Built in a Day?

Rome wasnt built in a day

By Steve Allder

As the Romans used to say, “Qui tacet, consentit.” So while I feel ambivalent about writing, it is better than silently accepting the status quo.

Despite the current crop of bad-news stories, I do not doubt the NHS’s incredible value at home and abroad. Its longevity and ability to preserve the ideals by which it was founded in 1948 signify its seminal importance. Only hindsight will show if the predictions of an ‘existential crisis’ are right, but I do sense trouble. I start with the NHS’s constrained funding as it shares the broader impact of public sector austerity, watch many in the system struggling and failing to adapt, and I worry that an authentic strategy is still some way away.

The question of how we approach the development of strategy is not conceived as an important task in its own right, and so we fail to address three key questions:

What is the aim; where is the opportunity; and what relevant capability does our system possess?  I cannot see that the Five Year Forward View tackles these questions. Moreover, I fear the sheer scale of the challenge of responding to these strategic questions.

It’s not that we lack knowledge but that transformational change is harder than almost anyone ever imagines, putting it beyond most leaders’ mindsets and skill sets. It needs personal transformation as leaders expose themselves to deep development, and so it is rare.

And now, given a readiness to ask, to address and to undertake personal development, what challenges face us?

  • This huge and highly complex service is most valued by the public for its independent front-line teams – so top-down initiatives are doomed;
  • Our quality measures are incomplete, but we are aware of deteriorating performance, fractured leadership and team dysfunctionality within a defensive culture;
  • Worse still, more efficiency tends to reveal more unmet need, eroding savings;
  • While standard improvement methods are emerging, the lack of a widely accepted approach, with appropriate data and support, leaves us overly reliant on worn-out ways to transform services.

The good news is that there are examples of sustained improvement and people with relevant experience whom I have found willing to help – some are inside the NHS and there is relevant experience in other sectors. Those particularly in the NHS need an invitation, they need to be listened to and their recommendations need to be heeded. I have always strongly believed that the future success of the NHS resides in the talented individuals who make up the workforce, and I remain optimistic of coming change.

Steve Allder is a consultant neurologist, graduate of the Executive Fast Track Programme and a member of the King’s Fund General Advisory Council. An example of his approach to improving quality and reducing cost can be viewed on King’s Fund website www.kingsfund.org.uk