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I have been visiting one of England's major teaching hospitals a couple of times every week for most of this year. My father in law is a ‘frequent flier’ with heart failure and various comorbidities. Seeing the NHS through the lens of his care is sobering. The NHS's addiction to structural change as a way of sorting things out seems unlikely to shift his shoddy support. This obsession with moving the resources around seems to know no bounds and yet is useless for him.
In the media we see continued coverage about sacking unaffordable staff this year and senior NHS and DoH leaders encouraging the closure of hospitals in the tail end of this decade. Others offer rationing services and big projects (like the national IT programme) as the only routes to sustainability. From my experience these are pretty irrelevant—what is really needed is a fundamental shift in how people relate to each other: staff to staff, patients to staff. And this is measured in the small things: the nurse who phones social services (again) to try to get a completed and accurate assessment—not the nurse who refused to go to the hospital shop to buy the barriernursed patient a bottle of orange squash.
If everyone who works in NHS did one extra act of kindness a day (the GP on a home visit who boils that egg for a housebound patient, the consultant who buys a phone card for a bed-bound patient and helps them to use it) and took one extra step to make things join up better for a patient (the SHO who phones the GP, the ward clerk who talks to the X-ray department, the sister who phones the relatives to brief them on a change in regime), the whole system would take a massive step forward in terms of service and smoothness, and would seem simpler to patients and more satisfying for staff. Once the NHS shifts out of its chaotic turbulence it is possible to try other improvements. Structural change is a side alley en route to giving patients and carers greater and greater value from the skills of staff. Process improvements with IT are only part of the answer. Changing the way that compassion is shown, kindness demonstrated, conflict is handled and decisions managed would be totally transforming. Starting with the little things is critical. It doesn't need a government policy or mandate from the top. This is a strategy that everyone can create—and all can implement.
Competing interests None declared
Dedication This piece is dedicated to Jane on F4, who took a step and changed it all.