In the midst of a storm it can be difficult to take stock and consider how we got there, what the future will bring, or even just to reflect casually on past experiences. Instead the focus is on navigating the ship through the immediate problem or just staying afloat. Whether or not you agree with the basic tenets of current NHS reforms it will be interesting to see how we will look back on the last couple of years.
Given the severity of this storm and the lack of visibility for those on the Bridge a new scale of healthcare organisational change might emerge: the Lansley Scale of Chaotic Engagement; named after Andrew Lansley, the Secretary of State for Health in England. Like its nautical cousin, the Beaufort scale, it will have twelve points; our current storm and turmoil being ‘hurricane-force’. At the other end there are the flat calm conditions of the bygone (and for many totally fictitious) age of the 1950s where matron ruled the roost and the likes of Sir Lancelot Spratt barked orders to junior doctors, nurses and patients alike, with never a manager in sight. So where would other notable changes to the NHS feature of the scale; changes such as the establishment of the regional health authorities in the 1970s, the Griffith Report with its focus on managerialism, or the NHS Plan of 2000. I would suspect all would feature at “Lansley Scale” six or below.
So what are the features that would make our current storm a “Force 12”? A scan of the national press, talking with fellow NHS managers, and a quick trawl through the Health Service Journal discussions boards provides at least some of the evidence.
- A general sense of bewilderment amongst commentators, patient groups, clinicians, managers. The disengagement Royal College of Midwives, Royal College of Nursing, the British Medical Association and others.
- Searching through the conservative manifestos for a hint of what was to come. It was David Aaronovich who wrote in The Times shortly after the election, when the nature of Lansley’s thinking started to emerge, that it was like watching television and hearing a squawk behind you only to find a penguin, and you think to yourself; “how on earth did that get there”!
- The shifting sands of clinical freedom moving from the early rhetoric of “ensuring clinical freedom” to the central control of the commissioning board which could be summarised as “freedom, but …”
- How the rocks on which the NHS could founder have become obscured by the present storm. For example, where is the wide scale public and political debate on: NHS budget pressures, increasing demands, the effect of long term conditions such as obesity and diabetes, an ageing population, greater citizen expectations and healthcare inflation?
So where does this leave us? Last year’s Pause announced by the Health Secretary provided an opportunity for everyone to reflect on progress. However I have not seen sufficient soul searching and transformative ideas needed to consider my last bullet point. There needs to be a real opportunity for all those in the health and social care community (patients, public, private, voluntary and third sectors) to be able to think differently about health and wellbeing, and not just about structures. If this were to happen perhaps we might look back at our Lansley Scale 12 storm as a tough, but creative time that helped to shift our way of thinking and that led to practical improvements.