Well, this is all a bit rubbish, isn't it? Two years on and still wave after wave of irritatingly more infectious variants, each one arriving just as we're seeing light at the end of the tunnel from the last one. I must admit to never hearing of the Greek letter 'Omicron' before the pandemic; if we were using the more accessible Welsh alphabet, I think we'd be on letter 'ff' which much better represents my current feelings.

I liked Ken Donaldson's blog a few weeks ago in which he wrote about the optimism of spring, and I have had real flashes of optimism throughout the pandemic. For example, I vividly remember our Pharmacy Director taking me to watch the first ever Covid vaccination in our region and thinking this was it, the beginning of the end, back to normal soon. Similarly, I got my first jab (it's not 'jag', it just isn't) on the morning of Wales' Grand Slam game against France in March 2021, what an incredible start to a new era. But Wales lost and have kept losing, and we saw the Delta wave and then Omicron spikes push thoughts of recovery further and further away.

Omicron Arrives in Dumfries

We'll get through the current surge of course, just as we have all the others (if we still have a dash of optimism left, it looks as though we could already be through the peak). But it's a bit daunting to look at the scale of the rebuild that will be needed to deal both with the backlog in elective activity and with the new demands that will come from the wider impacts of the pandemic, the lockdowns, and the growing crisis of poverty in our population. It is so easy to lose confidence in our ability to build our services up to what our region needs. But we need to avoid falling into this pessimistic trap and start planning a future for our teams that is a whole lot better than the two years we've just endured.

The Board ran a planning exercise recently designed to kick off deciding priorities for this next phase. We used a three horizons model you might have come across that requires you to first describe a high performing system with the vast bulk of our problems behind us, say, 10 to 15 years in the future. You then look at a halfway point to this perfection and describe what progress and milestones you should reasonably expect to have achieved. Finally, you look at the next year or two and agree the short-term priorities needed to start this transformation. It's sometimes quite a good tool to use when the scale of your immediate problems seems a bit overwhelming since you start from a point where they've all already been solved!

The only other framework we used was another simple tool, the balanced scorecard. The theory here is that a resilient, high performing system must be excellent in each of several areas.

  • Quality and Safety

This is the most obvious for us. Services that we provide in the future have to be of a measurable high standard and pass that critical test that we would be utterly comfortable in relying on them for our loved ones.

  • Workforce

Again, this one is self-evident. Our services, our facilities and our culture need to be such that we attract and retain the workforce we need to provide that high quality care. I think we can assume that we will be operating in a very competitive labour market and that to succeed in this area, our offer to current and prospective staff members has to be outstanding.

  • Performance

The pandemic and its associated effects have smashed apart our operating model and we are really struggling to deliver consistently fast access to services, in either elective or emergency pathways. We have to rage against this and avoid any temptation to accept it as some new normal level of performance for our population.  I read this week that public satisfaction with the NHS had fallen to a level last seen before the 1997 general election and we need to regain that lost support for what we deliver.

  • Finance & Sustainability

This may not be everyone's favourite quadrant of our balanced scorecard but it's absolutely critical to our success. We're going to emerge from the pandemic in a very difficult financial place, close to £30M a year from a balanced position. Unless we turn that around, it will begin to dominate our agendas, to the detriment of all that's set out above. Our income is pretty fixed, so these new service models that will deliver high quality, give fast access and be brilliant to work in... are also going to have to cost less. Sorry.

Oh, and we're going to need to be carbon neutral by the 2040s.

Hopefully you can see now why it's easier to start describing the system where all these problems have been fixed!

We'll take a first cut of the three horizon plans to the Board meeting in April, but we've got a lot of work to do to refine our ambitions into something more concrete. Much of this is going to involve talking with our teams, our communities and our partner agencies, building on the huge number of Sustainability and Modernisation (remember SAM?) ideas that you provided before the pandemic changed the world.

So despite some bruises during the pandemic, I refuse to give up on my optimism (except maybe about Welsh rugby over the next couple of years, don't get me started on our coaching team...). We're a system with an incredible track-record of successful change and we're going to plan our way out of this, one horizon at a time.

And finally, just because I can never say this enough times, please let me express my gratitude on behalf of the Board for all that you've done over the last couple of years. I've seen teams handle episodes of crisis before, but I've never witnessed that effort extended over such a time period, during which your own family lives were getting turned upside down by the pandemic and its lockdowns. Thank you.

Jeff Ace is Chief Executive Officer for NHS Dumfries and Galloway