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We have 19th-century American Protestant revivalism to thank for this phrase…
A ‘come to Jesus moment’!
Latterly, come to mean; hard-talk, facing blunt realities and frankly is what we should be doing right now.
We need a 'come to Jesus moment'.
The NAO has produced an overview of the Department of Health and Social Care…
On the measures patients actually care about;
- access,
- waiting times,
- responsiveness and
- flow through the system (aka social care)
… the NAO judges performance as, stubbornly poor. Fewer than half of DH+ headline objectives are achieved. The NHS remains a long way off most targets.
Read the report, judge for yourself.
Why does this matter?
Following the chaotic and ill-judged decision to abolish NHSE, the DH+ is set to take over and run the NHS,… in 300 working days. (See their graphic below). Yet…
… it’s a ‘come to Jesus’ reality… they are having trouble running themselves, never mind the NHS.
In the meantime …
… NHSE Workforce reductions of around 50% are already under way, before, yes, BEFORE the new merged, operating model is designed.
It is a ‘come to Jesus’ reality; this is cart-before-the-horse bonkers-ness.
Detailed organisational design is not due until August 2026, followed by a speedy, 45-day consultation. Cleverly, whilst we’re all away on holiday, and…
... the whole process to be ‘completed’ by April 2027… there’s yer 300 working days.
This time frame cannot be the work of skilled managers. It can only reflect political pressures.
The ‘come to Jesus’ reality?
Think about...
- time frame,
- drafting complex legislation,
- a vulnerable prime-minister on the defensive,
- an opportunistic health secretary on manoeuvres,
- an awkward House of Lords,
- a flat economy,
- workforce-chaos,
- employment law,
- no workable, future plan,
- no workforce plan,
- sticky waiting lists,
- budget squeezes,
- world-events and a
- local authority reorganisation that will impact social care…
… 300 days is 300 days too short, but enough to create; rush, slap-dash, guessing, pressure, bullying, rows, arguments and a…
… ‘come to Jesus’ epiphany; no civil servant running or organising any of this has actually 'done' big-organisation-change and this is as big as it gets.
A ‘come to Jesus’ moment, would also point out this whole farrago is now reframed, not as a merger, but euphemistically, the creation of a new, organisation… dissembling from what we all know (including Jesus), it’s a take-over.
A new ‘3rd organisation’ is not simplification. It adds new interfaces, creates additional transition risks and muddies accountability… precisely at the moment the system is already under severe pressure.
A ‘come to Jesus’ moment would tell us… this is change management upside down. Shrink first, design later. It’s naive, callow and haemorrhaging enthusiasm, capability, memory and grip.
You don’t need an epiphany to know… an NHS we won’t recognise, will be run by whoever is left, in a time frame that will be met by cutting corners.
If you were sending this lot as a parcel, you couldn’t find enough ‘fragile’ labels to stick on it.
No evangelical, management fervour is needed to realise, something very dangerous is manifesting… institutional overconfidence.
We’ve seen it before. Enron in the US. Carillion, here.
Different sectors? Yes, but same pathology.
Advisers paraded as expensive badges of legitimacy. Weak internal challenge. Political leaders convinced they know best…
… projecting confidence by avoiding explicit acknowledgement of risk.
Nobel-prize winning management guru, Daniel Kahneman called it the planning fallacy;
‘… the belief that this time will be different, despite all the evidence to the contrary.’
The NAO’s findings, experience and common-sense fit these warnings, uncomfortably well.
The function of mature management is to find ways to manage risk out of a system, not find ways to introduce it.
The whole shebang is a flashing red light.
I respect the efforts on the ground, but...
... a politically rushed, poorly prepared NHS upheaval, made worse by local authority churn destabilising an already brittle social care system…
… flagrantly ignores decades of management wisdom about what works, why and what doesn’t.
Why do the authors of this cat’s-cradle of a plan think they know better, or are they cornered into doing it?
Are they under pressure to deliver a political time-line to meet a more sinister agenda.
Are they simply holding-hands and jumping into the future, in the hope something, or someone will catch them?
The Lansley reforms were diabolical but these plans are Mephistophelian.
Ignoring the sirens of history, blunt-truth and reality suggests two things; this is not reform and some people are suckers for a political gimmick.
There's scant evidence wholesale upheaval improves NHS performance and it is a 'come to Jesus' truth...
... structural reorganisation of healthcare has never delivered lasting improvement or transformation.
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