This blog is well worth a read, as it highlights a fundamental issue within the health and social care sector: the incongruence between calls for greater autonomy and the pervasive ‘command-and-control’ culture. Far too often, we see individuals, particularly managers, ‘thrown under the bus’ to satisfy statistical targets and performance measures. The result? A succession of leaders who start initiatives but are unable to see them through, leaving a workforce lacking in identity, direction, and consistent guidance. Such a throwaway culture undermines stability and perpetuates failure. Instead of asking why managers ‘fail’ in isolation, we need to address the systemic factors driving this cycle. The Francis Report in 2013 highlighted many of these issues, yet here we are, still grappling with the same problems. Long-term change takes time—no doubt about it—but constant chopping and changing only creates further instability, ultimately compromising safety and care quality. We must choose a direction and commit to it, recognising that genuine, lasting improvement requires not just targets but an understanding of the cultural and structural forces at play.
Senior Consultant at The King’s Fund (all views here are my own not those of The King's Fund)
“The NHS is more hierarchical than almost any other organisation I can think of.” It was a pretty striking phrase in Wes Streeting’s big speech yesterday. And he’s right. Creativity, innovation and simple good sense are routinely stifled by the pathological command-and-control that starts in the Department of Health and Social Care and cascades all the way down to the frontline. So, it has puzzled many, to put it mildly, that in the same speech Streeting announced the introduction of league tables and centralised performance management for NHS Trusts. He also did his best Alan Sugar impression with blood-curdling rhetoric about firing failing managers, left, right and centre. But for the Secretary of State there is no contradiction. Yes, he wants more autonomy across the NHS but it has to be earned. All the tough stuff is about making sure the various bits of the health service are grown up enough to be given the keys to the car. Will it work? I have doubts. We’ve seen this movie before. Local Government has spent the last fifteen years earning its autonomy. And the upshot is that there’s been an awful lot of earning and not much autonomy. The doubts are deepened by the fact that the SoS framed hierarchy very much in terms of structure. But the big driver of the NHS addiction to control is its culture - the mindsets and behaviours that shape its everyday existence. These are the very same mindsets and behaviours that permeate central government and which have always stymied efforts at public sector devolution before. Indeed, the very notion that autonomy must be earned owes more than a little to that culture. A lack of awareness around this is troubling. Much more detail in the blog below. As ever, comments - critical and supportive - very welcome. #NHS #Health #publicservices #localgov #DoWith #innovation #productivity The King's Fund Simon Kaye Chris Ham Samira Ben Omar Simon Parker Andrew McCracken Matthew Skinner Alex Fox OBE https://lnkd.in/esWwEgTd
