|
In an uncertain world, one thing’s for sure…
… crowbarring NHSE and DH+ together is beginning to reveal something important…
… it’s a much bigger job than anyone first imagined.
Talking to people who were on the latest staff-briefing-call, and thank you to those of you, who've sent me the printout...
... it's clear, the intention was to reassure people.
The DH+ want to engage with staff and avoid the mistakes of previous reorganisations, but, digging into the discussion, one thing becomes obvious...
... this is still a work in progress.
A lot of the meeting was spent explaining basic concepts;
- What’s a ‘target operating model’?
- What exactly is a ‘function’?
- How might policy teams sit alongside delivery teams?
- What happens to subject specialists?
- Regional staff?
- Parliamentary functions?
When organisations spend this much time defining their vocabulary, it usually means they are still defining themselves. There were repeated phrases like:
-
we haven’t written it down yet, (I bet they have)
-
there isn’t a secret list,
(of course there is)
-
we’re still refining, (not a list, just how to tell you)
-
this is a 'live' document,
(if in doubt use a bit of jargon)
-
we’ll work through this together, (until we don't have to)
We can have a giggle but it is nonetheless, all very unsettling.
People are essentially being told… we’re taking off, heading north but not exactly where we’ll land. That matters because...
... ambiguity is exhausting. Stressful for people and their families and futures. The people running the meetings with jobs, are 'all-right-Jack', but the Jacks and Jills in the meetings are not alright...
... that dynamic needs kid gloves.
The merger (actually, it’s more an acquisition) sits on top of an already anxious workforce.
Thousands of staff have spent months hearing rumours of 50% cuts, regional restructuring, disappearing teams and duplicated roles.
In that atmosphere, uncertainty quickly becomes corrosive.
The deeper issue is that the new organisation is trying to solve a very difficult management puzzle.
The leadership wants more coherence; fewer silos,
less duplication,
more joined-up policy,
better alignment between strategy and delivery.
Perfectly reasonable, but…
… at the same time they know the NHS depends heavily on specialist expertise…
- public health,
- social care,
- digital systems,
- performance management,
- parliamentary handling,
- regional relationships,
- subject specialists who understand complicated operational realities.
Too much centralisation risks destroying exactly the expertise the system depends upon.
Too much localisation recreates the fragmentation they are trying to eliminate.
The briefing never fully resolved that tension because, in truth, no-one can.
Not yet.
Perhaps the most revealing moment came towards the end of the session when Emma Reed with a bombshell of candour, said;
“... duplication can be reduced. Working more efficiently will get us some way. But… some difficult decisions [face us] on things that we will stop.”
With much of the previous discussion framed around; collaboration, smarter working, coherence, professional groupings, better alignment, a collegiate future...
... the difficult decisions comment landed like a firework in church.
If the intention is to stop doing things, it makes this and any future meetings irrelevant until we sort out exactly what it is we will stop doing.
Careless words, corrode confidence.
This is presented as an efficiency exercises; streamlining, but, inevitably…
… mathematics eventually intrudes. Emma is right...
... a 50% reduction in staffing can’t happen without changing the scope of activity. That raises the uncomfortable question nobody seems fully, ready to answer… what exactly is the department going to do, or stop doing?
Policy? Performance management? Delivery? Oversight? Public health? Ministerial servicing? Operational control? Strategic direction?
The answer appears to be… all of the above. The department of everything, except anything it's going to stop doing.
There's been an attempt to polish this cowpat by describing it as the creation of an entirely new organisation. It's not, it's the old one with a sprinkle of glitter...
… doing the same-old-work. Except the bits we're gonna stop. Which bits? Dunno... my advice; get out if you can.
Repeated calls for ‘more engagement’, ‘more visual materials’, ‘more consultation’ and ‘more discussion’ seems to me, the early signs the leadership itself, is still discovering the scale and complexity of the task.
Meaning, their April timetable increasingly, looks ambitious. There are roughly 229 working days to get to 1st April 2027.
If I was a bookmaker; the odds on hitting next April cleanly, with the new organisation genuinely ready, I’d give you, 4/1 against.
If they’re crafty they’ll meet the April deadline with a short enabling Bill that legally creates the new organisation first, and...
... leaves much of the detailed structure, functions and accountability to be worked out later through regulations and guidance, requiring no Parliamentary involvement…
… commonly referred to as Henry VIII powers. D’ya trust Silly-Boy with that? He's unlikely to still be around. Worry about who's next.
I’ll give you 2/1-on, for them using Henry, to get over the finish-line.
Right now, the big bet is, what looked at first like simple merger, turning into a Byzantine exercise in statecraft, and…
… the slow erosion of time and ebbing confidence among the people expected to make the new system work.
Have the best weekend you can.
| 
