Forward View-We don’t want to go backwards

  |   Thought Leadership

NHSE seem to be waking up to the reality of public sector reform.


One of the most refreshing aspects of Simon Steven’s first year is his willingness to reduce the centralised “command and control” aspects of the NHS regime and place responsibility on local organisations to think as systems and collaborative partners. And his bravery in recognising that size isn’t everything. The Forward View has some Systems Thinking within it.


The 3 biggest challenges for the NHS in delivering this plan:


  • Collaborating to win-win;
  • Un-learning 15 years of the present style of management;
  • Our politicians.


Our politicians are lagging behind. Both parties remain obsessed with unproven and damaging “quasi-markets”. The issue for politicians still appears to be controlling people.


The present (and last 15 years) style of management in the NHS doesn’t work. It creates waste, drives up costs, worsens services and destroys morale.


We can use the example of regulation. We know that many people working in the regulators are dedicated, want transparency and want to improve services for patients.


But the inspection regime the politicians want is a command and control design and as a result, managers find their ingenuity engaged in survival because their goodness or badness will be judged by their compliance with the regime’s requirements. Working in such a regime takes the value out of the work. It is not motivating.


Managers are spending time avoiding “Special Measures”.


In the CQC, the overriding concern of their reform agenda is to prevent people from doing harm which itself is a noble aim. The method used is to advocate hierarchical authority, give instructions (specifications and targets), monitor, and reward and punish.


“Why can’t we make the worker the inspector?”


Our final point is about collaboration. “It isn’t about size”


Today, value creation can happen through the organising and connecting individuals together. You don’t need a merger. You don’t need to get bigger. In fact, consumers lose out when organisations become too big. Health care provider monopolies in the US have reduced choice, control prices, become “too big to fail” and their patients sit at the bottom of the value chain. Healthcare outcomes, efficiency and healthcare literacy are not going to be a function of size. The risk we run is that if we make hospitals bigger through size, then they will systematically eliminate options that they need to actually embrace (primary care development, open-sourcing,). The systematic dodging of what is deemed “small innovations” works for a while — until entire markets grow up around large institutions, causing them to pursue “efficiency” cuts over and over again instead of investing in innovations that matter.


So I ask you this question.


Is the Forward View your way to get bigger, have more system control and standardise variation?


Because if it is you are taking me backwards.