Sunday, 10 April 2011

A room with a view, but why is it sometimes difficult to see what’s there?

Last week I was on a brief holiday, re-charging my batteries in the tiny village of Roosebeck, in the South Lakes. The house I stayed in looked out over Morecambe Bay. Roosebeck is up the coast from Ulverston, and when the view was clear, it was possible to see Blackpool Tower on the horizon. However, there weren’t many fair weather days!

On the first morning I climbed up to the Hoad Monument in Ulverston. This is a 30m tower that sits at the top of Hoad Hill (133m) and it is one of the most iconic symbols of this part of the North West of England. If the weather is clear, there are 360o panoramic views of the Furness Peninsula, Morecambe Bay and the Southern Lake District to be had. However, when I got to the top, these surrounding areas were shrouded in mist and they were all but invisible.

And so it continued, apart from one morning when I was able to lay in bed and watch the most magnificent sunrise I have seen in many a year, for much of the time Morecambe Bay remained obscured by low lying rain clouds. The vibrant world that I knew to be there was turned into an unyielding, impenetrable greyness.

Problems with taking in a view was a bit of a theme while away. I was taken aback by the very intrusive reporting on the M11 crash of Monday morning – I did not understand why we were given a bird’s eye view of the devastation brought about in this accident. A film taken by a helicopter flying up and down the crash site was repeatedly shown throughout the news bulletin. It was an almost voyeuristic view of what would inevitably be a life changing event for all of those involved (directly and in-directly). Of course it is possible to argue that as individuals could not be identified from the helicopter view, such reporting was acceptable. However, the report left me feeling very uncomfortable and my thoughts go out to all those who will be affected by the accident.

The piece on the accident was followed in the news by the announcement that the UK Government plans to reform the NHS would be temporarily paused so that additional views might be canvassed, and where necessary adjustments made to the proposals. What fascinated me about the piece was the way in which those interviewed regarding the proposals appeared to become more un-knowing (and less bothered) about what the proposals might mean for them, the further away from Government they were. So by the time they report featured patients (sitting in a GP surgery), the views being expressed were characterised by perceptions of powerlessness and a wearying sense of ‘what will be will be’.

The problem appears to be a familiar one – the inability to communicate what the changes involve, what the impact is likely to be and the reasons for making the change in the first place. In fact one could easily substitute University Fees for NHS Reforms and arrive at the same conclusion. I am more interested in the NHS Reforms however. Many years ago I started my PhD looking at the way in which GP Fundholders used various forms of relationships to negotiate and take advantage of Margaret Thatcher’s introduction of a quasi- internal market for the NHS.

Towards the end of my PhD journey, the Conservatives were removed from power and Tony Blair swept in with a large majority and  hell bent on dismantling the NHS internal market. Out were to go GP Fundholders, and in were to come PCG and PCT’s. For six months or so, I had a very difficult time trying to avoid the thought that my study was now worthless. Thankfully, I had a very wise supervisor who walked along my path with me for for a while. And of course the reality was that whilst the language changed, and much money was spent on restructuring the NHS, the internal market continued and was possibly more successful than anything Margaret Thatcher could have ever hoped for. I also got my PhD.

I think the latest proposals to make further structural changes to PCTs and the Strategic Health Authorities do not appropriately reflect the contribution made by many managers and non-clinical staff in achieving the progress that has been made in the NHS over the last two decades. Whilst my own studies have shown that GPs will be able to commission the services required in the future, they will only be able to do so with the right kind of managerial support, leadership and infrastructure being available to them. Of course gaining access to these services might be just as difficult in the future as it can sometimes be now. I have been trying to get an appointment with my GP for nearly three weeks  – without success. No matter, working on the principle that 85% of the problems that result in us consulting a GP are self-limiting, I have given up trying to secure an appointment and moved on.