NHS England Lesson 3 – Parity of decision making.

In health and social care it would seem eminently sensible for everyone to be involved in decision making. Unfortunately, NHS England is essentially a passive aggressive organisation, brilliantly described in the HBR. As a result everyone has to agree to instigate change, as you can imagine this is impossible. In these conditions innovation cannot thrive. Those accountable for outcomes find they are only in the position to be blamed when delivery fails or is inevitably slow. In Gareth Morgans book, Images of Organisations, “the machine metaphor” describes the style of NHS England.

Lesson 3 – make sure your leaders are able to lead and that the organisation understands this. Enable decisions to be taken quickly, decide early and decide often.

NHS England Lesson 2 – What you see is not what you get

It may seem that NHS England sets the agenda for health and care in the UK, but in reality most of the time we are buffeted by the political, financial and social storms that rage around health and care in England. As a result everything is done at unreasonable speed. Lesson 2 – create processes that are inured to this day to day threat, do this by creating a clear vision and set of principles for action and stick to them. Put the public, patients and professionals at the heart of everything you do.

NHS England Lesson 1: It’s a lonely place

There is no working model for NHS England, processes seem arbitrary and inconsistent. Decision makers wanting to change things need to be courageous, you can expect all of your decisions to be second guessed and reexamined as the environment changes. You will get some support but it is often non-committal and vague. Lesson 1 – if you want to work in the upper echelons of the NHS make sure you’re mentally and physically resilient.

NHS England – the things I now know

For the last two and a half years I have worked at the heart of NHS England. I arrived as the Commissioning Board was being formed and I was fired enthusiasm for our new NHS . (I still have that passion, incase you were worried that this experience has dented it). At the time we all looked forward to a new less politically controlled future, one at arms length (Arms Length Body) from the Department of Health. We should have been beyond arms length.. the reason for that will become apparent in the near future. So sver the next few weeks I plan on blogging the 8 lessons I learnt.

Leadership in the NHS and why it may be looking in the wrong direction.

There should be a thought at the heart of every organisation; are we doing good or ill? In Microsoft we worried about a new found monopoly and we engaged with this through responsible leadership. We understood that our role as managers had to change, we had a responsibility to our partners and customers beyond just making money for our shareholders. And over a number of years we became a better group of leaders.

In the NHS I am not sure we have yet to fully understand the constraints and opportunities afforded to us by our health and social care monopoly in England. Monopolies nearly always display a number of traits:

  • A lack of transparency
  • Poor levels of service.
  • No or low consumer power.
  • high prices for low quality goods and services.
  • out dated goods and services with little or no innovation.

I believe that these ought to be leadership concerns of NHS England.

Despite rises in medical legal costs through greater insurance payouts and premiums, the Francis Report and the Institute of Customer Service Report 2014,that shows lower and lower levels of customer satisfaction within the NHS, the NHS has yet to focus managers in the same way as those of the commercial sector near monopolies.

It may that the NHS has never really developed, in organisational terms, beyond the passive aggressive org that Neilson so graphically describes in his Harvard Business Review article.

It’s time we all demanded more of NHS leadership, the call for privatisation is the wrong way of tackling the issues of lack of competition. NHS Leaders should address the monopoly traits. This could be achieved through greater transparency, and by commissioning services for improvements in public, patient and professional experience.

There is some light at the end of the tunnel, the Kings Fund paper Reforming the NHS… is a very good place to start. But until the traits are on the agenda of every NHS leader we are not going to make progress.