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Simple Is Not Easy - why changing stuff in the NHS can be so damn hard...

by David Gilbert

June 18, 2019

You may disagree but Leeds Utd played beautiful football in the 70s. Simple, short passes and/or elegant sweeping attacks. Jazz pianists make it all look and sound so smooth.

But, boy did both sets of players practice their moves. Simple is not easy.

A year or so ago, at our Sussex MSK Partnership, we found it hard to purchase the right chairs for people with who used our services. People in waiting rooms found our seating uncomfortable and some needed chairs with arms so they could lift themselves in and out of them. Simple enough, right?

But we rent our specialist clinic from the hospital. And we had to try to find its Estates and Facilities department. There was no additional budget for equipment our end. And the issue was nobody’s responsibility it seemed to me. It took months of wrangling over need, finding out where decisions could be taken and identifying pots of money. The physio lead and I were seriously discussing buying them out of our own money at the local Ikea. Eventually, through schmoozing and good relationships we got the chairs. This is nobody’s fault. Simple is not easy. The saga has become known as ChairGate internally.

Our patient and admin staff-led project now known as ‘Communication, Information, Access’ (CIA) has been calling for months for a total revamp of our website. Once again, there was need to demonstrate need (was it just a content issue? Was it about speed and functionality? How did it link to our wider comms work), think through whether it was a priority and find the right people with the time and energy to do it. It has proved tricky. It didn’t help when I confused the issue by raising the prospect of moving to a completely different platform (which was then understood differently by different people as requiring too much time and energy). We got there in the end and we should have a much improved website soon. Simple is not easy.

Meanwhile, the CIA group (and more particularly, one of the amazing admin members of staff, Julie) spotted that patients wanted to know whether our service had received their referral from their GP. Many were phoning their practice who would then ring us. A simple text confirmation that we had received their referral would fix that. Simple?

It has taken many many months to get there. It needed me to go up to the IT department and push a little (they are lovely but excessively under pressure) and to try and fathom how much it would cost and where it was on their priority list.

It is simple to say ‘just do it’ but the list of other stuff they have to do first is humongous. It helped that the person in charge of budgets was there when I went up to speak to the guy with the nous to work out how to do it – both had long recognised the need (all staff want to do the best they can for patients in our organisation, please believe me!).

So, finally, it all came together like the numbers on a padlock – aligned at last… evidence of need, desirable and feasible solution, gatekeepers to the decision making and unlocking of resource and money. Simple. Not easy. I do believe patients as partners in decision-making can smooth the path from idea to solution by the way!

This is the NHS. Many patients, justifiably angry when things are not done and justifiably frustrated when simple fixes cannot be done quickly can leap to a story about what happens behind the scenes – that those in power do not want to do the things that matter.

But there are two assumptions and interpretations made there – firstly, that there is someone who has that magical power switch and can just do it or get it done. Secondly, that the delay in getting it done must therefore be based in some sort of malign or blocking intent.

Well, sometimes the above things can be the case.

But not in our organisation I don’t think. What I have seen is that the systems and culture can be frustratingly difficult to navigate at times – sometimes for understandable reasons – and that aligning the numbers and releasing the padlock may look simple. But is not easy.

The NHS will never sweep upfield elegantly. It will never be a jazz pianist. Those who can influence culture and systems do need to make it easier for patient-led solutions to happen. I see that as very much part of the Patient Director role. But: simple is not easy.

Good luck with your own ‘simple but not easy’ work.


© 2019 David Gilbert

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One comment on “Simple Is Not Easy - why changing stuff in the NHS can be so damn hard...”

  1. Dear David

    I empathise with you but, it also has to be said that there are people in NHS organisations, quite often middle managers, who don't want to listen. My colleagues and I go and have a good look round from time to time and 3 times, when we have been asked what we are doing , and we explain, they say, "come with me" and show us things that they have given up mentioning through the usual channels, like Estates, (there's none so deaf as those who chose not to hear or see) where we have been able to get stuff done when the boss has been in his office writing lots of reports as to why something CAN'T be done.

    We got the water fountain linked to the water pipe instead of paying hundreds for the huge water fountains that has cost loads. We got fire corridors cleared of years worth of clutter, old desks, old this and that and worst of all, a fire door proped open with a fire hydrant.

    It can be done but it has to be said, it's sometimes easier than others. And there is still the issue of "the attitude " to patient reps (for want of a better word).

    It also has to be said that in reaility, NHSE just does NOT want to engage!

    It speaks with forked tongue. Don't do what I do just do as I say.

    Here's the proof: Malcolm Grant. NHS England Chair, at a meeting of NHS Citizen, said recently:
    “One of the wonderful things about the NHS is that it is one of the most wonderful institutions in the world. But one of the problems is that it is an institution. We talk about coproduction.
    Our statutory obligation is to consult; we’ll consult in many instances is telling people what we are going to do and then not listening and going ahead and doing it anyway”.

    Just look at NHS ladder of engagement and then look at the original; you circle of engagement: commissioners know nothing about it, let alone use it.

    That's what we are really up against.

    Keep up the good work

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