Will poor communication across the service cause TYC to falter
by Pharmacy Life - Published on 21 July 2014
With TYC now underway, many aspects of NI healthcare are up for debate. With that in mind, Northern Ireland Healthcare Review has partnered with The Association of the British Pharmaceutical Industry (ABPI) to conduct a series of 'Healthy Debates'. Chaired by West Belfast GP, Dr George O'Neill, the first in the series was held recently at HSC Leadership Centre in Belfast and, as you will read, the debate was both frank and insightful.
George O’Neill (GO’N): The motion of this first Healthy Debate is 'this house believes that poor communication across the service could cause TYC to falter'. Could we have the first proposer please?
Mark Roberts (MR): Thank you very much Mr Chairman. My background is in secondary care in acute medicine and I speak for myself and not for any particular Trust. I would also say that my view is unashamedly secondary care-based, and apologise if some people find that a little less palatable, but I would put it to you that it is my sector that needs to reform the most, more than all the others combined simply because, if we are to move care from the great edifices and brickwork to hub and home – we are going to need the secondary care sector on board, and I don't think it is at the moment.
I think we need to take a step back and ask: 'who is responsible for communication across the service?' I put it to you that no one is, everyone is, maybe nobody is. For that reason, I think that this debate is actually about leadership. It's about walking the walk. It's about sharing good practice. It’s about seeing good ideas proliferate. If we in this room believe that the premises of TYC are sound, then we need change to actually happen from the bottom up and not from the top down as we are accustomed to in the health service.
If you think about how many layers there are between the TYC director and my Consultant colleagues in acute medicine, I would count at least about seven layers and that'll be overwhelmingly by email route. If I receive a message at all, I'll receive it multiple times by multiple routes.
I'm a motivated clinician with a background in geriatric medicine, where there are great opportunities, but it's fair to say that there's a communication void. Does TYC need to be working and working fast, and much more than I see in my world? Of course, because my clinical world is more reactive and more about doing things just as we've always done, with very little confidence by frontline clinical staff to actually deliver the future. As part of my research for today I looked online at the TYC website, where I found some interesting web-based tools, which showed promise initially, but when I actually drilled down into them, were light on detail, high on promise. We’re talking about a very educated, very well versed, slightly cynical group of staff that needs to be engaged in NHS change. Experience of change in the NHS has often been negative, reactive and unplanned, which is the very opposite of what TYC is supposed to be doing. I’m not just talking about frontline clinical staff, I’m also talking about middle management, who many think I wouldn't speak on their behalf but I do so willingly.
So, in summary, I think this is a communication failure, one where change needs to happen from the bottom up - not from the top down - by people who share best practice and who are seen to be walking the walk.
GO’N: Terry would you like to come in here?
Terry Maguire (TM): Yes Mr Chairman. Have we got poor communication across TYC? No, we do not. I believe that we have a very clear view on the stakeholders, on the message, on the messengers, on frequency of that message and also on the resource. Clearly, we always want more resources and more communication, but what we do have is an ability to use our communication resources in a very smart way so that we get the right message to the right people in the right time to drive the project forward.
On a monthly basis, for example, Belfast LCG goes into the community with a very clear message which is fundamentally focused around TYC. Only last week, I was in Ballybeen, where we engaged with the community and addressed the resistance. They're not interested in TYC! They're not interested in the salaries that consultants get. They're interested in the health service performing for them. That's fundamentally what TYC is about, and it’s transformational. It's not about doing the same things, even with vested interests in place. It's about transforming it and working it differently. The system is no longer fit for purpose. Please accept that. We're trying to get our population to see it. To sum up, communication is far from poor. What is poor is the jaundiced view of those who feel threatened by change because it is change and no one likes change.
GO’N: Anne Marie, you are the second proposer of this motion..
Anne Marie Marley (AMM): I would indeed like to second the motion that ‘poor (if not difficult) communication across the service could cause TYC to falter'.
When you were chairman of the LCG, Mr Chairman, we had many conversations about funding the gaps on the COPD care pathway, which probably takes us back three years. The reason why I'm on this side of the debate today is because we're still waiting, eagerly awaiting positive news about the IPT and then we will have to collectively use our best communication skills to be able to implement what we've said we'll do.
Whether we work in secondary care, primary care, community service, or the voluntary sector, we are not good at having effective communication. We have Twitter, we have email, but at the end of the day we need face-to-face communication to build up credibility and trust and know that we are doing the right things for patients. At the end of the day, the most important communication that we have is the communication with the patients and their families and this is going to take training and support, with everybody on the same page. At the moment, it feels like we're all sitting on a jumbo jet and trying to do its annual service while we’re in mid air.
There are simple pragmatic things that don't take more resources, but which really do need a communication strategy, and it's the same old thing: leadership, it's hard to describe, but you know it when you see it. So I would like to back Mark when he asks 'who is leading the communication strategy?' because,if we don't get it right, we can’t go on. None of us has got it right yet and it's the probably the most fundamentally important cornerstone of what lies ahead. That's why I'm delighted to support the motion.
Heather Moorhead (HM): In opposing the motion I'm going to consider it from a wider, dual perspective: from a local government reformation perspective and from an NGO community perspective. Nobody could argue that communication isn't essential; it's fundamental to what we do, but it's not communication that's going to cause the change to falter. We need to talk about change in terms of a journey.
If you look at how healthcare services are being changed across the world, you'll see that NI is not alone. TYC is our own little acronym - but it's no different from what's happening in GB and throughout Europe. While other regions are fighting against different systems or models, we're making fantastic progress. In fact, in NI we are looked at with envy by the other regions of the UK because we have a budget, a plan and ministerial agreement. Although there are bits that people don't agree with, everybody is in full agreement with it. If you compare it to other change programmes, it's an amazing deal.
I agree a little with what you are saying Mark. It's everybody's responsibility to communicate and we can't blame it on anybody else. It's up to us to read the email and up to us to go to the meeting because it's part of our professional responsibility.
In the fifteenth century Machiavelli said: 'There is nothing more difficult to take in hand, more perilous to conduct or more uncertain in its success than to take the lead in the introduction of a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders of all those who would profit by the new order, this lukewarmness arising partly from fear of their adversaries, and partly from the incredulity of mankind,' and this is the bit that really strikes at my heart, 'who do not truly believe in anything new until they have had actual experience of it.'
We are trying to imagine something new and build it and that's a very difficult thing to do from a communication perspective. Change is very difficult to deliver on the ground. There's personal interest. There's disruption, there's a lack of levers. The power isn't always in the right place. So my contention is that communication is one element and one element only, and we will not fall over for lack of communication.
GO’N: Thank you. Kate?
Kate Fleck (KF): I'm going to start with a quote. Two words: information and communication. They are often used interchangeably but they signify quite different things. Information is giving out, communication is getting through, and I think that while we might be succeeding in information, getting through is where the difficulty really lies. If we believe that is true, then I believe that there is a really big challenge for TYC. The elements of good communication encompass for me listening, hearing and understanding, but also using appropriate language. Often the language used by health professionals or managers is not the appropriate communication style to get information across to the public. If there’s a lack of clarity in the message then we get acronyms of TYC morphing into ‘Transferring your care’, ‘Take your chance’ etc.
There are too many acronyms in the health and social care service. Does this really contribute to good communication and understanding for those who are users of the service? Indeed, I have now been asked to supply a list of acronyms within my quarterly reports with an explanation of what they mean. Over the last couple of years this has actually grown to a full A4 sheet which is pretty telling in itself.
If we look at the aspirational message of the original Esther Model, it was: the person at the centre of care; responding to individual needs and delivering service closer to home: simple, clear and easy to understand. There has been a failure to follow up on the momentum of this concept and we now exist in a communication vacuum. In other words, the original positive message and elements of TYC are being consumed by all the negative events surrounding the implementation, such as overcrowding at A&E and increased waiting times for diagnosis and surgery. The 'Nolan' factor means that changes initiated under TYC are being perceived by many in the community as ‘threatening their health service’.
In an information vacuum, misinformation thrives and that misinformation can do a lot of damage. What is needed is communication and engagement that has a positive impact in building confidence in the changes happening in the health and social care services. Currently I would say that confusion reigns for many people living with long-term conditions and other illnesses. They’re confused as to which bits of the service they should use. The Health Minister states that TYC is a three to five-year journey. What is needed now is coherent, consistent, transparent and regular communication and not just information, which instills confidence in people as to what is actually happening.
One of the biggest mistakes in the communication arena is that consultation is perceived as communication, especially within the third sector – and, speaking with my third sector hat on here, I'm afraid it is not. How often have we been consulted on things these days, yet never really get feedback on the impact consultations have made. So what happens? Cynicism and consultation fatigue set in.
We really have bought into TYC and we want to be there and we want to help to support it, but we often have no greater awareness of what's happening than our service users out there: this is why it's failing. I would make an appeal to those responsible: take the genuine buy-in support from the third sector to help achieve the TYC goals. Include us and work with us. At the end of all this, the most important people are those in our community who depend on the services that are delivered to ensure their health and wellbeing.
GO’N: Thank you. Stephen?
Stephen Slaine (SS): I'm going to return to the analogy of the jumbo jet. I was once at a meeting where Dr McCormack was explaining what was happening with TYC and he described it as a change process; much like redesigning an aeroplane while it was flying. Dr McCormack emphasised the fact that we need to keep the patient at the centre of this momentous change. So, as we are redesigning the aeroplane while it’s flying, what do we - as passengers - need to know? How long is the flight going to be? What are the weather conditions going to be like?
I think we have to view TYC as a journey. The communication needs will be different at each part of that journey and the message will have to change along the way.
The success of the communication process so far is how our different professional organisations are reacting to the strategy of TYC. There is no other alternative, so for me the successful establishment of 17 ICPs: diverse groups of individuals from primary and secondary care, and the community/voluntary sectors - should not be underestimated.
What has happened is that relationships have been established across the region and across the professions; building rapport and building an understanding of how each one of us can contribute to the delivery of care for the individual. There is a more united commitment for TYC to succeed and there is a team of individuals there now who want it to succeed.
I've been working in the respiratory pathway in the Northern area. There are multi-disciplinary groups, task and finish groups, and clinical lead groups: people from different disciplines working together to break down professional silos to deliver better and more efficient care. For me there is a sense of personal ‘buy in’ now and a commitment to the job ahead. I sense a definite feeling of ownership to the TYC project. I would suggest that this has been enabled by good communication and that we are now moving to a new phase of the communication process to get people to buy in from the ground up. I cannot support the motion.
Martin King (MK): I want to first of all state that I am from a student background and will be giving my opinion from that perspective.
TYC set out proposals for the future model of care in NI, which is different from that which we have. We want an integrated system with greater links between primary and secondary care, other healthcare disciplines, voluntary organisations and industry. All of these demand a good understanding of the main aim of TYC and that is to have the right care at the right time at the right place. When change is introduced to the system we currently have, people will apply and implement it and they will do it best when they understand the reasons for the change.
Students are the unnoticed eyes and ears of our organisation, but students sometimes feel that they have not been communicated with by the board and upper echelons of management. Students in NI currently feel they are tagged on, as if they have no role to play in delivering services, and this begs the question: how can such a large resource be used to deliver the aims of TYC? Should our health and social care policy be a part of our core curriculum? And should TYC be on the curriculum here in NI?
As a healthcare student, I'm in the infancy of my working life but I, like so many others, want to know about the system that I will one day work in. I want to be best placed to allocate NHS resources to effectively and efficiently manage the care of my future patients. This is part of what TYC aims to do but, as students, we are not communicated with enough at the beginning of our careers so that we can help best achieve this aim.
In NI in 2012, 84 per cent of medical graduates from Queen’s University decided to stay and work here. Is this not a fact to reinforce my point about the resource we have here in NI? Our students and young workforce are the future, whose careers will be based upon fulfilling the aims of TYC.
TYC began as part of a review into health and social care, with communication mentioned 34 times in the document. Yet students weren't even mentioned. Over the last year, I know that some students have had the opportunity to attend TYC events organised by the Queen’s Healthcare Leadership Forum. But why is it acceptable that not every student is aware of TYC?
From my personal perspective, the only platform for students to have heard directly about TYC has been the Leadership Forum. Of course students have used social media to obtain insight into the TYC policy, but for the most part the majority of people are missing out on updates and measures implemented.
There are some small adjustments and improvements happening to our health service every day, but there is no communication link. Without direct communication we, as students, remember more negative than positive information, and I would like to echo Kate's message on that. This is what is referred to as negativity bias and let me give you a prime example of this. The use of social media for large organisations highlights this. McDonalds uses Twitter for customers to give stories of their experiences in their outlets. Out of 79,000 tweets about Macdonalds, only 2000 were negative, so even though 97.5 per cent were positive, most of the headlines focused on the ‘failure’ of the campaign. The social media input and communication about TYC have been strong, but I believe there are more ways to advertise this information with stronger positivity so that student and service user both understand why - and not just what – TYC is about.
I would therefore like to uphold the motion.
GO’N: Tom?
Tom Richardson (TR): Coming from the voluntary sector, you'll probably find this more challenging and controversial. I certainly don't believe that communication is a major issue. It certainly won’t cure all the ills of the health service. We've mentioned the concept of a journey and I think we're on a communication journey. To put that in context, I suppose we should look right back to June 2011 when the Minister announced the review itself, followed by the TYC document, which was widely distributed and widely communicated across NI. The review was actually, in fact, a 213-page review: how much communication do you need? To finalise that review, 238 individuals and 56 submissions were received. The document was very clear and summarised well what needed to be done. In fact, John Compton gave a very strong message at the time - an interesting message - where he stated that the review was about change - not careless or haphazard change, but planned change over a five-year period that can - and should - improve care.
The report may have been contentious to some, but the review team saw clearly that there could be no neutral decisions with respect to the future. They took the view that managed and transparent change is better than unplanned and disorganised change. The review concluded that there was an unassailable case for change. A future model for integrated healthcare was subsequently developed and communicated widely again, and strategic population and implementation plans were drawn up and distributed widely.
In March 2013, the TYC: Vision to Action report was communicated. The board received 2242 responses across NI from individuals and organisations. It was also communicated to the NI public, with nearly 759,000 Vision to Action leaflets distributed.
After nearly two years of planning and widespread consultation and communication, my question is: are we all listening to this communication? Communication in relation to the new structures that have been put in place across NI? Seventeen ICPS focusing on local need, targeting conditions which we have seen growing and which will continue to grow. Frail elderly, diabetes, stroke, respiratory. MDGs – multi-disciplinary groups which have been set up in each of the geographic areas. I sit on the Northern committee, and I have to say it's a very robust group that we have there, driving communication and driving what we're ultimately trying to achieve: new pathways for better care. And, throughout all these changes, there has been widespread media, which has arguably been one of the most contentious areas of communication. Unfortunately, TYC has fallen into the media negativeness, merely because of the planning that has gone wrong: the planning that has gone on, for example, around A & E, and even this morning around the GP out of hours service. This is not poor communication: this is poor vision and poor implementation. The lack of vision will continue to reduce public confidence in health. There's a distinct lack of vision - it's not communication. How do we close an A & E department without understanding planning and fall out? It's not about communication: it's about vision and planning. The voluntary sector is waiting in the wings to engage on implementation. Poorly-planned implementation will be a reason for TYC to falter - not communication - and it will indeed fly in the face of what TYC set out to achieve. It also flies in the face of what John Compton said in his message: ‘managed and transparent change is better than unplanned, disorganised change', nothing to do with communication.
GO’N: Thank you. Now, I’d like to ask the proposer and opposer to summarise.
MR: I’d like to make three points in response to what has been said.
With regard to the description of people who propose the motion as ‘resistant to change’, I’d like to say that we’re not afraid of change: we want to drive change and to own it. It’s about how we communicate not about the poor communication.
The other thing I would say is about the point made at the end about implementation. Implementation on the ground is about communication and this is where we are failing because how can we fill the ground between the top, middle and the bottom?
And the last point I’d like to make on behalf of my team is that there have been a lot of process measures that have been cited by those opposing the motion. Process measures can be easily built and thereby give the appearance of change - but that doesn’t mean that it’s actually happening. We have the sparks – probably individual sparks - but what we really need is a fire.
TM: We’ve made some very passionate comments but what I would say first of all to Martin is don’t ask what TYC can do for you, ask what you can do for TYC. Students are active and intelligent – get out there and have your own conference – it would certainly get things moving!
In terms of Anne Marie – your comment is very well made about a journey, but the journey is taking much longer than expected. The reason is because the engagement process has not been as clear cut as we thought at the start and that to me is really a recognition of the engagement process positively developing the change.
And Kate, yes, your patients are vitally important. The patient is the main issue, but the patient isn’t interested in TYC, the patient is only interested in – as Martin said – the right treatment at the right time in the right place. So we’re getting that message across and you can clearly hear it. So the implementation phase has now been reached so let’s look at communication and let’s improve it going forward.
GO’N: Before I go forward, I think it reflects badly that Terry who sits on the TYC implementation board is the only representative here from TYC. They were invited but chose not to come. I think that reflects badly on the whole communication process.
TM: I don’t think that’s fair!
AMM: And I’ll second you on that objection!
TM: I don’t think that’s fair. There is a concern and a justifiable concern because of the way that communication can very quickly – with the Nolanisation of things in NI – can change from a positive into a negative and Kate very eloquently articulated that in what she said, how quickly that negativity can come to the fore. So there is perhaps a certain caution, but that caution I don’t think reflects an unwillingness to engage. Communication is not about avoiding engagement, it’s about making sure it’s done in a positive way.
AMM: TYC is about all of us and, most importantly, TYC is the patients we are paid to provide services to. The faults with communication sit with all of us. There is nobody who is individually to blame: we are all collectively responsible. We need to up the ante on this because, not only do we need to communicate across the sectors on this a lot more articulately, but we really need to engage patients. We are at a tipping point; we cannot provide health services with the growth and the demand. It’s not sustainable, so until patients and carers can be upskilled and are able to manage their own conditions, we’re all failing. TYC is not a few people drawing up business cases or sitting in an office making plans, it’s fundamentally all of us and how we deliver care. And I have to say, we were doing TYC before the document was even written!
GO’N: Can I just say I would suggest that TYC is predicated on a false premise: that it would be funded by £83m coming out of secondary care. Can I hear your views on that please?
MR: I’d like to come back to the point that Terry made. This is not about us standing on the sidelines waiting on handouts etc. We’re all motivated. I think this is a failure of how we communicate. I’ll give you a practical example. I go onto the knowledge exchange website for unscheduled care. It is very light on detail: there is little there. Yet I can give you an example from within acute medicine: a very innovative virtual ward concept, but it’s not on the website. Why not? Lack of communication. I know to put it on now but my management team knew of our work but didn’t know to put it on there. They actively sought to get some TYC money for innovations but were told there was no additional money out there. It comes down to the bottom line, which is how we make it fit for purpose and make communication better. It's about giving innovation the oxygen to breathe and to deliver the TYC aims and premise.
HM: In my role I cut across a lot of different sectors, but five minutes into any conversation you hear the same thing: we want change, we’re committed to change, but we can’t get change to happen. The levers of change, the mechanisms of change are not in place and the sense of power isn’t there, so there are people with great ideas and they want to make a difference. What I don’t think we’re good at is spending time talking about how we re-engineer the system. I spoke at the weekend to a doctor who said ‘we need to get rid of 75 per cent of people who get DSS. That’s what would make TYC.'
GO’N: Very perceptive!
HM: I wouldn’t necessarily argue with that point, but what I would say is that everybody has a solution to the problem and it’s never their profession that’s causing the problem. It doesn’t matter who it is, they’re blaming someone else. We need to take a wider view: how do we keep people well? This is about people understanding that the need is increasing at a great rate. We need to engage the whole of society, but it’s not just communication that does it.
KF: At a meeting at Skainos Centre in East Belfast service users voiced their feelings about being consulted, about being involved through Patient and Client Council, and yet nothing came of it. They were asking, ‘what is the point of us wasting our time?’
I am one of the strongest proponents of the self management agenda: of giving people the skills, support and motivation to actually manage their conditions, but to do that requires time and commitment. We go back to that journey: it is a journey to do that and we have lots of evidence-based material to support that, but we do need to invest in it! There are a lot of healthcare professionals out there who are at the coalface day in and day out who are carrying out good work, but it’s primary care here, nurses there: it needs to be joined up. It’s the lack of joined-up thinking and implementation that’s really undermining the process.
TR: I’ve been on numerous committees where I’ve seen that budgets are tight and they’re being held to the chest. People simply will not give out money, they’re not sharing that money, and if you do want to make a difference, you do need the funding to follow the patients. We’ve had four years of the stroke strategy now and while we’re getting the patient out through the door, we’re not supporting them post stroke. There are ways of doing it but there have to be budgets for implementation.
AMM: We have to focus on keeping our communities healthy in the long term. In the amount of time that I have left to work I don’t want to be concentrating on patients where the eggshell is cracked and they’re ‘broken’. I would love to spend part of my career looking at stopping people from becoming ill in the first place but it’s not politically advantageous for our Health Minister to invest in something that’s not going to reap dividends for another ten to fifteen years. So we need to communicate with our political representatives to say ‘be courageous in the long term’ otherwise we could be having the same conversation in ten years’ time. Except that, by then, the jumbo jet will have crash landed and it’ll be a total disaster.
MK: To continue the jumbo analogy I'd like to focus on the crew, ie, the leaders of TYC. They need their communication and instructions. Our service users have been given responsibilities but it’s not being communicated to them about the services that TYC can provide for them.
GO’N: In short, we need a fully engaged community and we don’t have that. How do we communicate that down the food chain?
MR: With regard to public health, we need to consider education, transport, food, employment. Some people have said that the greatest contribution the NHS makes to health is the fact that it employs more than one million people across the British Isles and NI. Where’s our engagement for example with the transport sector – Translink? How engaged are you with them?
TM: We are very strategically linked to Translink through the Belfast Strategic Partnership. Active Belfast is a concept which has grown out of the partnership between the Trust, Belfast City Council and the Public Health Agency. This has been a very clear consensus for some time.
MR: I understand the aspirations behind this model – but how are you measuring the results of this? Are you measuring how much people are walking for example?
TM: We are referring people into Active Belfast….
MR: That’s a reactive health service model, I’m talking about the Translink model of improving the distance the population travels on foot and public transport.
TM: It’s not different. It’s reflected in the number of walking spaces, it’s about cycle lanes. We are measuring those.
KF: That’s all very well, but what about the rural locality? We’ve actually had to start putting on transport to bring people to self management classes because no one else is going to help them. That’s great in Belfast but there’s still a mass of people out there, who are unable to access these types of services.
TM: If you look across Northern Ireland, the public health strategy is beyond health, it's about joined-up government. Many people think that health has to take everything on and that’s not possible. The government has made a contract with the public to deliver but the public are not actually delivering on their side of the contract if they refuse to take on the messages.
KF: Yes, but Terry they can only do that if they are given the support to do it. Often people are left to their own devices to make themselves better. It hasn’t been ingrained in us to take responsibility for our own health. People have to take responsibility, but they will need the skills and especially the support to do so.
GO’N: Is that the role of TYC?
HM: We need to change the conversation from ‘them’ to ‘us’. We are all service users and we can all be empowered so we need to change the conversation from a disempowering one to an empowering one.
GO’N: I would agree wholeheartedly with Heather. There is not a separate species out there called ‘patient’. It is all of us.
TR: I think in terms of patients with complex needs, post stroke for example, we need to get back to the subject of self management. People are very willing to engage post this very traumatic period in their life, but the support is not there and, if TYC is going to work, it has to implement that support. We did a study which showed that in the first 30 days post stroke, twelve per cent were readmitted, mainly because they weren’t given support.
SS: I would refer back to Kate’s point about information giving out and communication getting through. I see that increasingly through the work of the ICP. We are receiving training as a group within the ICP and the penny is already dropping in different people, who are beginning to see how the process can work. There are those who haven’t bought in yet but, as Mark says, there are sparks which need to become fires and these sparks need to be fanned so that the change comes from the bottom up.
MR: In the Belfast Trust there are 22,000 staff and the vast majority of them still don’t know what TYC means. Complacency is too rife at the moment and the reason it’s too rife is due to a lack of leadership and a lack of communication, and this takes me back to the motion.
SS: You need foot soldiers to articulate the message and that will then be communicated through to the other levels.
AMM: We have a long way to go to help our service users. From an evidence point of view it has to start with supported self management until it gets to a stage where we lay people can lead these groups. We have to bridge that gap but we need resources and it needs to be coordinated and systematic. Patients are not people without a voice: in fact, they are the most powerful voice. A few years ago a COPD sufferer had to make a speech about the effect it had on his life. He had forgotten his glasses and couldn’t read what he’d written so he spoke from the heart. The impact that that man had was breathtaking. We refer now to it as ‘what would Frank say?’ If there’s anything we need to consider when dealing with a COPD patient we ask ourselves, ‘what would Frank say?’ It’s the Esther story in an NI version.
GO’N: Any suggestions as to successful models that we could use to convey this message?
TM: We need to consider what connects the practicalities of running a health service with the emotional issues that people have around their own health because that seems to be at the centre of this communication problem. At the end of the film Captain Phillips, there is a nurse who tries to engage with him but he needs an emotional connection and all she wants to do is take bloods. That sums up the limitations of the health service.
GO’N: Where is the money coming from? To me the whole thing is predicated on releasing £83m from secondary care.
MR: Mr Chairman I think we are much too focused on money. You could put a totally different slant on it and say that needing to save £600m is a fantastic opportunity! Over the last ten to fifteen years we have developed a bloated, bureaucratic, unresponsive health service which has bolted on, added on all sorts of services and layers and now we can’t see the wood for the trees. We need to take the opportunity to start again but more capital is required to do this. It is about communication and it is about leadership: the two are intertwined. At the moment the money is going to the wrong places.
GO’N: Is the present model fit for purpose?
TM: No, it’s gone completely beyond that and I agree completely with Mark. There is a project in Mount Vernon at the moment doing exactly that type of thing. It’s getting home help going; it’s about volunteering; it’s about people being trained; people who haven’t been active. And it’s going along the lines of the Take Five initiative, whereby people become more active and more engaged, which automatically improves their health anyway. In this way we’re changing society.
MK: I think everyone is agreed that TYC is not a static process. You’re talking there about making efficiencies. If we continually review TYC we can develop it and make it more effective. We can’t just say ‘this is TYC and that’s it’.
TR: I also think that more joined-up thinking is required between the different agencies. At the moment we have five Trusts who all seem to want to do their own thing, for example, producing information packs on the same issue. Why are we doing this? It’s a waste of resource. We’re not collectively thinking. More joined-up thinking and breaking down the silos is required.
MR: Mr Chairman, I can’t think of a better way of summing up the motion!
GO’N: In summing up, as professionals working on a daily basis in the health service we see great work being done every day, so let’s not end on a negative note. There are however so many things that we could do better. We need leadership. We need risk takers without being reckless. We need to empower people – and that’s the cry that has come from this. Also those who are responsible should be made accountable: financially, clinically and otherwise. We don’t do that. This has been generally positive but it’s leadership that we’re crying out for. Thank you very much for your attendance and for your contribution.
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