The #1 Question NHS Leaders Need To Be Able To Answer

Long waits in A&E, financial deficits, cancelled operations and high cost of temporary staff are once again all the news. Just like they were 10 years ago when I was working in the NHS at Board level.

As anyone who has worked in the NHS knows there is always a challenge between delivering on the short term operational demands while trying to plan for longer term success.

When every news report is about the number of hospitals at breaking point, it’s necessary to get everyone, whatever level they are at working on solving the immediate crisis.

On the other hand when the immediate crisis is over, there is one big question that should be being considered at government, CCG, Trust and supporting organisations.

That question in my mind is the following:

“How do we continue to provide a quality safe service with the resources available given that we have an ageing population?”

It might feel easier to take one element or the other and focus a lot of attention on that.

Trouble is this goes much further than 7 day working or balancing the books.

The reality is that the longer people live, the more likely they are to access services.  It’s widely known and understood that elderly patients once they are in a hospital tend to have more complex needs.  As a result lengths of stay can be longer.  Sometimes they can only leave hospital with appropriate out of hospital support.  Most of the time demand for those support packages out of hospital exceeds availability.

Another challenge is that with hospitals being so busy, there really is no contingency for the unexpected.  I can recall being on call one week where we had the equivalent of two wards closed to new admissions because of an outbreak of winter committing virus.  If already running at near capacity there is very little scope for deal with this well.

Of course it’s easy to highlight the issues and a whole lot more difficult to come up with answers.

It’s clear that all partner organisations across health economies need to have the discussion to come up with solutions.  Personally I would put doctors at the heart of these discussions with non clinical managers being in more of a facilitative role.

We can give them indicative costs of providing different services and they can advise on priorities based on clinical evidence and benefits.

We can call on their expertise on how best to organise things to make the best use of resources while making sure quality and safety is not compromised.

We should also encourage innovative ideas.  For example when working with a group of hospital doctors on leadership recently, it was suggested that maybe all care homes should be required to arrange and pay directly for their own dedicated on call primary care specialist, such as a GP or nurse practitioner.

While there are no easy answers or quick fixes, taking the time to think and take action to address some underlying challenges through open debate and discussion could be a useful starting point.

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