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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