Leaving The Front-Line, But Joining A Larger Fight.

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Cameron Whytock, Haelo improvement fellow and a new member of the NHS Quest PMO, discusses his reasons for embracing a year in improvement science.

Since I was 15 my life has been focused towards becoming a doctor.

A doctor sees patients in clinic. A doctor does ward rounds. A doctor prescribes fluids, writes discharge letters, does home visits and breaks bad news. A doctor does not work in an office, full time. Yet that is what I have ahead of me for the next year. Why have I departed the clinical front line for a life of office meetings, web conference calls and endless cups of coffee? (OK, maybe that last one hasn’t changed much)

After only 2 years in the NHS I’m concerned. The combined trusts’ deficit for the 2015/16 year was £2.45bn. That’s versus £822m for 14/15 and around breaking even for the years leading up to that. Things have gone downhill quickly.

It’s scary and the effect of that deficit filters down to the front line. Trust me it’s being felt, I’ve been in the middle of it. I’ve had a patient in A&E with an acute bleed in the brain wait over 5 hours for a transfer to the specialist centre for the life-saving surgery they needed. The radiologist had reported the CT scan as ‘imminently coning’. ‘Coning’ is the process of part of the brain being squeezed through a hole it’s not supposed to be squeezed through, usually resulting in death. The receiving hospital had not a single bed available. The conversations with the worried family explaining for the third time that we “were doing everything we can to speed things up” were some of the hardest I had to have. I hope they helped, but in the end they didn’t magic another bed into existence. If you think about situations like this, and the direction you feel we should be moving, you’d like to think they were becoming less frequent. But they’re not, they’re becoming more.

We know where the problems lie. There’s undoubtedly an economic issue and there’s a debate to be had around that. But we have a rapidly aging population with more complex combinations of health conditions and that problem requires more than throwing more money at it (also – where is that money going to come from? The UK government deficit still stands at £69bn at time of writing!). We need to start thinking about, and doing things, differently.

In my mind the NHS is one of the pinnacles of our achievements as a civilisation. Think about it – we’re really just apes evolved a few hundred thousand years down a different path yet we’re at the point where we have a system of healthcare which is gloriously equitable, universal and cost-free at the point of use using phenomenal advances in biology, chemistry, physics and technology to improve our well-being on a scale like never before. You’re treated based purely on the fact you’re a human being therefore your humanity is valued most, as opposed to the contents of your bank account.

But another advantage of the NHS, which I believe is under appreciated and is being under-utilised, is the potential for massive collaboration between different hospitals, trusts and regions. As we’re all singing from the same hymn sheet in terms of attitude, aims and philosophy there’s a huge opportunity to learn from each other. What problems do we share? You try that, we’ll try this and we’ll see what works. What have you done that has worked well? How can we use it ourselves? What hasn’t gone well and what lessons can we all learn from it? There are 154 acute trusts, 56 mental health trusts and 10 ambulance trusts (plus other community providers). That’s at least 220 opportunities to try improvement ideas and find solutions to problems from which we can all improve.

NHS QUEST embodies the philosophy the NHS as a whole has to adopt in order to survive the economic and demographic catastrophes arriving in the middle-distance. We can learn from across the NHS and need to promote that, versus trusts acting as small independent kingdoms. That’s why I’m briefly leaving the front-line for a Haelo fellowship. Part of that will give me the opportunity to work with the NHS QUEST team on improvement projects – to help in whatever way I can to make the changes I believe have to be made in order to make the NHS sustainable.

Even if that means working in an office.