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The path of least resistance is the path of the loser

"The path of least resistance is the path of the loser.” H.G. Wells, author 

“Join Campaign to Save Our Services” reads the headline in this weekend’s edition of a local paper in one of the areas I am currently working.  There then follows four pages of news, comment and stories surrounding and detailing options for service changes at the start of a period of public consultation, with the options that those on high would like to plump for.

We have heart-breaking stories, worries about the “disastrous” implications, comments and support from local MPs, campaigners slamming “flawed plans”, and comment from leaders.  And it’s those leading the process who, unsurprisingly, come in for most of the stick from campaigners, who demand proposals to be rethought, and believe that leaders “have not listened to or addressed serious concerns”. 

For me, given that this is a part of the country tens of millions of pounds in the red currently, and heading for a projected overspend, the last I heard, somewhere in the region of £165million by 2020 if nothing is changed, to say that the need for major change comes from recruitment difficulties and not the need for cost cutting is somewhat disingenuous, I feel.

Don’t get me wrong, there are without question real and challenging recruitment difficulties across primary, community and secondary care in this part of the world, but to pretend that a humungous hole in the finances isn’t the main reason for the changes being put forward is rather assuming that the local population will happily have the proverbial wool pulled over their eyes with ease.

Furthermore, with one of those leading the change stating “It’s not a vote. It’s not a referendum…nobody holds a veto”, in the words of the song “I predict a riot”.

Without a doubt, change is absolutely necessary in this part of the world, and some of the proposals put forward have good and genuine rationale behind them – a lot of hard work and time has gone into developing them.  But here’s the thing: we’re back to a process of change that is top-down, command and control, pretend we’re including people and letting them believe they have a voice when in reality they don’t.

As the newspaper states, this is the start of a public consultation process.  Why on earth were the public, i.e. the ones who will be on the receiving end of the changes and the most important voices to be heard, not involved right at the start?  Why is this a consultation process instead of an engagement process?

While the NHS keeps doing things the same way, it will continue to get the same answers and nothing will change.  And my goodness, things need to change, not just in the place I’m talking about here, but right across the care system.

However, politicking and self-interest abound.  How else do you explain the fact that the CCG has told local GPs that they cannot commission the myriad of non-commissioned services in the area such as 24-hour ABPM and ECG, DVT management, PSA monitoring and so on and so on and so on, just to keep 5-day a week services on the road, yet can find funding for one of the CCG GP clinical leads to fund 7-day a week services in the town in which he practises?

In the part of the world described here, if someone leading the process had had the foresight to properly and meaningfully engage the public, as well as front line staff, right at the start; if they had had the difficult conversations, clearly and honestly laid out the challenges around finance, recruitment and geography, and asked for collaboration in terms of coming up with proposal and solutions, who knows where we might be now and what other options might have been put forward.  And everyone would have owned what would have been put forward, and there would have been commitment to take tough decisions around change, and make them actually work.

But they didn’t.  They have taken the usual approach of only involving selected senior leaders and clinicians in the typical steering group-type approach (obviously with lots of sub-groups and committees and sub-committees, etc, etc), and so it should come as no surprise to them that they now have cynicism, anger and resistance as the upshot.

It will be interesting to see what the outcome is for the people who live and work in this particular part of the country.  On the basis of what’s been written in the local paper, it sounds to me like change will be imposed regardless of what the public say, want or need.  How successful will it make those changes, how safe will patients be, how detrimental will it be to care, will it bring about financial balance, will it improve recruitment and retention and will it ensure resilience going forward?  Who knows, but I strongly suspect the answer to all those questions will be to the negative, and that is not going to be good for anyone living or working there.

I have asked in previous blogs, what price not genuinely engaging all stakeholders right from the start.  Well here you have a prime example of exactly the price.

So: time to take a different approach, time for proper, meaningful, full engagement from the start involving all stakeholders.  It’s not easy, but it gets real change happening in a positive and constructive way, and also ensures resilience for future challenges. Whether you have 9, 900, 9000 or more stakeholders to engage it is possible to engage them all, given them a voice and drive the changes you want to see. Are you up for that?

If you are thinking about working at scale, and would like more information on how BW Medical Accountants can support you, or to arrange to speak to one of our experts please contact enquiry@bw-medical.co.uk or call 0191 653 1022.

Additionally, if you should have questions for us please email Rachael Mackay rachael.mackay@bw-medical.co.uk and we will do our best to answer these within the blog.

Scott Mckenzie

Scott Mckenzie

NHS Management Consultant

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