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A Slow Train Coming

  |   Thought Leadership

In 2013, we commented that it was good news that the incoming CEO of NHS England  seemed to understand the NHS and had spent time away from it.


The 5 Year Forward View published in 2014 was a well-crafted political document from a sophisticated politician. It bought Simon Stevens time, intellectual capital and also a set of excuses if not a lot happens.


This week the Labour Party published its 10 year strategy for the NHS.


Darkness falls when you watch the NHS discuss content, implications and implementation of both the 5yFV and the Labour Party’s 10 year plan.


The issues for us arise when implementation is discussed.

“Implementation is a set of skills. It requires resilience, focus and flexibility. It is nourished by outcomes. Implementation is absolutely NOT a Programme Management Office.”



In the NHS, small Integration pilots are described as “pioneering”. Deeper Integration requires mutual intent, shared cultures, systems and outcomes.

“To implement integrated care, organisations have to be selfless in a time when the Dalton Review calls for them to obsess about form.”



Traditional strategy is dead in global markets. Global pioneers in business are building connections and breaking down bureaucracies and their obsession with size. In the NHS, we can’t de-politicize decisions, we obsess about form (Multi-Specialty Providers this week) and we believe size is the way to achieve scale. General Practice being the current example.


Gripped by nostalgia, the NHS is a traditional organisation, which is being indoctrinated by a think tank culture and feedback loop that supports sameness, and as evidenced by recent history, certainly defies progress. It is saturated by academic and organizational responses. We don’t hear from the front line anymore.


When we do – for example a David Oliver blog in the HSJ or BMJ, a lot of people are bowled over by its sense of reason, common sense and realism.


That’s why the NHS feels stale, and stagnant. Who we are is what we create. Stale doesn’t create innovation. Fresh creates innovation.

“When you deny different, you deny innovation, and ultimately you deny growth.”



The opposite of growth isn’t stagnation, which is only slowing growth. The opposite of growth is decay. And that is the risk the NHS is facing — organizationally and culturally. Unfortunately the same can be said for the Labour Party and its 10-year plan:


A plan to manage for yesterday’s conditions, rather than invent the future.