As a child I remember standing on a beach and marvelling at how unnaturally still and calm everything seemed. It was a few hours before a hurricane hit the coast.
The financial year has been accounted for – literally. The finance team worked seven day weeks to complete all the work that was necessary and can now have a few days of well earned rest. The strategic operational plan has been up to the SHA and put before our board. We have had two four day weekends in a row associated with great weather. Email traffic has been at a trickle rather than the customary deluge. We are in purdah and there is the “pause.”
Yet despite this period of respite the storm clouds are gathering. I took our strategic operating plan to present to the newly elected team in one of our consortia. The actual plan is inscribed on 169 PowerPoint slides (it makes it easier to read on screen rather than a Word document and saves paper). I used just a few slides of my own to get the point across that the whole plan was meaningless without their and their constituent practices’ ownership. The plan is predicated on clinicians agreeing and delivering changes in thresholds for treatment, reducing variation, and leading the necessary changes in pathways, and the way services are configured.
That evening I went on to participate in a meeting with consultants from the acute trust about redesigning a service to meet new national standards. There were two of us there from commissioning, myself and the GP chair from a consortium and a whole heap of consultants. The passion, skill, experience, and knowledge in the room was impressive. The palpable potential for a leading edge service was self evident. The difficulty of delivering it, because of the significant changes required in pathways of care, whilst preserving local delivery of what should and could be delivered locally in a rural area the size of Lincolnshire felt enormous. If it is to be done well it can only be done well with the commitment and leadership of the consultants and the support of excellent management. All the ingredients are there but it is a complex recipe.
People have said, are saying, that with the economic challenge the NHS faces we should not have embarked on such significant reforms. Yet at the heart of the reforms is something vital: engaging the medical profession in accountability for sustaining and improving quality across the system. Lose that engagement and I worry that much else will be lost in the coming storm.
Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.