The Post Boat

The Post Boat

When I was 11 years old my family had the unexpected opportunity to have a holiday of a lifetime. Friends of ours were living in The Bahamas at the time, and we were invited to stay with them. We arranged a 10 day break during the Easter holidays. The trip would be our first and last overseas holiday as a family, and involved our first journeys by aeroplane. You can’t fly direct to Marsh Harbour where our friends lived, so we had flights from Heathrow to Nassau, and a connecting flight onwards. All very exciting.

The outward journey went well, we arrived safely and had a wonderful time. Part way through the 10 days our hosts checked with my parents about our return flight time. My mum explained that she had been rather taken with their descriptions in the past of how people sometimes used the Post Boat to hop from island to island rather than flying. We had therefore got a flight arranged back from Nassau to Heathrow, but thought we would just jump on the Post Boat for the short trip from Abaco Island back to Nassau. 

There was a stunned silence. “The post boat takes at least a week to make that journey,” we were informed. Ah. Our flight back to the UK was in less than a week. There was no way we could use the Post Boat, it was just going to take too long. To make matters worse, it soon became apparent that there were no available commercial flights either. We were stuck on the island, which me and my brother thought was great, but was somewhat stress-inducing for my parents!

It can be pretty stressful when plans fall apart. Sometimes it can be because planning has been poor, sometimes our planning was based on poor or inadequate information, and sometimes the planning might have been fine, but other circumstances beyond our control come into play.

We have known for a while that our local health economy was heading for financial difficulty. I recently blogged about that in a post I called Glass Half Empty. Our plan for some time has been to collaborate and work with local providers to integrate and transform our local system. We have known there wasn’t enough money. We have known we couldn’t carry on with the current levels of activity. We had a plan. It has become apparent that our plan is like the Post Boat – it is going to take time, and our flight is leaving now. The Post Boat still seems like the better way to do it. A better journey, a better or at least the same end point, cheaper and smoother. We’ve run out of time though.

In 1982 my parents had to charter a 6-seater plane to get us back to Nassau. The picture with this blog is of my family standing by the plane (I’m the older child). I dread to think how much that cost. It wasn’t what we wanted. It was stressful and expensive, but it was quick. There were longer-term implications I am sure in terms of our family finances. 

Our CCGs need to find the equivalent of chartering a light aircraft. We have to save money now, and our integration programme is going to take too long. We have developed a Financial Recovery Plan. It has all kinds of things in it, some of which sound really good for  both our CCG bank balance and for patients (I particularly like the idea of the Virtual Fracture Clinic), but many of the schemes are going to be about cutting or reducing services. We will have to look at how many cycles of IVF we can afford to fund. We will have to consider our prescribing, and are looking st promoting self care, and reducing prescriptions for Over The Counter medicines (in other words, please don’t ask for prescriptions for paracetamol or calpol from me, as refusal can often offend). We will have to consider referral thresholds for procedures like hip and knee replacement (so, for example, you might not be able to be referred unless your BMI is below a certain value and only if you are a non-smoker, and you might have to complete a 6 month lifestyle class first). We will have to consider all kinds of things that are unpalatable, unacceptable to some people, and certainly unpopular. 

The Kings Fund recently published a blog from Ruth Robertson about public perceptions of NHS finances. It’s worth a read and gives us an idea of how the public are likely to react to these initiatives. The key message for me is that we need to very quickly present these plans and schemes to the people of the Central Cheshire area. I believe that an informed and engaged public will understand and be tolerant of our actions. What we need to try and avoid at all costs is just cutting services without explaining why. I am disappointed that there is not a higher profile national conversation going on about this, as we are not the only area to be struggling with money. I have said before, and will say again now that I think the government and NHS England have a responsibility to be informing the public of the implications of austerity on the NHS. 

34 years ago, we missed the Post Boat. This year we are realising that the integration boat has already sailed. We still need to do the integration work but it is not going to solve our immediate financial problem. 

This blog is a warning. A warning to fellow commissioners who might still be on the Post Boat – are you sure it’s going to get you there in time? A warning to providers that the money is running out, and that drastic commissioning actions are about to be taken. And most of all, a warning to the public that NHS services as you know them are about to change. You may not like that. You may well blame me for them, and I can understand that, but the most important thing is that you understand why we are taking the actions we are. We want to do this with you, not to you, and the first step in that is letting you know what’s going on.

We’ve missed the boat, let’s make sure we all get on the same plane. 

Dr Jonathan is a GP at Swanlow Practice in Winsford, Cheshire, and Chair of NHS Vale Royal Clinical Commissioning Group.

Follow Jonathan on Twitter @DrJonGriffiths


No words?

No words?

My social media feed has been filled with posts about Jo Cox MP. I’m sure yours has too. I’m not sure where or how to start this blog, but writing about anything other than the multitude of awful things that appear to be going on in the world just didn’t seem right. I noticed some people shared the news on FaceBook simply by saying “no words”. In some ways that’s how I feel, yet I’m going to write some.

I’m generally a positive, up beat kind of guy. I see the best in people, and expect people to behave in ways that align to my own values. In the face of Jo Cox’s murder, which comes swiftly on the back of terror attacks in Orlando, I am confronted with the reality that some people’s values are so far removed from my own that I am left confused and lost for words. We like to believe that life is good, and getting better. We like to believe that we can do or achieve anything if we put our minds to it. We like to believe we can persuade people to do what’s right. I like to believe all of those thing. Am I being naive?
I cannot help but think about the individual stories of pain that are behind the headlines we read. We see the numbers of people killed in Orlando. 49 people in a nightclub. 49 people out to enjoy themselves, with no thought of malice or intent to harm. 49 people with relatives, friends, loved ones. 49 people who have left behind scores of people personally affected, bereaved, traumatised, scared. 49 people whose deaths will continue to affect the lives of those who cared for them. Jo Cox had a husband and children. She will have had wider family members, friends, colleagues and constituents who valued her leadership and advocacy. 

Individual stories get lost in media headlines

As you look around you will see that the world is not always a great place. There is murder, terrorism and war. The are floods, earthquakes, volcanic eruptions and hurricanes. There are illnesses and diseases. There are individuals facing the consequences of these things all the time.

From my perspective as a GP I see the personal stories of loss and struggles with illness. Many of the people I see don’t look ill, yet their outward appearance is not a reflection of their inner turmoil. One of the points of a previous blog was that you never know what others have gone through, or are going through right now. We may all change our social media profile pictures to show solidarity for Paris, Brussells or Orlando, but this doesn’t happen often for the person living down the road who’s just been bereaved. Yet the trauma of losing your loved one to a sudden heart attack can be just as real as if they had been the victim of terrorism. 
The world is full of personal tragedies. Most of them will never make the news. They are tragedies nevertheless. As a doctor and a health commissioner I need to remember this daily. I need to remember that people are people, not numbers. I need to remember that those seeing me may be anxious, troubled or stressed. I need to remember that treating all with care and compassion can make a real difference. Personal greetings, taking time, listening, understanding. Small, easy things, yet full of such power to help.

So, what should we do in the face of the awful things we see in the world? Should we rage and shout and threaten and seek to take revenge? Surely not. Filling the world with more hate just plays into the hands of those inciting violence. If my life experiences, values and beliefs  have taught me anything it is that we should love. Not a word often used in professional circles, but one I would like us to reclaim.  There should be more love in the world. Why do we leave this most powerful of emotions to the song writers, poets, novelists and film makers? Let us remember that the patients we treat love and are loved. Let us acknowledge that for many of us we are driven by a love for those very same patients, towns, and communities. Even more, can we acknowledge our love for our colleagues and co-workers? For the people who make our working lives more fun, more interesting, worth getting out of bed for?

What am I saying then? What is my conclusion following all that is going on and how does it relate to the NHS?

I think I am saying that we should love and not hate, talk and don’t shout, welcome and not push away, give and not take, be open not closed. These attributes and values need to apply to us all, but I can clearly see how a compassionate, caring NHS needs to embrace them. Wouldn’t the world be a better place if we all acted like this? Wouldn’t the NHS be a better place if we treated individuals  as individuals. I have previously quoted the NHS constitution in my blogs. I will end by quoting the first paragraph again here:

“The NHS belongs to the people.
It is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health.
It touches our lives at times of basic human need, when care and compassion are what matter most.”

Follow Jonathan on Twitter @DrJonGriffiths 

Dirty Hands

Dirty Hands

I was recently the guest at a birthday party. It was a great night, with excellent live music from The Rubber Wellies. If you like folk music, then I suggest you check them out. Favourite songs for me include “Ban The Bomb!” and “The Beard Snood”, but I want to talk about “Dirty Hands”.

For me this song is about doing the right thing, and sometimes doing the right thing means getting your hands dirty. You can read the lyrics here, but this is the chorus:


“Well, there’s only one thing I want, when my time on this Earth ends, a pair of dirty hands, O Lord, and a clean conscience.”


Sounds easy? I think not. This song is about integrity, speaking out, and not turning a blind eye. This is hard stuff. A pair of dirty hands implies hard work, of getting down to the business at hand and seeing it through. I’m sure we can think of examples where this just does not happen.

I could choose to talk about Mid Staffs. I could chose to talk about equality, diversity, racism, sexism and homophobia in society and within the NHS. I could talk about the failure to maintain duty of candour when things go wrong, of cover-ups and re-writing of history. I have my own personal examples, and you will have yours.

Sometimes our Governing Body conversations seek to tackle difficult issues. I am so glad that I do not chair a Governing Body that sits quietly, unquestioning and letting the executives get on with it. I see challenge, concern and a desire to understand. I also have seen our Governing Body make decisions which have put our executives in difficult situations, where they have then come into conflict with colleagues from partner organisations. Sometimes it feels as though the CCG is being asked to do or report things in a particular way that we do not agree with. Deciding to put ourselves in a position of conflict in this way is an example of getting your hands dirty. We have a duty to the people of Central Cheshire. We have for a long time felt uncomfortable about how we are asked to report our financial situation. I encourage you to check out some finance papers from CCG Governing Body meetings. I suspect you will find phrases like (example only) “forecasting to meet our control total”, but quite possibly in the same paper “we have £2 million uncovered risk”. Let me interpret this – it means they are forecasting to end the year £2m below their control total. (The control total is an artificial zero that CCGs all have to work towards, it is intended to provide a buffer so that you don’t go into the red. If your control total is £1m, and you have £2m uncovered risk, you are essentially forecasting a £1m deficit.) If you speak NHS Finance, you understand this. If you don’t, you won’t. Governing Body members are supported and trained to understand this language, but our public are not. We do not think this is transparent. We think this is potentially deceiving our public, which we do not want to do. It is, however, how we are asked to report. Our Governing Body do not like it. We want the people of Central Cheshire to understand our financial situation.

Moving away from finance, CCGs have a responsibility for quality of the services they commission. The Governing Body of the CCG will have its eye on quality, safety and effectiveness of services. Holding providers to account for the quality of their services is not always easy. People and organisations get defensive when challenged. People and organisations may look to discredit the data, to explain it away, and to reassure you that all is well. Being able to hold the line and pursue your agenda can be hard work. Turning a blind eye can feel like the path of least resistance, but is not the right thing to do. Let’s not be complicit. Let’s speak out and challenge until we are assured.

You never know when you might be required to get your hands dirty. Doing so is likely to require hard work and personal resistance. We hear stories of the challenges faced by ‘whistle-blowers’ – criticised, ostracised and intimidated. Surely in the NHS we need to develop a culture of transparency, integrity, honesty and support.

In this blog I would call upon you to consider how this might apply to you. Where are you being called to get your hands dirty? Where do you need to stand up and hold the line? Or perhaps you need to support others who are putting themselves in the firing line in this way.

My personal hope is that when required, I will have the integrity and resilience to do the right thing, and that you might be there to support me.


“Well, there’s only one thing I want, when my time on this Earth ends, a pair of dirty hands, O Lord, and a clean conscience.”



Dr Jonathan is a GP and Clinical Commissioning Group Chair

 Follow Jonathan on Twitter @DrJonGriffiths