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nhsManagers.net

7th October 2025


News and comment from

Roy Lilley



Don't we...

_____________

Do you ever wonder why people get stuff so wrong?


I know, sitting on the sofa, atop a mountain of ignorance, it’s easy to be wise…


… but if something is wrong, it’s usually obviously wrong.


We all know, anyone with just a pinch of common sense can see it. It’s instinctive.


In his new book; Steven Pinker, the Johnstone Professor of Psychology at Harvard University, ‘When everyone knows what everyone knows’, picks-up this theme...


... tells us, in terms;


‘… [there is an] awareness, which we experience as something that is public or ‘out there,’ called common knowledge and it has a momentous impact on our social, political, and economic lives.…’


Pinker talks of;


‘… [making] sense of many of life’s enigmas: financial bubbles and crashes, revolutions that come out of nowhere, the posturing and pretence of diplomacy, the eruption of social media shaming mobs and academic cancel culture….’


However, people also go to great lengths to avoid common knowledge


... to ensure that even if everyone knows something, they can’t know that everyone else knows they know it…


... so we get rituals like benign hypocrisy and pretending not to see the elephant in the room.


Extrapolating from Pinker’s baseline, standing on it, using it to look at our landscape right now, might help us to think about the killings in Manchester, the protests in London and elsewhere and the political response... and learn some lessons.


We all know this dreadful issue is not binary. It’s hugely complex but the political response has been binary; use the law to stop people protesting on the grounds that police services are stretched…


... as a result…


we all know, on top of legitimate reasons for protest and demonstration from either side of the political, religious, humanitarian and legacy divides and whatever the rights and wrongs might be… people will now have another reason to protest…


… we all know, protesters will protest about not being able to protest.


In trying to stop people demonstrating, HMG may have guaranteed more demonstrations.


We all know, it’s a classic case of reacting to symptoms rather than causes. Poor decision-making… the failure to understand why something happens before deciding what to do about it.


It’s not like we don’t know. How to handle difficult events is not a secret.  


We all know management gurus have been trying to teach us about this for decades. 


W. Edwards Deming, the father of modern quality management, said when something goes wrong, the temptation is to fix the noise… not the cause. 


Curtailing protests fixes the noise. The real cause? People are frightened, bear scars and memories, unheard, unseen, or excluded from the decisions that affect them and the people they care about.


Peter Drucker warned that the most dangerous mistakes aren’t wrong answers but wrong questions.


Instead of asking, ‘How do we stop protests?’ policymakers should ask, ‘Why do people feel the need to protest’…


… that’s the harder question but it’s the one that leads to understanding.


Herbert Simon, perhaps lesser known; a US political scientists, who showed that people rarely make ‘optimal’ decisions.


They make 'satisficing' ones… just good enough, under pressure and within the limits of time, information and politics. 


You can see it here; a rushed, politically expedient response, to a noisy problem and…


… of course, every decision comes with unintended consequences. 


Chris Argyris, another American business theorist from Yale, would call this a failure of double-loop learning… adjusting actions without questioning the underlying assumption...


... fewer protests equals greater order, goes unexamined. In truth, it’ll be the feeling of being silenced that drives disorder.


We all know people react more strongly to losses than to gains. Tell people they can’t protests and they will.


We all know the question to ask is; what assumptions underpin this and are they right? 


Politics is management and a lot of management is politics.


Five things to remember;


  1. Diagnose, before you decide
  2. Engage dissent, talk first
  3. Test and learn
  4. Create feedback loops
  5. Reflect on values, what assumptions guided this reaction?


We all know there are events and times to respect, particularly today.


We all know we don’t want disharmony in politics or society.

  

We all know we don’t want aggravation in management or the workplace.  


We all know we don't want decisions that make bad situations worse.  


We all know, good decision-making isn’t about control. It’s about understanding. The more you try to silence a system, the louder it gets. Whether it’s a protester with a placard or a workforce with grievance.


We all know, the trick is to listen, learn and then decide...


We all know... don't we?

Number 1

Top Listen

NEW - NEW - NEW

Podcast with

Niall Dickson

and

Roy Lilley


Claire Murdoch


Her first interview since dramatically

quitting as

National Director for Mental Health Services...


... after nearly ten years in the job.  


In the podcast, Claire says she quit because she felt she no longer had political support and reveals her dismay at the failure of the new government to maintain the share of NHS spend on mental health.

In a strong defence of what has been achieved on her watch, including more than doubling the number of professional staff working in child and adolescent services, much improved access for young people, despite a huge increase in demand, and great progress on a nationwide roll out of mental health support in schools.

Looking forward, she says the share of NHS spend has been phenomenally helpful and must be protected and that as far as she is concerned it was ‘job begun not job done’.

But, this discussion also reflects the reality of mental health care in England today with services desperately struggling to meet the explosion in demand and with patients of all ages unable to access the support and treatment they need. 

For all the previous

In the Loop

podcasts with

Dame Jennifer Dixon

Lord Darzi

Professor Tas Qureshi

Dr Penny Dash, chair NHSE

Richard Meddings,

former chair NHSE,

Sir Jeremy Hunt,

Sir Andrew Dilnot,

Paul Johnson IFS

CLICK HERE


-oOo-


Probably the most listened to

Podcast in the NHS!

FREE!

Want to contact Roy Lilley?

Please use this e-address

roy.lilley@nhsmanagers.net 

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Dr Paul Lambden


The Diabetic Foot


'... post-amputation survival is poor with an estimated one in twelve patients dying in the peri-operative period following such surgery...' 


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__________


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