This is the fifth part of the BMJ Leader blog series written anonymously by “Magical Meander”, a medical manager working in the NHS, to help align perspectives and build understanding of medical management across these two professions.

Health care workers seem to like badges. Maybe that’s not unique but there does seem to be a joy in or a habit of adding stickers or badges to lanyards: post flu (or even COVID) vaccination or to connect to campaigns e.g. improvement. I think this speaks to the need to feel connected and the pride that many show in what they do. The badges or stickers are a visible sign of this.  There is a tension though in this connection: is it to the NHS or is it to the employing institution e.g. the hospital or GP Practice. The recent clap for the NHS and the extraordinary response to COVID has absolutely been at a national (and regional level). A feature that has stood us well and differentiated us from other countries. I know I found it hard at times to contain tears on a Thursday evening. I could not help but wonder what Bevin would have made about how dear the NHS had become to the public.

But when you ask employees: they are very much connected to their local institutions. I remember as a medical student being told by a senior academic that he cried the day he received a pay cheque bearing the new name of two recently merged trusts, rather than the original hospital he had served for decades. I was struck by the passionate response – tears are a strong reaction, especially for someone in the business of health; used to dealing with challenging conditions and situations.  I remember too, a hugely insightful framing of this that health care workers work “for” an organisation not “at” an organisation.

There is such a delicate balance to achieve. We need staff to listen to national directives, to connect to their professional bodies, to learn from similar organisations. Yet we also need the connection to the local environment, the nuance of the local population to be at the fore of what we do. This is especially true if the NHS is to achieve a core principle of the NHS’ founding father – the idea that a National Health Service could lead to less rather than more demand for care. Achieving this requires shifting from a reactive to a proactive service. One that relies on developing nuanced population based management that is generic yet nuanced thanks to the evolving science of artificial intelligence. These systems can trawl organisation data looking for cases and prodding clinicians to act or at their most automated acting on our behalf. But the systems need to grow from brilliant initiatives from innovators. So we need uniqueness and we need homogeneity. We need top down and we need bottom up.

The most important bit is the transfer of information. Something we are not quite as speedy at as other systems e.g. the military, or maybe we weren’t but are getting faster thanks to COVID, which has catalysed profound change: maybe not quite 0 -100mph in seconds (but close with respect to video-conferenced based appointments and other game changers). All too often in the past we have excelled at inertia rather than change. Again my mind wanders back to the comment of a Professor that he spent his lifetime disseminating a novel surgical technique that reduced infection. He travelled the world, he published, he taught a generation of clinicians and yet he was still taking referrals from the hospital adjacent to his own to resolve infection related complications due to the non-adoption of this very technique: wilfulness, just ignorance or inertia?

So as we face another wave / surge or spike of COVID. As we demand yet more from these dedicated workers. Let’s show our pride with rainbows, with cities washed in NHS blue, but let’s also celebrate the brilliant innovation that happens locally and let’s focus our efforts on how we transmit information. We should wear with pride connection to our institutions but let’s build connections to our regional brethren. Interlocking distinct entities that draw strength from each other are real possibilities- whether they are called Integrated Care Systems or Networks or any other name.

Magical Meander

Magical meander is an anonymous blog written by a medical manager working in the NHS and published every six weeks on BMJ Leader Blog.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.