{"id":22995,"date":"2012-12-06T17:56:00","date_gmt":"2012-12-06T16:56:00","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=22995"},"modified":"2013-02-13T11:55:00","modified_gmt":"2013-02-13T10:55:00","slug":"pritpal-s-tamber-its-time-for-a-few-good-punch-ups-in-the-nhs","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2012\/12\/06\/pritpal-s-tamber-its-time-for-a-few-good-punch-ups-in-the-nhs\/","title":{"rendered":"Pritpal S Tamber: It\u2019s time for a few good punch-ups in the NHS"},"content":{"rendered":"

\"\"<\/a>The National Health Service in England needs a goal, and a plan on how to get there. Its local leaders should be appreciated more, not constantly pilloried. Primary care is on the brink of failure and needs to truly understand its role within integrated care. And we all need a few good punch-ups to get the right kind of debates going.<\/p>\n

So say senior figures of the NHS who met at the exclusive Cambridge Health Network\u2019s<\/a> Christmas Event. Four of the senior figures were challenged with offering a \u201cshort, fun, little ditty\u2014their Christmas wish for the health sector in 2013,\u201d as Pam Garside, one of the founders, described it. The audience was then invited to comment and ask questions. <\/p>\n

Mike Farrar kicked things off with an impassioned plea for more recognition of the hard work delivered by local NHS leaders, especially chief executives. This was perhaps not surprising given that he runs NHS Confederation\u2014an organisation that represents NHS Chief Executives\u2014but a recent survey<\/a> published in the Health Service Journal<\/em> does suggest that CEOs are feeling pressurised in ways that are not healthy. Many describe a \u201cbullying culture\u201d with one going as far as saying: \u201cA climate of fear pervades the NHS, driven by ruthless governance and accountability regimes that have little interest in achieving anything other than the avoidance of blame.\u201d<\/p>\n

Farrar\u2019s specific fear for 2013 is a backlash against managers in light of the findings of the Francis Inquiry into failings at Mid-Staffordshire NHS Foundation Trust. Although the health secretary has promised that the recommendations will not add to the bureaucracy faced by managers<\/a>, Mike\u2019s fear is that statutory regulation of managers will be \u201canother opportunity to pillory managers.\u201d<\/p>\n

Up next, complete with flashing alien tentacles (I kid you not), was Stephen Thornton<\/a>, the chief executive of the Health Foundation<\/a>, an independent charity that looks to improve care in the UK. The tentacles indicted that he was from outer space, the vantage point from which he described how the NHS intends to operate once the government reforms are implemented. At speed he named all the bodies being introduced and how they allegedly fit together. Bewildering is the only way it can be described. \u201cPeople on the ground are hugely confused,\u201d he warned.<\/p>\n

David Bennett<\/a>, sadly, left his comedy tentacles at home (I hear they\u2019re massive), but the chief executive of Monitor<\/a> offered two positive predictions for 2013. Firstly, although he thinks we\u2019re about to see greater fragmentation of services, he believes this will drive more transparency and hence the desire for more rigour and collaboration. Secondly, he believes we\u2019ll see real progress in the much needed reconfiguration of services, although he didn\u2019t really say why. Tellingly, he felt that both these positive outcomes would be by accident rather than design.<\/p>\n

Transparency featured repeatedly in the fourth and final speaker\u2019s \u201cditty.\u201d Nick Seddon<\/a>, the deputy director of Reform<\/a>, a charitable think tank that suggests better ways to deliver public services, hopes to see more openness about such services. In the same breath, however, he worried that the huge amount of government talk about openness was part of the \u201cLaw of Inverse Relevance\u201d\u2014the less you intend to do about something, the more you have to keep talking about it\u2014made famous by the satirical television show, Yes, Minister<\/em><\/a>.<\/p>\n

Seddon also pointed to the need for a mature discussion about the use of human capital. Delivering healthcare is personnel intense, but discussions about the better use of people often get emotional\u2014not surprising when it often means pay cuts and redundancies. One group grasping this nettle is the NHS South West Consortium, a group of about 20 NHS Trusts who have decided they\u2019re tired of waiting for national pay negotiations and are clubbing together to decide what salaries to pay across the region. Seddon hopes the consortium succeeds despite union claims of it being a cartel<\/a>.<\/p>\n

Among Seddon\u2019s other hopes was an echo of Farrar\u2019s request of a proportionate response to the Francis Inquiry, that we might actually do something with the recommendations in the Dilnot review of the funding of care and support<\/a> and that the failures in south London<\/a> teach us that incremental improvements to healthcare are not what we need. He hopes that in 2013 will see more outside players innovating in care, perhaps leading to a few good punch-ups\u2014or \u201cdisruption<\/a>\u201d as clever business people call it.<\/p>\n

Questions from the audience almost immediately focussed on integrated care. Barbara Young, the chief executive of the charity Diabetes UK, asked the speakers if they thought integration would ever happen, especially as she believes ministers have started to understand that the policy levers they\u2019ve developed \u201caren\u2019t attached to anything.\u201d In reply, Bennett hoped that we\u2019d see more experimentation in integrated care in 2013, although Farrar made the point that somehow our definition of integrated care does not include primary care and that this needed addressing; \u201cPilots that ignore primary care will not work,\u201d he warned.<\/p>\n

This focus on primary care seemed to chime with the audience with a small flurry of comments about \u201cthe need to take responsibility for the poor quality of general practice\u201d and the strangely unchallenged assertion that \u201cgeneral practice will fail within a few years\u2019 time.\u201d As heads nodded in agreement we drifted into the familiar waters of having to learn from successful integrated approaches in Valencia, through Kaiser Permanente, and in Scotland. We docked at \u201cweighted capitated budgets administered through primary care to deliver integrated care\u201d and the discussion looked set to close in an all too familiar place.<\/p>\n

Thankfully, there were newer voices in the audience (at least new to me). One audience member asked why no speaker had mentioned the promise of digital health. Her fear was that the promise of digital<\/a> is all too often reduced to using video conferencing as a way to \u201csee\u201d your GP, and the inevitable press reaction to it<\/a>. One member asked why the discussion only focussed on healthcare when the future has to be about health and avoiding the need for care. Another member said the NHS needed a goal that extended beyond electoral cycles and a development plan for how to get there.<\/p>\n

As the Yuletide wine beckoned, I couldn\u2019t help feeling there is a lot of anger in the system. From Farrar\u2019s plea for less pillorying of managers, Thornton\u2019s worries about confusion on the ground, Bennett\u2019s caveat that his positives would be by accident rather than design, and Seddon\u2019s fears of the Law of Inverse Relevance, it seems that 2013 might be ripe for a few good punch-ups. Good. Glove up.<\/p>\n

Competing interests: The Cambridge Health Network commissioned this post and approved it before publication. No material changes were requested as part of the process and I think they\u2019re sending me a small token of thanks in the post. I have no other competing interests in relation to this post.<\/em><\/p>\n

Pritpal S Tamber<\/strong> is the Director of Optimising Clinical Knowledge, a consultancy that helps different types of organisations in and around healthcare design and deliver clinically credible strategies that have a measurable impact on performance and care.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

The National Health Service in England needs a goal, and a plan on how to get there. Its local leaders should be appreciated more, not constantly pilloried. Primary care is […]<\/p>\n

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