We Haven’t Got a Plan, so What Can Go Wrong? Where is the NHS Coming from?

Abstract

There is no getting away from the fact that the UK’s National Health Service (NHS) needs managing. However, it seems there is no word that sits more uncomfortably than this one when it comes to the necessary business of administering the NHS. There are a hundred-and-one ways to interpret the form and function of the NHS, but one thing is for sure: it is an unsettled environment. There is a direct correlation between its perceived public health efficacy and the “reforms” instituted and administered down the years, both nationally and locally; and for those who are the administrators of the system, both front line and managerially, these reforms come so thick and fast that it seems there is never an opportunity to consolidate change.

At the apex of all this change are the political taskmasters devolving politics straight into the NHS via the NHS strategic health authorities (SHAs). The SHAs offer their vision for the future in their strategic frameworks, offering glimpses of the future via policy interpretation.

However, more is needed beyond strategic frameworks and the increased use of targeted performance measures to address the ills of the NHS.

There is one thing that will never change, whatever the future holds: people make the NHS function. No matter how these relationships are as dictated in the future, no matter how systemically the NHS changes, it will always need people to make it function. The current political climate dictates that reform is a collection point that beleaguered clinicians and managers need to gather around. The time for clinicians and managers to argue whether they are playing on the same team is over. The story is no longer the polemic of individual patient care versus resources and productivity, but one of joint leadership and mutual dependence between clinicians and managers. Taking a systems approach to handling this relationship step change can help overcome the culturally habituated behaviors that have held back the development of satisfying working relationships so far. Modeling these relationships is easy, and they are the focus of this chapter; embedding them in the belief that they are the only way to protect the dispensing of services in a locally sensitive way is another story.