"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Wednesday, 1 August 2012

Footpaths Across the Grass

Unfortunately I cannot find it, but a few years ago I read an article about a local council who were annoyed that people ignored the "Keep Off the Grass" signs in one of their parks. The council looked at what people were doing and found that the people who walked on the grass were simply cutting off a corner when walking from one part of the park to another. The existing paths were to parts of the park where people did not want to go. So the council simply created a path where people wanted to walk. This solution meant that the grass was not walked upon and there were no unsightly bare-earth paths.

This is an important lesson. If you make rules that no one wants to follow you should not be surprised when no one follows them. Equally so, you should not be surprised that it costs you so much trying to make people follow those rules (like employing extra park keepers to shout "Oi! Keep off the grass!")

This story came to mind yesterday at a meeting at my local CCG where a member of the committee I was on asked why a cancer patient was not getting treatment and who was it that would take up the patient's case to ensure that the treatment was delivered. That question was followed by a lengthy discussion from officials about how the complaints and advocacy system should work and how it should work in the future with Local Healthwatch. They gave no reason why this system didn't work for this patient, and although they didn't say it, I got the impression that they felt the patient was at fault for not using the system the way it was designed to be used.

The problem is that the system is not working for this patient because the various providers (the GP and the local acute hospital) and the local PALS service are not working how they should be. The concern is that the new structures will not work how they are supposed to work, and this is more to do with the system not being designed around how the organisations actually work and how patients use them. It would be far better to observe how these organisations communicate and to improve that, rather than changing completely how they work together.

(My opinion is that GPs should be empowered to act as advocates in such a situation and have the responsibility for ensuring that the care is delivered. GPs are patients first point of contact with the NHS.)

Put the path where people want to walk rather than telling people to walk where they don't want to go.

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