The Great Escape

Many people, who do not work in the NHS, must think doctors are an ungrateful lot. Largely educated at public expense, paid huge amounts of money and doing a job most admit they enjoy doing, and yet they complain; usually about politicians or hospital managers.
Just to give an idea of what we put up with and what is p!ss!ng us off I have reproduced an email sent out this week to all the consultants at a Trust somewhere in the UK (I have taken out the initials which identify the Trust and replaced them with ....):

"PURPOSE OF REPORT: TO SUBMIT, FOR DISCUSSION, AN OUTLINE APPROACH TO THE DEVELOPMENT OF A MEDIUM TERM STRATEGY IN LINE WITH THE LOGIC OF THE ‘GREAT ESCAPE’.

1. Introduction

This paper sets out for discussion a (high level) outline approach to the development of a medium term strategy in line with the logic of ‘The Great Escape’.


2. Some context

‘Strategy’ is defined as follows

• Strategy is about role and direction
• A strategy should be based on an analysis of the external forces and drivers for change impacting on the health care system and/or individual services
• This environmental analysis should in turn drive a definition of organisational purpose (mission) and the development of a set of organisational values or decision making criteria; mission and values in turn should shape stakeholders thinking about service development, service design and service delivery together with the nature of the relationship between partner agencies.
• A strategic plan needs to cover a minimum of five years and specify key milestones.
• A strategic plan must be explicit about both income assumptions and the balance between costs, volumes and quality.
• A strategy should be sufficiently succinct for service staff to carry it ‘in their heads’

The key force or driver for change in an NHS which is moving towards a competitive market-driven regime is the aspirations of ....’s customers: PCTs/ LHBs, GPs and individual patients.

It also needs to be recognised that strategy formulation and execution is as much a micro – political process as a technical one.


3. A suggested approach

A three stage approach based on a modified version of the ‘top down, bottom up, top down’ model is suggested. It also suggested that the process is overseen by a reference panel made up of representatives of the PCT/PBC groups and .... LHB, local politicians, members of the public and senior clinical staff (possibly based around the existing FT Project Board?). The development of the strategy will need to be supported by a managed communications plan.


STAGE 1: Production of an .... strategic framework

The objective of this stage is to agree a Trust level strategic framework to provide the parameters for more detailed directorate and care group level clinical strategies

The strategic framework will be based primarily on the IBP and outputs to date from ‘The Great Escape’.

STAGE 2: Production of directorate level clinical strategies

The objective of this stage is to develop draft directorate and care group level clinical strategies.

This more detailed work would involve workshops focused on answering the following questions:

1. What are the forces and drivers for change impacting on and shaping the future of .... and the services provided by the directorate?
2. What gaps or weaknesses are there in the services provided by the .... and the directorate?
3. What are the outputs of any benchmarking exercise?
4. What issues (relating to capacity and efficiency in particular) do ... and the directorate face in delivering access targets and other S4BH core standards?
5. What ‘fixed points’ are there in ...’s strategic ‘trajectory’ over the next 5 – 10 years?
6. What values or deign principles should underpin the development and delivery of ...’s services (including expectations of partners within the local health and social care community)?
7. What are the options for service delivery and what is ...’s and the directorate’s preferred direction of travel?
8. What are the corollaries of this direction of travel in terms of location, site usage and accommodation?
9. What are the critical success factors in realising the preferred direction of travel?
10. Of these critical success factors, what is the top priority?

Debate at the workshops will be supported by where possible by ‘hard’ analysis of demand/workloads, changes in clinical practice, policy and comparative performance. Critically, the resulting draft strategies will be need to be ‘owned’ by the relevant clinical teams and ‘signed off’ by commissioners and patient groups. The Medical Director will have a particular role in challenging and supporting the work of the clinical teams.

It is suggested that a consensus development conference is run to secure the ownership and sign off required. The conference consensus (which would need to run for between one and three days) would be divided into two parts:

• Part one: An internal ... event in the course of which the Medical Director and Care Group Clinical Directors take the lead in ‘cross referencing’ the draft clinical strategies to ensure consistency with the strategic framework and with each other and in ensuring that their contents represent a robust and ambitious set of proposals.

• Part two: An ‘external’ event to which .... customers (commissioners, GPs and patient/ public representatives) are invited to review and comment on the emerging clinical strategies.
Each strategy will need to be tested for affordability in advance of its submission to the Board for approval in principle.

STAGE 3: Production of the Trust strategy

The objective of this stage is to review/refine the clinical strategies and incorporate them into an overall Trust strategy for approval for the Board.

This will involve the Board and Executive Team ‘reading across’ the clinical strategies to ensure that they complement each other and testing them against the strategic framework for consistency. The resulting Trust service strategy can then be amplified to incorporate a capital and financial strategy. The role of the reference panel will be to ‘referee’ the development of the overall Trust strategy. The Trust strategy will be tested in a second consensus development conference for stakeholder groups before formal adoption by the Board.


4. Timelines

The key determinant of the timetable for delivery of a formally adopted/ Board approved strategy is the FT application process.


5. Communications

Although the primary focus is on the engagement of clinical staff, workshops for non – clinical staff and support organisations employing the format set out in section 3 will also be organised.

A week long interactive exhibition to attract patients/ visitors sited at a suitably prominent part of the hospital will be organised.

Invitations to the Consensus Development Conferences could be extended to members of existing patient groups. Certainly the opportunity to participate in dedicated workshops would be provided.

Finally (in support of increasing FT membership) a suitably amended version of the attached would be widely distributed.


6. Recommendation

The management team is asked to discuss the above."

I don't blame anyone for giving up after the first couple of lines and if you did read it all I don't blame you for not understanding it. No-one does understand it but the "logic of The Great Escape" is intriguing. Several senior managers at the Trust where this email was circulated have already made their Great Escape and some now work for the private sector so perhaps they are suggesting the managers plan their exit before the DGH is closed down. Here is an email reply sent by one of the Consultants which I thought was funny:

"I've worked it out I think!! In the classic film a huge effort was put into the planning and execution of the escape involving extensive team working and coordination. Unfortunately, although the escape went ahead, the end result was unsuccessful; all the escapees except one (Charles Bronson) were recaptured and if I remember correctly rounded up and summarily executed. Thus the take home message was that despite all the careful planning and teamwork and effort, the plan was ultimately comprehensively thwarted. So what's new about "The Great Escape" thinking in NHS strategy??"

This report was written by a highly paid director while the Trust is making front line staff redundant. And you all wonder why we complain.