The discussion in GP land continues to rage between those who oppose the reforms, and those who support them.
One side shows the government the red card, claiming that the reforms risk “unravelling” the NHS irreversibly if major elements of the plans are not revised. The other side passionately claims the reforms are the first significant attempt to coordinate all aspects of care - primary, secondary, community and social - into a coherent and seamless whole.
Leaders often don’t have the luxury of time because it might mean your plans become outdated
Then there is the debate about leadership. In the red corner there is the popular view that the NHS is overly bureaucratic. In the blue corner the King’s Fund report on leadership in the NHS suggests this apparent excessive bureaucracy is exaggerated and calls for the government to revisit its plan to impose a 45 per cent cut in managers.
Add in the arguments about price, competition and quality, and it is a heady, confusing brew.
No one would disagree that the combination of sub-optimal outcomes compared with the rest of Europe, and the economic demands of the next few years, justify the need for reform and transformation but how have we arrived in this pretty pickle?
I am not brave or bright enough to give a definitive analysis, but there is probably some wisdom and guidance from the rules that govern the management of change.
Fifteen years ago John Kotter published Leading Change, seen by many as the bible of change management. He revealed only 30 per cent of change programmes succeed. Twelve years later a global survey by McKinsey showed only one in three major transformation programmes succeed. This is not easy terrain to navigate.
Classically, change management entails thoughtful planning, sensitive implementation and the involvement of the people most affected by the change. Without this the default position is that problems arise. Time needs to be taken so that the people affected can understand and cope with change.
Leaders often don’t have the luxury of time because taking too much of it might mean your plans become outdated. So I modestly offer some top tips for minimising risk and increasing the chances of success:
- Dynamic environments require dynamic people and flexible processes and systems, so put them in place and support them.
- Plan the long term broadly; what really matters is a granular plan for establishing and measuring the delivery of immediate actions that continuously inform your medium to longer term plans.
- Communicate incessantly with those people who can assist in making change happen, and be prepared to change course.
- Drive decision making at local operating level and delegate the responsibility to go with it.
- Try to avoid autocratic interference from executives and hold people to account.
- Encourage and develop capable people who share the vision and agree to champion the change strategy and to be active in other areas.
- Focus on using IT to provide critical information to aid decision making and teamwork.
- Be mindful that the chief insecurity of most staff is change itself. Senior people responsible for managing change do not, as a rule, fear change - they generally thrive on it.
I don’t believe anyone argues against the fact that the NHS must undergo fundamental change over the life of this parliament and in the next decade. Nor can anyone argue that the NHS has coped with a continuing cycle of political and environmental change over past decades, while sustaining a broadly positive image in the minds of patients and the public.
What is really at stake this time though is the opportunity to deliver a radical and long lasting transformation. The choices are not easy and will be testing in the short term but let’s hear it for the management of change - it is the only way forward.