I Wanna Be A World Class Commissioner

The importance of going to the 'sharp end' is not to be understated- and not just to inspire confidence in acute staff that the PCT is there, but for our own understanding. Learning the pure theory of commissioned services and actually witnessing them involves a huge gap. Knowing how an ambulance crew prepare themselves in eight minutes is importantly different from being at a PCT and asking why they can't do it in five.

I Love Socialised Medicine

To move from internal communications to external- the impression of the NHS from outside is obviously varied. Before doing this orientation, I wondered how much fact there was to the idea that NHS staff on the managerial side are more or less like any stereotypical office worker in the private sector. Professional, motivated, ambitious, but ultimately doing their job (albeit well) to collect their paycheck.

This way of working is most certainly fine and shouldn't be criticised whatsoever- I know of many private companies who specifically desire their employees to be financially motivated- to prove they will work hard to climb the ziggurat for more pay. But I was pleasantly surprised to find that almost all those on the management side (I imagined clinicians to already have an idealistic streak) did their jobs with a real passion for what they felt the NHS stands for.

You see stories regularly in various newspapers along the lines of 'more NHS managers taking salaries that could be used for USEFUL things like MORE NURSES' and the general demonising of anyone who isn't a clinician and doesn't seem to facilitate care at a face-to-face level. A jobsworthy outlook perhaps.

This underlines a real key- any challenges faced, for the most part, are always hindered by a lack of communication and structural inefficiency, and very rarely because of a lack of motivation to the ideals of healthcare.

Man from the PCT

Commissioners are looked upon somewhat as either 'heard-and-not-seen' or just 'not even heard'. The amount of not just clinical staff but their management that were unsure of the PCT's function (or even existence) was shockingly high. One of our primary goals is to come forward, be seen and be known as the local leader of the NHS, but if our managers in-hospital, in-clinic, etc do not know of us then the patient (and the wider media community) never will.

There are of course those who do not need direct contact with the PCT, but a knowledge of the system you are in and your role within it is important at all levels- context is key. More surprising and more worryingly, the managers, some quite senior, had only a vague sense of what the PCT does. Because of a lack of understanding and contact, the PCT is seen as an overseeing taskmaster, handing down demands for 10% more productivity while losing 5% staff and budget, or to do something in four weeks rather than ten. They don't know the PCT itself is limited, restricted and regulated. They don't know there are often myriad reasons for the PCT to ask for things. They just have the e-mail, the phone call from someone unseen and understandably don't always react well.

It's not as bad as an us-and-them viewpoint; everyone realises everyone else cares about patients and about the NHS. Most genuinely wanted to understand more and asked about the PCT. But the thing that struck me most was how glad those who did know who we were were that I and my colleagues were there, seeing their job in action. I was told on multiple occasions that when they know you've experienced a snapshot of the work- when you know it takes 4 minutes not thirty seconds to fetch a drug for a real reason, they are so much more likely to respond to requests and see you as a support to patient care, not a hinderance to their jobs.

Who Are You Again?

Every person I asked in every department responded that the huge majority of issues with getting something done in their area of work was down to communication, rapport or lack of the two. Only a small proportion of those I spoke to talked of lack of funds/organisation/computer software as to blame for frustrations in achieving their goals.

These are all busy people, some on that real 'front line' of providing direct care, but all feel the pressure more when they don't feel informed.

I spoke to a porter at KGH who commented that sometimes when a patient is moved for an unscheduled prodecure (or occasionally if a patient has actually died overnight) his team are never at the top of the to-be-informed list. This makes sense, as those closer to life-saving care rightly come higher. But to be left off completely on a regular basis? The ramifications are wider than the immediately obvious- a porter arrives on time with a bed for patient x, finds they're not there and now that porter has to move that bed back and has lost time. It is the pileups of small contrivances like this that add to the lack-of-bed-capacity backlog that then plague A&E as they try to keep to their 4-hour time. It frustrated the porter staff; those of whom I met truly enjoyed their job, feeling themselves the crux of day-to-day hospital running, and wanted to be provided the same forethought by others in senior positions as they do to keep themselves organised.

The point here is not one of demanding the PCT somehow jump in and shake KGH until it Does Things Better, but to highlight my earlier point of how concerns like patient pathway speed, quality of care and staff morale can be distilled in one single problem and how easily it could be managed.

A Trip to the Hospital

The facts of healthcare operation in Northamptonshire is a thing rarely glimpsed by anyone not employed in an acute trust, excepting perhaps the patient experience, and this of course being a somewhat narrow overview.

A 6-week orientation experience around Northants healthcare providers, from GP's to trauma wards and the mortuary, would reveal, surprisingly, at least as much about why NHS staff act and work how they do than as how operations function under the umbrella of a fairly unseen PCT.

It also provided an incredibly fascinating insight into the path the patient takes while under our care- from a GP visit for a persistant headache to a speedy arrival at A&E in an ambulance.

The thing that struck me most was the personal aspect of the entire operation- as much as it seems fairly assumptive in the NHS that personal communication would be and should be as important as good governance and efficient systems, there is a real difference in this outlook compared to employment I have experienced in the past. Knowing who is at least as important in our business as knowing what and why.