We have very caring and committed staff who want to do their very best for people who use our services and I know you have been very accommodating in trying to stretch services to meet increasing demand. But it is not acceptable for our services to be stretching caseloads beyond their means without this being recognised with additional resources. This isn’t good for our staff, it certainly isn’t good for patients and it hides a fundamental problem of a mismatch between the expectations of our services and available resources.
So what are we going to do about it?
As a start, we need to be having a different conversation with our commissioners about what we can provide within the resources we are given, as is starting to happen at a national level about the total funding the NHS has. We should not be trying to meet greater and greater demand, with an expectation we can continue to provide everything we currently do, if this means we are providing a lesser standard of care. There should be no more compromises on quality.
In order to change things, we are beginning to have this conversation with our commissioners about the quality, financing and demands of our services. We have signaled an intent to agree some clear and fixed standards of quality for all of our services and to co-produce with staff and our commissioners a service offer that ensures we can deliver to these standards.
This may mean not being able to provide everything we currently do. I know how difficult it is for staff to say ‘no’ when all you want to do is provide care and support to everybody who needs it. But if it isn’t safe or affects quality, then we are going to have some difficult discussions about a different service offer and what we potentially won’t be able to do. So, agreeing these standards, thresholds and pinch points needs to be a clinically-led discussion, in collaboration with our commissioners, service users and local communities.
As a starting point, we are currently working on putting some quality principles into our contracts for next year for those services that are struggling the most, which includes our mental health wards, district nursing and community mental health teams. This will provide us with a lever through which to start negotiations about what resources these services need in order to meet demand and provide safe, high quality care. It also means that staff can be clearer about what is and isn’t acceptable and are empowered to escalate when safety or quality is being impacted.
These improvements won’t happen overnight, but I want to reassure staff that you have the full support of the Board to address the challenges facing you on the frontline. We need to support you to get back to providing the very best care you can, without compromise.
I’d be really interested in hearing your thoughts about this, so do email firstname.lastname@example.org with any feedback.