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There’s something happening that in all the years I’ve been in and around the NHS, I’ve not experienced before.
The best I can do to describe it is; the NHS feels stuck.
Not imobile. Not collapsing. Not even standing still…
… just stuck.
That may sound odd when there's so much going on… NHSE is speed dating with the DH+. Thousands of jobs disappearing.
Industrial action looms, again.
The workforce plan is delayed. AI is arriving faster than anyone seems prepared for. Waiting lists remain politically toxic.
Suppliers complain about late payment. The Jim Reaper, heading off in October, to his Keep on the Tyne, with rumours he will not be replaced.
Despite all this activity, the overwhelming impression is… stuck.
For almost two years the service has been bombarded with announcements. New priorities. New operating models. New stuff really rehashed to showcase the political ambitions of a very-Silly-Boy.
If you stop almost anyone in an NHS corridor and ask; what are the three most important things we are trying to achieve… I’d lay money you'd not get the same answer twice.
There’s no shortage of plans. The problem is a shortage of bandwidth.
The NHS is suffering organisational stress, and…
… a stressed organisation behaves differently from a healthy organisation.
It narrows its focus. Becomes risk averse. It stops innovating. It hoards information.
Delays decisions. It concentrates on survival rather than improvement.
It looks to me there are just three things it should concentrate on.
First, look after the people we already have.
Right now a workforce plan is irrelevant. When it comes it'll be full of fairy-tails about tech, AI, new roles, fewer people, and a cocktail of hope that we can do more for less, and…
… no money to deliver it in time to make any difference in the next five years. It can wait. Today’s workforce cannot.
No workforce plan will end today’s uncertainties and will never succeed if the people expected to deliver it have lost trust in the organisation.
The immediate job is not another glossy strategy document. It’s stabilisation. Clarity about jobs. Decent treatment for people leaving. Support for those staying.
Removing pointless bureaucracy and making daily working life a little easier.
The DH+ sees a completed restructure, when all the survivors see are empty desks.
Second, focus relentlessly on access and patient flow.
Don’t over-complicate what the public want. It’s easy.
The Five Gets;
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Get in
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Get diagnosed
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Get fixed up
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Get out
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Get on with their lives, and...
... where can they get and arrange care for an elderly relative.
That means concentrating on flow through the entire system.
Management guru, Russell Ackoff argued that organisations become dysfunctional when they optimise parts, rather than the whole.
A&E improves one target, discharge improves another, elective-care chases a third and nobody manages the system as a system.
Patients do not experience separate targets. They experience one NHS.
Success should be measured by whether it becomes easier and faster for patients to move through it.
Third, fix the centre.
Before launching another reform programme, or any initiative, or frankly anything, the DH+ and NHSE need to work out who ’s doing what.
It’s clear to me and obvious to the people who are stuck with it and write to me about it, too much energy is being consumed by the machinery of reorganisation itself.
Reporting lines are not clear. Responsibilities overlap. Decision-making feels slow and uncertain.
The merger risks creating two organisations; the official one on paper and the unofficial one people use to get things done.
The first task of leadership is not creating new policies. It is creating clarity;
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What does the Department do?
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What does the new NHS executive do?
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Who decides?
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Who is accountable?
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What work stops?
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What work continues…
...answer those questions and publish the answers in six pages, not two hundred.
The striking thing about this list is what it excludes…
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No new structural reforms.
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No grand AI strategy.
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No fresh ten-year vision.
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No fashionable management slogans.
Those things may matter, but… they are not today's priority.
Today, the NHS resembles a football team that’s become fascinated by tactics while forgetting the basics. (England please take note!)
Keep the players on the pitch. Help patients get through the system. Make sure someone is actually running the team…
… everything else can wait.
Perhaps the guiding principle for the next two years should be brutally simple;
Stop starting things. Start finishing things.
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