Let's take stock. Trusts are being asked to wear their underpants over their trousers and:
- Claw back and reverse a �2 billion deficit
- Deliver the first year of �5 billion of Carter Review efficiency savings
- Slash spending on agency staffing
- Deliver planning guidance
- Come up with a local five year Strategic Transformation Plan
- Get targets back on track for A&E, ambulance wait, elective treatment and cancer
- Improving one year cancer survival rates
- The seven-day 'thing' and a strike
- Sort out an approach and deliver two new mental health access standards
- Jack-up the dementia diagnosis rates
- Transform care for people with learning disabilities
- Improve quality
- Introduce a new system of publishing avoidable mortality rates
- Do Vanguard stuff
They then must leap tall buildings in a single stride and:
- Cope with out-of-control demand and sort out delayed transfers of care that social service can't sort out for themselves.
The financial prospects for adult social care could not be worse and are set to deteriorate further.
The King's Fund tells us by 2020 there is a social care funding gap of between �2.8bn and �3.5bn. Councils, being able to set a 2% precept on council tax for social care, will work in the better-off areas but not in the areas where demand is likely to be highest.
There is an all-around financial squeeze like never before.
However, let's look on the bright side:
There is the prospect of a share of �1.8 billion of sustainability funding (but with more strings than a marionette) and Monitor seems to be getting the message - giving the Trusts a good kicking does nothing but give them a sore toe.
On the other hand:
The CQC have lost touch with reality and want to charge shed-loads for out-of-date reports that no one takes much notice of anymore. Everyone is in the same boat.
There is one ray of hope; Lord Cater is going to show us how to buy cheaper bog rolls.
Everyone is running around saying the NHS must change. I'm not sure from what to what? They forget, organisations don't change. The people in them change and they only do that when they can see what they did yesterday is no good for today. Even then they'll need to see the 'how'.
It's not enough to want people to do their best, they must first know what to do and then do their best. Asking them to 'do everything' is as useful as asking a canoeists to do a handbrake turn.
Can the Trusts see the wood-for-the-trees? Do their best? What started as the pursuit of excellence has become a quest for survival. Is it about brilliance or existence?
Overload leads to paralysis. If the task is too big, too complicated and too much... they give up. The status-quo is seductive. If they give up, management becomes more raucous. More top down. Cajoling gives way to insisting and gives way to bullying.
Bob Alexander's demand for Trusts 'to cut head count' so that he can balance the books is the crassest, most stupid, ill judged piece of idiotic, bullying management I have seen in years. I suggest he starts with the entirely superfluous TDA and himself. His 80's style of Doc Martin management is totaly out of place. This style of manage led us down the M1 to Mid-Staffs.
The NHS is sliding, slow-motion, into a ditch. Management by 'more stuff' is not management. It is desperation.
Being in control means having realistic expectations. Being truthful about prospects.
The first trick is to make problems so interesting and their solutions so positive and productive, everyone wants to join in, roll up their sleeves and be part of the answer. Make everyone involved feel fulfilled, valued and satisfied with their work.
We need to get relationships with the people right and then we can set about making the organisation right. Show them that the task is not beyond them.
There are some things you can't put on a PowerPoint slide. I think it was Edwards Deming who said 'eliminate fear and management by objectives'.
He is right. Staff should contribute ideas and concerns equally; forget objectives and look at the processes and measure them... not the people.
It's time for management by vision, ideas and excitement.
