Cybernetics

Credit: The King's Fund

The King's Fund published this diagram to explain the complexity that has been created in the NHS.  There is a risk that, just like the many plumbers who visit our houses and stare in disbelief at previous work, our NHS is at risk of strangling itself through ever circular systems of complexity and inept planning.

This blog is a scratch pad to record passing thoughts.  (These came to me at the traffic lights.)

I imagine that I would very much have enjoyed attending the Macy Conferences that took place in New York between the dates of 1941 and 1960.  Here, representatives from different academic disciplines gathered to share their work and perspectives on their subject.  This collaboration allowed common themes to develop, often promoting novel ideas and approaches to be explored through the cross fertilisation of very different ideas and experiences.  The reason I know about this is because the field of Family Therapy was greatly influenced by   the work of Norbert Weiner, an American Mathematician and Engineer, who attended the Macey Conferences, and collaborated with Margaret Mead, and others to create a holist framework to understand the complexity of human interactions and wellbeing.  Chemical Engineering spoke to Sociology (called anthropology at the time.)

The link I made at the changing of the lights was between economic models of understand the world, and and that of the inner world of the child, in particular, how we learn to regulate our emotions.  

The story goes like this. 

Young babies are born with the greatest capacity to develop in any direction they will ever have.  From day one, this is reduced by their environment until the child is set on ever limiting course of expectations.  For example, little children have the potential to speak any language perfectly.  Adults will struggle to do this.  To communicate audibly, young babies just cry.  Their cry is set to be very disonat, requiring attention, as with a house or car alarm.  The parent is left wondering what the cry means.  Is it serious, or trivial?  Consult the doctor, or Health Visitor.  Over time the child learns that it is useful to adjust the crying from Red, to Amber to Green.  The parent lead as they become experts in assessing risk.  The collaboration  reassures both parties, this helps the  child to self regulate.  For me, the most exciting thing to come out of Solihull (other than my great grandmother) is the Solihull Approach, which says to the professional - "start by containing yourself".  This will help contain those around you.  "Panic" is not likely to be helpful, though sometimes we do have to act quickly and urgently.

In a similar way, children learn to control their bladder.  At the beginning it's complete guess work, like flicking the switches on a fuse box in the dark, watching to see which is the most effective. Eventually the child works out what they have to do in their brain to control the bladder, and with a few mistakes, the skill is mastered.  In the same way we learn to manage our emotional state so that it does not spill out at awkward moments.

And world economics?  Economics is likewise a very complex affair with many factors at play, some with in our control, some our influence, and some beyond our reach.  Control over emotions has a complex array of influences, and we learn that we tamper with the controls and influences at our disposal.  For children up to the age of about eleven, that control is not very strong.  We accept this, and children are only regarded to be responsible in law for their action only when they have reached their eleventh birthday.  This is why counselling young children is controversial, because it is important that they do not get the message that we expect them to be in control.  Indeed, we take preventative action all about children, removing hazards as they haphazardly wonder through their lives. 

PS - Keir Starmer said recently that the NHS must "Reform of Die".  

I say (though it matters little) The NHS requires commitment to the cause of providing an excellent health service to the rich and poor alike.  This means common sense principles that we have not seen for many years.  In my book (blog) these are:-

1) Share Health and Social Care budgets.  The money comes from the same place, and needs to be unified and rationalised.  My CEO (of Leicestershire Partnership NHS Trust) once told me that he has a Sunday morning call with the other NHS CEO in the area to discuss the current conundrum.  Ambulances late to attend vulnerable patients because eight of them are clogged up at A&E, with no room to transfer patients because others cannot be discharged because the care they need is waiting for social work and OT assessments (Local authority budget).  Where do we find the incentive to crack this crazy problem?

2) Get rid of waiting lists.  Lots of social care systems do not work with waiting lists including Ambulances, A&E, the police, the fire service and social services.  Long waiting list are a sign of very poor management, like someone living on their overdraft limit.

3) Prioritise how funds are to be spent, and maximise the efficiency of the system so that maximum treatment can be offered.  At the moment long waiting lists and dysfunctional poor coordination cost 15-20% of the overall budget.  When the system is working well, people are more confident, less ill, and the staff have greater pride in their work, and so work harder.

Starmer speaks as if the NHS is a naughty child that must reform or die.  The responsibility is with the Government to steer the system into better ways.  If it dies, it is because it likely to be homicide, or murder.

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