“Freedom brings men rudely and directly face to face with their own personal responsibility for their own free actions. (Frank Meyr, 1962 in Defence of Freedom).
Do you ever get the feeling that the NHS is trying to run a five star service on a one star budget? Quite some time ago a motivation speaker came to talk to many of the senior managers within D&G NHS about the indisputable fact that demands on the NHS would continue to increase and resources would continue to decrease proportionately. He asked them to think out of the box about how we could start to overcome this increasing discrepancy. So, here’s some thoughts…
It is almost as though the welfare state (indisputably needed and a mark of a civilised and moral society) has created its own Catch 22 with so many people believing their right to a choice, their choice, is paramount regardless of the impact on anyone else either individually or corporately.
This fundamental change in people’s expectations comes with an increasingly litigious mentality and is leading not only the NHS but all welfare provision to breaking point. The boundaries of personal and social responsibility seem to be getting dangerously blurred and I believe that it is time to start defining healthy and sustainable boundaries again. To start saying, dare I say it, ‘No’.
Before you all shoot me down in flames please be aware that I am not decrying the drive to improve patient care or the patient experience – we all want the best treatment and care for our patients, but it has to be within reasonable and sustainable limits.
It seems to me, and a lot of my colleagues that it should be possible to cut back without affecting front line services – but the cuts would affect at least two forbidden areas: the patient experience and those strategists who think that forty page documents talking about interface working and cross sectional content mean or change anything.
The latter is probably best summed up by a quote from an anonymous but very well known NHS source: “As is well reported the management and administrators within the health service could keep themselves busy in an empty hospital with paper exercises.”
Maybe we could summarise the government’s strategic direction 2020LDP paper thus: “Continue to work together to provide the best patient care across all services within budget constraints.” One person, two minutes, cost to the NHS about 20pence.
O.K tongue in cheek but you get my point.
Any measures that negatively affect the patient experience would be controversial but when you look at it in terms of managing your own home and how your budget affects the choices you make and are sometimes forced to make surely it becomes simpler. Running your own home involves setting limits and boundaries, it involves denial, taking second and third best or frequently going without at all and it is not just you, the adults, but your children that are affected by the choices you make. If you teach your children and help them understand why they cannot always have just what they want when they want they learn to value your family resources, understand why sometimes the answer is ‘No’, maximise family resources and then take on their own responsibilities as they grow up.
Perhaps it is time for the NHS to set some realistic boundaries of its own and make it clear that it simply cannot meet every demand or expectation, public or otherwise. Can we really expect to be able to continue paying for patients to occupy acute beds simply because they don’t want to go to a community hospital? Or let patient choice costs tens of thousands of unnecessary pounds when there is an alternative that costs so much less? Can we expect to continue to fund hundreds of unnecessary visits to A&E or GPs, to shell out blanket free prescriptions? Or, on the other hand, continue to allow employees to stick to procedures that not only cost more but have a negative impact on a patients physical, mental and social well-being – just because they have always done it that way? Or to recall patients repeatedly for hospital check ups when a telephone call would do? Or to take up an acute bed simply because a patient needs an urgent scan but is otherwise well. Or to …. the list is endless.
Why is it so difficult for people to set sensible and realistic boundaries and stick to them? Why do we, as staff, so often capitulate to our patients every whim: “Not eating that sandwich I want grated cheese not slices!” and with each capitulation re-establish the boundary even further in the patient’s favour.
How too is providing for every expressed patient need going to encourage the culture of self management that is being flagged up as an essential part of the NHS future? Granted there are a huge number of things that are crucial to improving the patient experience that should be a fundamental part of the treatment they receive anywhere in the NHS – respect, courtesy, clear information, empathy and openness – but maybe we need to remember that the original ethos of the NHS was treatment free at the point of delivery based on clinical need.
Clinical need – not desire.
Anne Marshall is a Staff Nurse on the Renal Unit at NHS Dumfries and Galloway