Organisations get themselves into terrible pickles over 'change'. I don't know why. Everything 'changes'; the weather, the kids, the news. TV entertainment focusses on make-overs, scrub-up and 'change'. People love 'change'. They go on holiday 'for a change'. The buy new clothes to 'change their look'. They change their car, their homes and often, their partner.
Why do we have such a problem with 'change? People are not opposed to change. Ask the front-line anywhere and they will spontaneously propose changes and suggest different ways of working that are always better than ideas from the Board Room.
The reason it all goes wrong is that we forget the secret rule of managing change. Here it is, in ten words; 'people love change if they feel they are in charge....'
People understand that sometimes changes will happen that they are not entirely in agreement with. People understand that change is not a one way process; sometimes there will be good change and sometimes not so good.
In the NHS the public rail against change and wage war from their word processors. Ordinary folk who have never before protested about anything will turn their garages and back gardens into placard factories. Public meetings will explode into acrimony.
That's what happened in Lewisham. The pressures on the local health economy, dragged down by the load-stone of PFIs meant that the Trust failure regime was given its first airing. The special administrator's neat solution was to redesign service delivery across the local health economy, keep the PFI places going and make the popular Lewisham hospital the shock absorber.
But... the Act was designed to deal with Trust specific problems not to rope-in neighbouring hospitals in search of a solution. It can't be used for wholesale service reconfiguration. It was obvious from the start that this was the case and NHS watchers pointed out that the Administrator exceeded his powers.
However, it took an almighty row; goodness knows how much money wasted on lawyers and a High Court Judge to confirm the obvious. Irritatingly but understandably, the DH pressed their case to appeal to make sure the interpretation of the law was correct. It was.
This left the DH beached. Since Strategic Health Authorities have been scrapped and CCGs fragmented decision making, there is no mechanism to bring about strategic change or reconfiguration across a health-economy. They were like a ship with no rudder, no compass and no idea what to do next.
The solution is to tag-on changes to the catch-all Care Bill passing through Parliament. The changes will allow the Trust Special Administrator to take into account the wider aspects of the local health economy and impose solutions on innocent bystanders like Lewisham. My guess is the Battle of Lewisham is not over and you can bet the DH or Off-sick or the TDA will come back for a second bite.
And, you can bet; with a quarter of FTs and half of Trusts in special measures or financial difficulties, or undergoing investigation the new powers will be used down-your-way. There is no other mechanism. There is no tactical oversight any more. This is it. The powers are draconian, the opportunity for consultation brief (45 days and the consultees at the discretion of the TSA and not necessarily commissioners or the LA) and the decision, with no appeals process, final. The whole idea is to make the procedure time-limited and swift.
For me the impressive thing about the Lewisham debacle was the protesters' grasp of the issues. They fully understand the need for a sector wide shake-up but not imposed through dodgy legislation on the basis of equally dodgy, uncorroborated data. There was no needs assessment, no impact assessment worthy of the name and a consultation that mocks the definition of the word.
The need for change is pressing and urgent but the Care Bill and the TSA are not the solution.
What is the solution? Maybe it's time to try Citizen's Juries. Decisions made by local people who have paid for, use, value, understand and work in local services. Forget the one-size-fits-all, top down processes. What works is what counts and what works here may not work there. Ask the communities; but that means treating people like grown-ups.
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