|
He didn’t exactly stand on a stage with a chain-saw, but he might just as well have done.
The Jim Reaper is back… don’t mess with him.
Sir Jim MacKey with a mandate to bring NHS finances, that are up the swanny for £7bn, back into balance announced ICB budgets were to be cut by 50% by Christmas.
There was more to come.
The PM announced NHSE was to be abolished, their roles taken back into the DH+, now the DH++.
Probably 13,000 job cuts.
Anyone who recalls the days of LaLa madness and the Lansley reforms will breath a sigh of relief. Ministers were never going to let go control to an arm's length body and overtime the DH shadowed and duplicated most of what NHSE was doing.
Clunky and a dreadful waste of money. Streeting has done the right thing. But he should not underestimate the size of the task and how exposed he will be as the man running the NHS.
He can't hide.
If history, experience and the Porter study of mergers is anything to go by, 18% of top performers will jump-ship and get a better job elsewhere. It always happens.
The time-served, with a decent redundancy package will turn-it-in. Taking with them experience, legacy and memory. Local pubs will do well, with leaving-do’s.
Apart from this ‘brain drain’, what else? We know. Tick them off;
-
Survivor Syndrome: Remainers experience guilt, anxiety and reduced loyalty. They worry they’ll be next.
-
Lower Productivity: Fear and uncertainty leads to disengagement and ‘presenteeism’.
-
Loss of Institutional Knowledge: Meaning disrupted workflows, loss of experience, critical to continuation.
-
Internal Competition and Politics: Defensive behaviours, people withholding information to make themselves indispensable.
-
Short-Term Focus and Risk Aversion: avoiding risks or innovating for fear of mistakes. Focus shifts from growth to survival, less creativity, a drop in efficiency.
-
Resistance to Change, Increased Cynicism: People actively resist restructuring and disengage from corporate messages about ‘exciting new plans’.
-
Absenteeism: Uncertainty and fear means higher sickness rates. People mentally 'check-out' and they’ll use-up their leave before redundancy hits.
-
Hoarding Resources: Managers protect their budgets, making collaboration more difficult. Departments become territorial, leading to more inefficiencies.
-
Increased Union Activity; aggressive challenges to job cuts.
Apart from that it should go well…
… this will be a huge challenge to the leaders who are left. A lot of skill will be required and a lot of goodwill. And, this...
... rules out any prospect of a Ten Year Plan landing well. Forget it. People will have more important things to think about and no bandwidth or patience to handle any Milburn Madness.
On the bright side?
ICBs are too small, varying from a population of 3.2 million to 850,000.
The prospect of getting back to something like regional authorities with a single head office is good news and rolls us back nearly 30 years.
My guess is there will be a collective sigh of relief that Streeting has done the right thing but he will have to understand he wasn't elected to cut NHSE but he was elected to cut waiting lists.
This is probably a two year programme and the transition will be tricky but if Sir Jim can pull it off we should have a leaner, innovative and more productive NHS…
… but without fixing social care, it’s a big ask.
Have the best weekend you can.
| 
