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CCG Series: On five year plans


28 May 2014

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Dr Joe McGilligan outlines his vision for the NHS in five years time and the risks of being innovative in a conservative culture
When I met NHS England chief execuitve Simon Stevens I noted that the last person I knew to introduce a five-year plan was Stalin and he had Gulags for his dissenters! However, I do realise that the difference this time is we are being asked to imagine the world we want in five years, then look back and work out how to get from now to utopia.

Dr Joe McGilligan outlines his vision for the NHS in five years time and the risks of being innovative in a conservative culture
When I met NHS England chief execuitve Simon Stevens I noted that the last person I knew to introduce a five-year plan was Stalin and he had Gulags for his dissenters! However, I do realise that the difference this time is we are being asked to imagine the world we want in five years, then look back and work out how to get from now to utopia.
The vision 
My vision in five years is to have an NHS which is truly national. There should be no more postcode lottery but a public understanding of what is possible within the envelope of staff and financial resources; true honesty of where and how care is delivered and why. The analogy of an environment agency, which has £100 million to spend deciding whether should it be on 900 houses on a flood plain or 11 million in the Thames estuary, springs to mind. If there was £200 million they could do both but there is not an endless supply of money. 
The public must start taking responsibility to keep well, listening and hearing the public health messages and using the advice to prevent them developing ill health. Social services, council and health combining budgets must share responsibility for the public pound. This will enable the equitable care offer to all, irrespective of ability to pay, and focus on wellbeing and the wider determinants of health.
Everyone has a bed and it is at home – we have a care system set up to keep them there. Hospitals are only used for conditions that require them and they work in harmony rather than competition. Specialist centres providing the best outcomes not worrying about incomes. Primary care focussed on prevention, keeping people well, anticipating problems and providing timely solutions. The cradle to grave responsibility of the registered list, which is the cornerstone of the NHS, goes beyond the medical model and delivers wellbeing as well as health. The difficult conversations about planning for end of life (or death as it should be said) are part of normal life. Simplifying access to healthcare by commissioning care where patients access it; their GP or A&E. Blame culture transformed to learning and supportive collaborations.
The medical profession still pushing the boundaries, but remembering the Hippocratic Oath of thou shalt not kill, thou shalt not strive to officiously keep alive. Personal Responsibility for Individual Delivery of Effort, or PRIDE returned to the NHS and those who work for it. 
Troublemakers
There is an advertisement on telly where a boy, with a severe stammer, talks about risk: 
“To laugh is to appear the fool. To reach out is to risk involvement. To place your ideas before a crowd is to risk being called naïve. To try is to risk failure. To live is to risk dying, but the greatest risk in life is to risk nothing. The person, who risks nothing, does nothing, has nothing and becomes nothing. Only the person who risks is truly free!”
In the NHS, a culture has developed where risk taking has become so abhorrent you are labelled a maverick or troublemaker. I asked former NHS England chief executive David Nicholson many years ago about leadership in the NHS, mentioning how if you are a tall poppy everyone wants to cut you down to size. He agreed!  When I put my head above the parapet I expect snipers – just not from my own side! 
I risk being called naïve and risk failure by trying. But you miss 100% of the shots you did not take!

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