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Silly-Boy’s gone…
No mass outpouring of grief in the NHS. No flowers or teddy-bears left at the gates of the DH+…
… and we continue to doom-scroll through unlikely people to take on running the health service. My 22nd…
… James Murray…
… apart from a brief and rather opaque period as a management consultant… for whom or where… dunno…
… he's spent most of his life, bobbing about, floating in the warm bath of politics.
Probably, a jolly nice chap. Lives with his husband. Reminds me of the lady next door’s very polite son… turns up every Sunday in a suit-and-tie, carrying a bunch of flowers.
Pleasant enough… but with no obvious experience of running large organisations, budgets or operational systems… and there is this... slightly awkward when considering he'll be sorting this out.
He'll soon find out he inherits one of the most difficult jobs in government at one of the most unstable moments in history.
As an 'ex-consultant', I hope he’s across Michael Watkins’ book; The First 90 Days… Critical Success Strategies for New Leaders at All Levels.
Ninety days…
… during which he’ll never again be more powerful or more influential.
In politics, authority is front-loaded.
Everyone assumes the new minister has the Prime Minister’s confidence, the Treasury’s ear and the political momentum to get things done.
The Queen Bee will be leaning forward. The Jim Reaper, deciding if he wants to stay beyond October.
After ninety days, reality takes over.
The NHS is not in a period of stability where a clear reform programme can be executed. It's entering a period of organisational turbulence, financial compression and managerial exhaustion.
Normally, ministers use the opening months to announce initiatives, reviews, unveil strategies… signal change.
We’ve had years of that… thank you. Plans are not the problem. Bandwidth is.
The danger for Mr Murray is mistaking activity for authority.
He’ll discover…
- a reorganisation creating anxiety and distraction;
- thousands of unsettled staff across NHSE and DH+;
- ICBs under pressure, unsure of their future role;
- social care unresolved;
- productivity fragile;
- waiting-list gains politically exaggerated, operationally brittle;
- and…
… and the silent refrain… we’ve 'eard it all before, my son!
Murray’s test is simple…
…does he understand the difference between headlines and grip? Number 21 didn't.
The NHS is less a machine to command… more an ecosystem to influence. The service decides, slowly, what will really happen.
That’s why his first 90 matters.
Added to which the government itself is politically fragile. I’m already bracing for No 23.
If Murray was a timepiece, he'd be an hour glass, with the sand, like his authority, draining away.
So… in ninety days… five quick must-do lists;
1. Pause the reorganisation
Not because reform is unnecessary. Because exhausted organisations make bad decisions.
The NHS is consumed by perpetual structural change. Management attention is distracted by uncertainty, decision-making slows and money burns away in transition.
Stability is underrated. Signal a pause.
Ask;
- where are we?
- what problem are we actually trying to solve?
- what happens if we stop moving the deckchairs for five minutes?
2. Publish a simple, credible workforce reality-check
No… fantasy, heroic productivity assumptions, brochure-ware, just;
- How many people are needed?
- To do what?
- By when?
- Where are the shortages?
- What happens if productivity assumptions fail?
- What is the retention plan?
- What is the impact of AI… clinically and administratively?
3. Fix flow before chasing waiting-lists, and before winter.
Five things people want from a health service, to;
-
get in,
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get diagnosed,
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get fixed up,
-
get out and
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get on with their lives.
So, think Flow. Think Goldratt;
‘… organisations fail when they optimise fragments instead of improving the flow of the whole system.’
... Red-Box reading.
Corridor care is not a hospital-management problem. It is system failure, made visible.
3. Create clarity; who runs the NHS?
DH+?
NHSE?
Regions?
ICBs?
It’s blurred, shifting, ambiguous and corrosive. Nail…
- Who decides?
- Who is accountable?
- Who owns the risk?
- Who has authority?
If nobody knows, drift takes over.
4. Spend more than half the ninety days listening to the operational NHS
Work shifts with all of these;
ward clerks,
bed managers,
discharge teams,
matrons,
district nurses,
health visitors,
community psychiatric teams
ambulance crews,
junior doctors,
porters,
GPs,
GP receptionists,
social workers…
… people who actually make the NHS function.
5. Find out how the NHS rarely collapses because of one catastrophic decision...
... it erodes through accumulated distractions, constant policy churn and leaders mistaking motion for progress.
Ministers come and go. The successful learn quickly... headlines are easy, grip is hard and the service always outlasts the politician.
Ninety days.
After that...
... the NHS will decide whether James Murray matters.
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