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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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Happy families in the NHS? – or time for some PCTs to leave home?

Filed Under (Culture of the NHS, Expenditure, Health Policy, Primary Care Trusts, Public service reform, Reform of the NHS, Secretary of State, Uncategorized) by Paul on 18-05-2010

One of the few consistent and long term insights that ‘management literature’ has given me is transactional analysis. Managers may be treated by those they manage as “parents” and managers can treat those they manage as “children”.  Sometimes managers are good parents and sometimes they are very bad parents.  Sometimes children are naughty and demand to be punished, and sometimes they want to leave home and set up for themselves.

Often it’s a bit of an emotional mess as manager and managed fail to act in synchronicity. And messiest of all is when parents and child are trying to negotiate leaving home and living independently.

This devolution of power from one tier of management to another is full of false starts and hesitations. Do mum and dad really mean that I will be allowed my own independent life when only last week they were shouting at me about failing to hit the 18 week target (cleaning up my room)? Do the children really want to leave home, since now they have their own flat they are always coming home for me to do their washing and to ask for me to pay for their 5 million pound deficit (subbing the rent?)

I have seen meetings between PCTs and SHAs, turn from really grown up and progressive discussions to family rows of horrific proportions as these different ways of feeling have splurged all over the place. The stand off is usually characterised by both sides shouting “Why don t you make up your mind whether you want to be (want me to be) independent or not?”

I’ve not got kids, but these moments of transition from home to independence seem to me to be very hard indeed. My experience of the NHS is that we are not very good at this. SHAs have treated PCTs as people in their late teens for a long time. Sometimes loving to do their washing or give them a sub for the rent; sometimes saying, “No. It’s time for you to learn all about the world on your own”.

I have never really known what external pressure might transform this relationship, but I think we might be about to find out.

There is a strong rumour that SHAs, as a complete tier of management, are under threat. The Lib Dems had the abolition of the SHAs in their manifesto and the Tories did not have in theirs any pledge that there would be no “top down” reorganisations. Every other Conservative health policy document for the last 3 years has pledged no “top down” reorganisations but this manifesto did not. There was a deafening silence.

So I think the new Government may just be preparing to do away with the mum and dad of this relationship with PCTs. This has all sorts of implications.

The grandparents that construct the parents, that construct the children, all live in Richmond House. Of course most of the grandparents have been parents themselves. David Nicholson has run two families, one in the West Midlands and one in London. David Flory ran the North East and Jim Easton, South central.

As grandparents they will find it very difficult to believe how the family will be able to achieve anything without its parents. After all it’s the parents that pass on the messages from the grand parents to the kids. How on earth will the kids know what to do if there isn’t a monthly meeting of all the parents and the grandparents so that they can pass on the instructions to the kids?

So it’s not just the kids that could be bereft, it’s the grandparents too. But let’s leave aside their pain and concentrate on the PCTs.

I have no doubt that some of the PCTs are more than ready to leave home and set up for themselves independently. For some time, if the truth be known, they have been going home just to look after their parents – even though the parents feel that they have been doing the looking after.

For the best PCTs the abolition of SHAs will simply reduce their transaction costs. They will work with each other to provide support guidance and good practice and the fact that mum and dad no longer hold them to account will be a great relief.

There will be others that will look at the removal of mum and dad with some anxiety. “I really don’t know if I can manage on my own and whilst mum and dad could be a bit shouty (big deep breath) I think I will be fine without them.” They will be.

Then there is a third group who have been itching to leave home for years. They are not necessarily very grown up having failed to do their essays at University term after term – and they run out of money by the fourth week of every term. But they think that if only mum and dad didn’t shout at them all the time they would grow up immediately. They just want to be given mum and dad’s money, house and car and they will be fine. Unfortunately most of them won’t. They will spend the money, wreck the car, and then look around for more.

These children will be big trouble for the Government within 6 months.

Finally there are those kids who are just not ready to leave home. Mum and dad infantilised them some time ago. When mum and dad go away for the weekend, these kids are traumatised by the responsibility of running the house. They wait for Sunday night and do little more in between than hide under the duvet. If mum and dad never came back, they would stay under the duvet until social services come round.

These will be big trouble for the Government within a few weeks.

When I have discussed the possible abolition of SHAs with leaders in the NHS there is disbelief that the whole system will be able to operate at all without them.

I think the full answer is that while some will be able to do very well – and even better without them – in other areas there will be a disaster. This would be a brave policy when there was a lot of money, but in some parts of the country not having a state organisation performance managing the resources will lead to a big problem for the NHS.

I think the Chancellor of the Exchequer is going to be pretty angry if the extra money he gives the NHS leads to very big deficits in some parts of the country. And I am sure that he will ask the secretary of State for Health what he was doing abolishing the “mum and dad” that stopped such a spending spree in the past.

But that’s in the future, as of now it’s pretty certain he will be pleased to get rid of the expense.     . 

…and the next instalment of “happy families” is how PCTs have learnt to be parents to their GPs, now that they will be given the family resources to work with.


One Response to “Happy families in the NHS? – or time for some PCTs to leave home?”

  1. Mr Corrigan,if you want a reality check you need to read my pathway of care in ophthamology.I was asked to record it when Neil Mckay was Chief Exec of LTHT.I was vice chair of the patient PPI group and sat on the quality sub committee with Hugo Mascie Taylor.Informatics let any new system down as the systems just don’t support the patients,who always seem to be the fallguys 129 mail bags undelivered.I also submitted a paper to the select committee on this very subject it was published on 30th March 2010 item 3.It is only when the real patient experience is acknowledged will improvements occur.I live in hope.
    Kind regards
    Mary E Hoult

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