can still too often be quoted in almost congratulatory fashion of the percentages of increase of patients seen in the NHS and a system held randsom to demand. It simply cannot be accepted as right that dealing with more people in the same way is essentially the best option available.
- Sick is not health
Making a sick population better is a lot more costly and risky to life than keeping a healthy population well.
- Cost is not money
Pursuit of monetised savings creates systems division, not flow; pursuit of a proactive, predictive, data led system will create a longer term, sustainable approach with reduced crisis driven behaviours.
- Patient is not person
The longer we refuse to let go of the patient paradigm in the NHS the longer we will hold onto a deficit model of health; seeking to fix what’s broken rather than seeking a base to make people and the systems around them more resilient.
To quote from Einstein, “intellectuals solve problems; geniuses prevent them.” For too long we have been jockeying the intellectualisation of health, solving and reacting to crisis. It’s time to look beyond crises to prevention. It’s time for a new system paradigm; it’s time for population genius.
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