This is the seventh 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.

A funny thing has been happening near where I live. On one single road in a short window of time; barely a few weeks apart, two road traffic accidents occurred. Not surprising, maybe, but what was surprising was that both led to destruction of solid objects. The first was a gate with brick surrounds, the second led to a rare red post box tipping precariously and eventually falling over. Both episodes it seems were caused by young men driving too fast. Luckily all involved were ok. I suppose lockdown has funny effects. What struck me was the lucky escape for the humans but also made me connect with something that I had recently read in my local paper; about the post box types in my area and for some reason this fascinated me. What fascinated me even more, was that the tumbled box was not removed and replaced. Instead, early one morning when I was out running I saw a two man crew righting the box and stabilising it. (Sadly they did nothing about the graffiti that now covered it).

This led me to think about how we in the NHS manage things when they are knocked about and tumble over… COVID clearly hit us at speed and has definitely knocked the NHS about more than a bit. The effects on waiting lists, excess mortality and staff wellbeing and retention will be with us for a long while yet. So instead of sending in a two man crew to right us, we are about to embark on yet another reorganisation, in post box metaphors this would be moving the damaged post box a few meters up the road and possibly changing its paint colour. Whilst few in the NHS would say no to reversing the Landsley reforms I doubt that many are welcoming learning yet another litany of new terminology and somehow navigating yet another new landscape.

Maybe though I am misreading the metaphor maybe I should focus on the rebuilding aspect. The focus in the new proposals is on collaboration not competition. The focus on geographic area ie STP or ICS is clearly about mending and re-fashioning and rebuilding. Putting the NHS back in control is also at the core of the proposal to remove the need for competitive tendering. I worry though about the additional layers of oversight: the newly righted pillar box didn’t have a new camera installed to watch for further speeding recklessness.

More than anything though I worry about the forgotten bit – the graffiti if you like. The financial situation, or brutally the lack of money. Shuffling things around without grappling with this will not help the waiting lists or the staffing situation. But more importantly I worry that this is a missed opportunity. I don’t want a spanking new post box, one made in our own queen’s reign. I wanted the box replaced with a shiny new old one. I don’t want a totally new NHS but I do want one that aligns the best bit of healthcare with a new way of managing social care. Just as the post box “righters” missed an opportunity to tidy up the graffiti we are missing an opportunity. We should do what our extraordinary forefathers did coming out of war, bravely embrace a new social compact by creating the NHS. We need a National Social Care Service. Without this we will not sort out the underlying issues that all too often lead to the long term health problems. If we want to make the sacrifices of so many in the last year valid and valued we need to be working to reduce future burden.

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.