Next stop Stockholm … – Johnny Marshall

With all of the hype surrounding the recent Jubilee celebrations it would be almost possible to forget that we are on the edge of an economic precipice in Europe at present. The joy of smiley painted faces, vigorously waving flags and the Great British stiff upper lip in all weathers seemed to replace fears of fading economies, empty bank vaults and European not so bonhomie. But at FDG this week all this was blown away as EU themes took centre stage.

The recurrent theme of this week’s meeting was system leadership. How does the NHS move away from the old centralised authority (Department of Health) to one where the new central authority (NHSCB) has a subsidiary function, performing only those tasks which cannot be performed effectively at a more immediate or local level? On the one hand it seems to be what everyone has been asking for, “No more top down targets..”, but on the other it would seem there is a danger of the question morphing into,”….so what do we do next?”. Somehow being liberated suddenly doesn’t feel so liberating.

My initial instinct was that whilst there seems to be a genuine intellectual acceptance within NHSCB of the required change, it makes turning round an oil super tanker look like ice dancing.  However, as the discussion progressed it was clear that with the central authority gone some parts of the NHS might feel like they were being asked to ice dance on water! Curiously, I found myself empathising with the central authority I had so long felt held captive by. Was this the NHS version of Stockholm Syndrome? Was I witnessing the central authority deep in self-reflective group therapy? How was the NHS going to respond to such a diagnosis?

You might be surprised to hear that as a GP I had absolutely no idea how to manage Stockholm Syndrome, perhaps I missed National Stockholm Syndrome Week. So, I responded like any GP would and googled for a self-help guide on managing Stockholm Syndrome. Whilst I could not honestly profess to have found a wealth of evidence-based information on it, there do seem to be some interventions that might also be applicable to victims within the NHS:

  • Helping victims to recognise which of the behaviours shown to them are acceptable, remember last month’s “Jack Welch conundrum”?
  • Self-help groups to deal with feelings of isolation
  • Developing alternative sources of care and nurturing
  • Acknowledging the presence of the conflicting behaviours of abuser and supporter       in the one authority

All of which are currently available on the NHS in one form or another without having to go and see your GP for a referral.

The final problem up for discussion was The European Union Cross-Border Healthcare Directive. In a nutshell, this means home states paying for treatments their citizens receive in the EU, if they would have been provided under their home healthcare system, and each member state being required to inform and assist their residents in making use of these arrangements. EU member states are required to adopt this directive by 25th October 2013, at the latest.

You don’t need me to tell you what problems could be associated with this, or do you?

The solutions seemed to come straight from the Stockholm Syndrome treatment manual. The NHSCB could just take over the whole issue but simply directing everyone else was not consistent with the behaviours now expected from it. Sharing an understanding of the problem with CCGs, who could also call on support from other agencies, was likely to result in CCGs feeling less isolated and more likely to acknowledge the value of the co-existing conflicted behaviours required from the NHSCB. All resulting in common intention rather than central direction. Simples …!?

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