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There’s never a good time to reorganise the NHS…
… and this is far from a good time.
Before the election our-great-leader appeared to eschew the prospect of a massive reorganisation.
He said;
‘… I could spend a hell of a lot of time in parliament and a hell of a lot of taxpayers’ money changing some job titles, Tupe-ing over staff and changing some email addresses and not make a single difference to the patient interest.’
He was right but by breaking his word and closing NHSE, he has undermined the trust we might have had in him as a leader.
Unpredictable... Trump-like.
Streeting is my 25th secretary of state for health. This, my 23rd major reorganisation.
Predecessors have upended the NHS with reorganisations. None of them have them made a blind bit of difference to what happens behind the closed doors of a GPs surgery, or within the curtains around the hospital bed.
Streeting says he intends to streamline decision-making and improve accountability. That's code for ‘I want to run the NHS because I think I can do it better than my 24 predecessors.’
The reality is, he has one job… reduce waiting list… but for the Service to do that and cope with the dysfunction that comes with major reorganisation and a ‘10yr plan’… you can’t. End-of.
Why?
For organisations to succeed they need momentum… it creates a cycle of progress, motivation and performance.
When an organisation gains momentum, small successes compound into larger achievements, making it easier to sustain growth and innovation.
It’s the compounding effect of success. Why we have the Academy of Fabulous Stuff.
Jim Collins, in his book, Good to Great, calls it the ‘flywheel effect’. Right now Streeting has created what Colins calls the ‘doom loop’.
Big, dramatic moves, hoping for quick fixes rather than steady progress. We can already see morale is lost, high turnover of top people people, others will follow, because of instability.
Foolishly calling the NHS ‘broken’, instead of building on previous successes. People withdraw their discretionary effort...
... that means good people, worried about their jobs, create a staccato effect. Stop-go. Momentum, lost. Institutional apathy.
See it in the struggle The Jim Reaper is having with balancing the finances. People are creating fairy-tale budgets, why bother with the real thing, ‘I’m not gonna be here… get 'em off our backs.’
If they can see their jobs going, who's going to put any effort in saving them for others?
Instead of looking to the future, they will be looking over their shoulder.
Streeting has sucked the momentum out of the system and created huge risks.
I’ve seen how quickly political-will fades. The anticipated ten year plan, across two parliaments, is too long a planning period. World events too unpredictable. It will be shelved and forgotten about.
Perhaps, reached for in times of trouble;
‘Something needs to be done’… ‘
Wait for the off the shelf answer;
‘It’s in the plan!’
Of course, it doesn't mean it will 'be done'. The public will see no benefits of administrative changes, neither will clinicians.
No previous reorganisations have delivered projected savings. When GPs were given their chance, by 2013 when they were dumped, only a handful of the 151 PCTs supposed to be run by GPs, had active GP leadership.
Reforms never deal with bureaucratic inertia. The NHS has hugely complex structures and people simply don’t know how to do what needs to be done. Unpicking Lansley’s reforms will take years. Creating a gulf of stasis.
Investment and innovation will fizzle out. There is no point in aspiring innovators trying to engage with the NHS when their contacts are facing the sack, get shifted to other jobs, or departments closed.
I have no joy in writing this. It's just what happens.
So, what's next?
No one knows. The luxury of direction is confined to the mind of our-great-leader. The burden of travel… on the backs those whose lot it is, to deliver the day job as well as his fantasies.
There is no impact assessment. No risk-register. No plan. No policy. No consultation. Nothing in a manifesto. Nothing…
Move care from hospital to the community? We’ve done;
1. 1962 – The Hospital Plan
2. 1980 – Care in the Community
3. 1990 – NHS & Community Care Act
4. 2000 – NHS Plan
5. 2006 – Our Health, Our Care, Our Say
6. 2014 – The Five Year Forward View
7. 2019 – NHS Long Term Plan
8. 2022 – Integrated Care Systems
… all focussed on shifting care... all fizzled out or failed.
Do you seriously think Streeting will do any better?
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