WHAT IS A BLOG?

What is a blog? I suppose it means whatever you want it to be, a conversation to make a point, create a two-way discussion in developing further understanding or just getting something off your chest. In this case it is to highlight the lifetime of memories working in healthcare, the ups and downs and what happened when I became a fulltime carer for my Mum and Step-Father, so they did not have to go into care. Retiring from fulltime work, took me away from having to work within the healthcare box and allowed my mind freely to go where ever it wanted to go. In the beginning it was strange not going to work and having to deal with the daily challenges of solving problems of running a large care home, staffing, administration, the always changing needs of those you were there to provide care for and meeting the daunting task of providing a safe environment that does more than meet the standards expected by the CQC.

In those early days of being a fulltime carer, provided time for me to think about what was happening around me, about the NHS within the crazy situation following the vote to leave the European Union. Somehow in a strange way, I was glad I could turn off the TV and not get involved. With what little I saw of it, drew anger from the depth of my soul about the confusing media coverage, the distorting of the facts, developing sound bites of what the media, no matter which channel, develop the information to play one side off against the other, depending on their bias. The Prime Minister thinking that there was no way he was going to take the UK out of the EU, stating ‘that he would carry out the public’s wishes’, but when it came to the decision to leave the EU, he picked up the football and left the game, like a spoilt child after not getting what he wanted, leaving the Government of the day in turmoil. It seemed to the public that parliament had become a schoolyard playground for those who wanted to play politics’ trying to make a name for themselves splitting party lines. What happened over the next two years made our parliament procedures a laughingstock and allowed the EU negotiators just to sit back and watch as they did not have to guess what was going to be on the table, all they had to do was block everything that the UK wanted as the EU negotiators planned to add more turmoil before ever getting to the negotiating table, thinking if they held out the situation would collapse and return back too business as normal.

After just about getting to grips with the negative approach by the EU and the stupidity of the UK parliament progress was made after several years of infighting, then the world was hit with a pandemic that shocked every corner of every country, changing life as we once knew it for ever. On top of all the issues of climate change people started asking what the hell is going to happen next? Throughout this time I started to write down the memories of not only my working life, but also my personal life and how the memories had influence my decisions taken over time. This led me to bring together conference papers, reports, projects and all the work that had gone into gaining a high distinction for my Master dissertation, months of writing and then at last having a book published The Art and Soul of Service.

For much of what has been written in the book is about healthcare in both Australia and the UK, the systems that are developed by bureaucrats who play with the infrastructure and how much it costs. Developing frameworks and rules that has in the end created such a sluggish unconnected systems of silos that used those who ‘suffer’ as a pawn in a four dimensional game of chess, where all the main players act as part of the infrastructure, the king, queen, bishops, knights and rooks squabbling over who should have the money provided to the NHS by the Government. The book is not about nocking the NHS, far from it, as the frontline carry out heroic actions every day in saving lives. This was the best decision to come out of the aftermath of the Second World War and still the envy of all healthcare systems around the world. The question is how has it come to the point that the healthcare powerbrokers hiding behind the curtain, pulling all the strings, have become catatonic, can see, can hear but unable to move, as if frozen in time, without a clue how to correct the historical problems that has developed over the last forty odd years.
The book talks about three concepts to describe a visual picture of what is happing to the NHS. The first, is about the over swollen foot of the NHS being squeezed into a worn out shoe, which is falling apart at the seams, creating an impossible task of the foot fitting into the shoe. If you take a moment, to just think about you trying to force your foot into a shoe that is too small for your foot to fit in, and if you do manage it how uncomfortable would it be making it difficult to walk.
It would be necessary to treat the NHS foot and allow it to heal. At the same time development of a new shoe is necessary, one that is comfortable and fit for purpose. If you add that to the Iceberg Principle with its visual picture of an iceberg floating in the sea. It shows a waterline, with the top of the iceberg above the water line, visible to be seen by passing vessels, with the weight of the bottom of the iceberg, the part not seen or its size and controls what can be seen above the waterline. If you take the iceberg as what can be seen by the general public traveling in their vessels, not understanding what is controlling and shrinking of the healthcare that can be seen above the waterline, that provides the direct hands on care to the general public. The infrastructure gets bigger, the hands on direct care available shrinks the ability to treat the growing problems of a population that is not only becoming older, but the increasing waiting lists of people needing treatment with some dying before they become the next in line for treatment. The Iceberg Principle is a tracking mechanism of where the money provided by the Government is spent on and defines funds that are spent on systems that support direct hands on care and funds that are spent on quangos, jobs for the boys (and girls) and speculation that have no chance developing any benefit to direct hands on care. Traveling up towards the part above the waterline with all the branches that siphon off funds never to benefit direct care. The third is the amount of care (as water), being poured into a vessel that is too small to contain the amount of water and it is spilling over the sides. The one and a half pints being poured into a one pint pot. The visual picture is very clear that you cannot fit the one and half pints of water in a one pint pot. It is necessary to either reduce the flow of water or increase the size of the pot with the flexibility to take the odd increase of flow from time to time.
These three visual pictures clearly define what is happening in this time of many confusing problems in the NHS and also being played out around the world, which just seems to be heading for a disaster that the human population may not survive. We need to treat the deformed foot before putting it in a well-made shoe fit for purpose. It is very clear that throwing money at the NHS within it historical framework is never going to work, as it only allows a small amount of money to reach direct hands on care. It is thought to be one third to direct care and two thirds to infrastructure but it could be as low as a quarter towards direct hands on care and three-quarters used on infrastructure. There are many sub-sets to investigate but the two which takes out billions and billions of pounds out of NHS every year, is theft of funds and equipment and the amount spent on negligence that gets paid out of court or instructed to pay through the courts. There could be a case to be made that much of the money paid out due to negligence is due to the lack of learning or not following rules that have been developed to make care safe or poor healthcare systems that are not fit for purpose. Theft is a growing problem in this age of pressure caused by buying on credit and not having the ability to pay it back or people in authority find ways to line their own pockets. There could be a case to be made that recruitment is not producing the right person with the right skills, with the right authority in the right job at the right time has caused this downward spiral of efficiency.

 

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