Sunday, 17 March 2019

A nod is as good as a wink when it comes to delivering transformational change


I see that last week the Institute and Faculty of Actuaries revised their life expectancy prediction for British men. It’s not good. They predict that men are expected to die at 86.9 years old. This is lower than the 87.4 years they predicted in 2017. If they are right with their predictions, it means I have just 209,364 hours to live. A sobering thought and one that made me think that I cannot afford to waste even one of these hours by doing something that’s unnecessary, not enjoyable, productive or satisfying.

So last week I had someone fit a log-burning stove in our lounge, something I might have done in the past without thinking about it. I had Ash (yes, that was his real name) come and take down several trees in the back garden, something just a year ago I spent a whole summer doing in our previous house. My Husqvarna chainsaw stayed unused and lay contentedly in the shed. Even my Amazon delivery (sometime between 08.00 and 14.00) came at 08.30, freeing up the rest of my day! 

Sadly, it wasn’t quite the same for some of the other activities I was engaged in last week. In fact, as I started thinking about this week’s blog, I played with the idea of substituting the word NOD in the blogs title with NED. Yes, I know, my reasoning is slightly hard to follow here, but stay with me please. The thought about substitution, perhaps reflected my end of week low mood. For me, it had felt like a tough week, characterised by several early morning and late evening long car commutes. After what feels like a lifetime of early starts and long commutes, it’s not my favourite way to start the day nowadays. They were hours spent in a car that I am never going to get back again. These lost hours certainly weren’t satisfying. At the end of each morning commute were a series of meetings, some of which were immensely interesting and productive, whereas others seemed rather pedestrian and pointless. 

One of the better meetings involved a feedback discussion by one of the Trust’s lawyers on our position regarding a major contract we were negotiating with our local commissioners. The lawyer was a partner from a major law firm. He was at the top of his game. He clearly knew a great deal about procurement law, and what he didn’t know about NHS regulations could be put on the back of a postage stamp. For younger readers, this was something your parents would have used before email, Twitter, Facebook and so on to send something called a letter to someone they wanted to communicate with. The lawyer’s presentational style and his communication skills were superb. He had one of those soft, but compelling voices. I could have listened to him making his arguments all afternoon. But I was already conscious of those precious hours slipping away, so was thankful that the meeting finished as scheduled. 

In contrast, on a different afternoon I attended a meeting characterised by the lack of compelling voices and a distinct lack of any informed decision making. It was an expensive meeting too. In attendance were two Chief Executives, two Chairs, a range of Executive Directors from three major organisations in the local health and social care economy, several Non-Executive Directors (NEDs) and a sprinkling of other senior managers. I wondered at the collective cost of bringing all these people together for an afternoon’s meeting. The meeting’s purpose was to deliver the transformational objective of bringing together all these agencies and organisations into a single integrated care system (ICS). Integrated care systems allow for new partnerships to be developed that bring together NHS organisations, local councils and others, to collectively manage resources in delivering NHS standards and improving the health of local populations.

Locally provided integrated services can ensure that more joined-up care is available to individuals and communities and that folk only go to hospital when their health needs can be best met there. It is an exciting time in the history of the NHS. Which is more than can be said for the time spent at the meeting. Yes, there were some interesting updates around some of the developments in mental health care, care in the community and so on, but the meeting didn’t really get anywhere near the positive decision-making focused approach that I think was required. The discussion was rather rhetorical. Agreements felt as if they were as valid as a nod or a wink to a blind horse, and I slowly came to realise that once again some of my precious remaining hours had been lost to too much enthusiasm and not enough substance. 

On reflection, it may be that my expectations of the progress that could have been made were too high for the transformational stage all the organisations were at. And, on reflection I have also changed my mind about substituting the NOD for NED in the blog title. My first thought had been a consequence of the popular (intuitive) interpretation of the 16th century phrase – that is, to the blind horse (or person) a nod or a wink has very little purpose, both being equally pointless. However, the original use was ‘you may nod or wink, I will take your meaning either way’. So, while my frustration at the ‘nodding and winking’ going on at the meeting, which seemed to reflect the slow progress being made towards developing our ICS, we are at least making progress. But the hours are relentlessly ticking away…

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