My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Getting going or standing still?

Filed Under (Health Policy) by Paul on 27-09-2010

An interesting insight from Alastair McLennan (editor of the HSJ) in his editorial on 16th September about the sharp difference in rhetoric between David Nicholson and Andrew Lansley in describing the nature of the tasks facing the NHS leadership over the next few years.

It has been possible to verify this distance in the regional meetings that the current Secretary of State has been holding. The SHA CEO (or NHS boss or pen-pusher according to the current Secretary of State) is as far away from the SoS in language and position as you can get and still be in the same town. They are talking to the same staff, ostensibly about the same thing, but with totally different meanings and emotions.

Alastair goes on to talk darkly about an NHS internal resistance movement boiling over. But I think that misses the cultural point about the way in which the NHS resists change.  It never needs to boil – or even get a little tepid. All it needs to do is remain frozen in the attitudes and behaviours that it has been working in up to now. And through its very frozenness it stops change. Rather than “boiling up” resistance this is much more like the classic old army way of stopping activity. My dad talked about this from his time in the forces in WW2 – it’s what the sergeant major called “dumb insolence”. You don’t rebel, you just stand very still.

In some ways it is not at all surprising that there should be some rejection, since the current Secretary of State has made it crystal clear that he want a paradigm shift on how the NHS is run. It looks likely that not many of the very senior NHS staff will make that transition into the new paradigm. The announcement of the 30 transition leads from all the SHAs may be an attempt to provide some security for those that will have to lead the transition. But if these will be genuinely transitional they do not guarantee employment at this level on the other side of the bridge.

I can, for example, see the new National Commissioning Board wanting to appoint their own people to do the jobs that a brand new organisation needs. I would not expect the NCB to believe that you make the new by rolling forward the old. This is not to say that some of these people will not be employed. Those with experience of managing good commissioning will be vital to the future of the NCB.

But I think there is something more important than even the conflict of rhetoric that has emerged between these two approaches and that is the conflict about how change will be created. Crudely there are two different ways of making a very new future. The first is to build on the present and reach out across the gap to the future. And the second is to grab the future and pull it into the present by shaping the present into the future now.

There are two very different messages coming out about whether GPs should be encouraged to take over commissioning in some areas from April 2011. There are a few areas where GPs are up for this, where they want to get some real experience as soon as possible. PCTs in those areas would be wise to facilitate that new approach given they are the future. So we could expect 10-15 PCT sized areas from next April with GP commissioning really getting under way.

But the counter position from those that favour the existing system is that we need to get everything right (getting the design right) before we actually do anything. This means that the future is designed whilst the past is still in charge and when the past is ready and it has designed the future it will flick a switch and all over the country the future will start.

And funnily enough under those circumstances the future will look a lot like the present.

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