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The NHS doesn’t suffer from a shortage of ideas.
It suffers from an inability to nurture and keep them alive.
It loves anything new.
Ministers announce. Executives mobilise. Staff are told, ‘this time, things really will be different’, then…
… the money moves, the leadership changes or another priority arrives.
Staff disperse, dumped. Knowledge disappears. Successors expected to rediscover the same territory.
Very few NHS management models have enjoyed five undisturbed years before being reorganised, renamed, absorbed, redefined, shrunk, merged or threatened with abolition.
The NHS talks endlessly about evidence-based practice but remains remarkably tolerant of evidence-free, political-management reform.
Medicine advances because people challenge accepted wisdom, test new treatments, and…
clinical science progresses cumulatively.
Each discovery builds on what came before.
NHS management works in the opposite direction...
... it treats clinical knowledge as an inheritance but managerial knowledge as disposable.
James March warned about this and distinguished between...
... exploration… searching for new possibilities, and...
... exploitation…developing what an organisation already knows.
The NHS repeatedly rewards exploration; the announcement, the pilot and the reorganisation and…
... neglects exploitation… persistence, refinement and taking something that works to scale.
It doesn’t merely fail to learn. It repeatedly abandons what it’s learned.
The irony is almost too perfect. In 2000, the NHS produced a report called An Organisation with a Memory. A quarter of a century later, it’s gone... forgotten.
Neighbourhood health? Its family resemblance to earlier community health, locality working and care-closer-to-home programmes is unmistakable.
Integrated care has travelled through a succession of structures and vocabularies.
Hospital at Home has reappeared as the virtual ward.
These are not necessarily bad ideas. The failure is not always in the initiative. It’s often in the NHS’s inability to give it sufficient time, continuity and support to become established.
NHS managers and leaders are not perfect. They make mistakes and take wrong turns, but…
…the greatest disruption comes when politicians, without waiting for the evidence, change the destination.
The consequences are expensive.
Experienced teams are broken up. Relationships with councils, voluntary organisations and communities must be rebuilt.
Evaluations stop before yielding useful conclusions. Capabilities that once existed have to be bought again…
… staff become cynical. They learn that the safest response to a new initiative is to keep-yer-head-down and wait for it to pass.
‘This time it’s different…’
It isn’t.
What the NHS needs, before another restructuring team or programme office, is a Department of Have We Done This Before?
DeHaWeDoB4.
Not a real department. The NHS has enough. It’s a discipline that should sit inside boards, policy teams and ministerial submissions.
Before approving the next big idea, it would ask… have we tried this before?
What was it called then?
What worked?
What failed?
Did the idea fail because it was wrong, or because support was withdrawn? Where are the people who remember? What can they tell us?
If it was a success, who do we ask to tell us how, this time?
It might save the NHS from repeatedly buying-back its own discarded ideas.
That doesn’t mean preserve everything.
Some structures deserve to disappear.
Some practices have failed.
Some traditions obstruct improvement.
Institutional memory must not become institutional inertia. The task is to protect the best of the past, and take it with us into the future.
To do that…
… requires a different kind of leadership. Less fascinated by novelty. More interested in stewardship. Less concerned with leaving a personal initiative behind; more willing to develop something started by a predecessor.
Real innovation is not always invention.
Sometimes it means recognising a good idea, protecting it from the organisational weather and giving it long enough to work.
The future of the NHS will not be secured by keeping everything that has gone before, nor by discarding it whenever something shinier appears.
Progress means knowing what to keep, what to repair and what to leave behind.
The NHS does not lack ideas. It lacks the patience and institutional memory to turn its best ideas into lasting improvement.
Before launching the next new thing, refer it to the DeHaWeDoB4.
Its first question would be the simplest…
What happened to the last one?
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