Deregulation: the land of opportunity

It is possible to sit back and mourn the disappearance of the old ways of working in the NHS.
The loss of system control, the inherent waste of confusion and chaos, lost functionality that accompanies every structural reorganisation in any industry are real, but despite this downside the current impact of the "not yet enacted" Health and Social Care Bill means that there are opportunities around every bend. The bill effectively opens the market place for competition in a number of areas, verging on a deregulation of healthcare.
Some players sense this, others fear it, for they know it to be true, and some, a smaller number embrace it.
History tells us that the smaller, hungry, driven start up will win out in such arenas.
So what then for the existing players, the big trusts, the large providers, the incumbent practices, what is their future?

Doing nothing is an option, being herded by policy and victim to competition may actually feel like business as usual. However it is not a successful option.
Consolidation of the old ways is also an option, actively perusing a policy which seeks to ensure that all of a particular disease comes our way, "because we're good at it" is also comforting and attractive.
Unfortunately the really successful solution is the most challenging to pull off. The transformation of a big player, to new ways of working, new patterns of care, is almost impossible. Riding the changes of policy, finance and technological innovation is tricky.
New models of care will require considerable effort and disinvestment in older ways of working.
Is it possible for most clinicians and managers to buy in to this vision? Is it possible that a declining status quo will be so attractive to those whose institutions have institutionalised the minds of their key clinicians and managers, that the alternative routes to diversity, transformation and success in a new world will look far too risky?
The next two years will be critical times for the NHS, innovate or die- you decide.

Inside out, outside in.

Organisational structures are a major barrier to good care.

This is the premise behind integrated care. The organisations do not have to merge or cease to exist, but simply to recognise the barrier exists and deal with the problem.

Simply re defining discharges as transfers to primary care will change attitudes about how a "transfer" to primary care is performed.

However beneath this simplicity lies a complex issue, the knowledge and relationship of the competencies possessed by each of the parties is on both sides limited.

GPs who used to work in hospitals will remember how it used to be, Consultants who have never worked in primary care will imagine the jungle, the savages, the fear that returning the patient to the wild will see it lost forever.

How then to make visible those who provide safe passage and care through the jungle of primary care and the urban landscape of secondary care.

Choose and Book did much to separate individuals from communicating directly. Perhaps now is the time to pervert the Choose and Book directory of services into the tool to put those networked around the patient into a system which allows all participants to recognise each other and communicate.

Time Flies like an arrow, fruit flies like a banana

The delay of a month since my last post is not an indicator of inactivity - far from it. We do live in interesting times, and the changes that the NHS is facing seem to grow daily.
There is a widespread and growing viewpoint that says integration is the answer. However the money is still the question.
Solving this dilemma will require something different, something new and innovative.
It will require the NHS to want to learn from other parts of the NHS and adopt the "industrial scale innovation" which was key to the Nicholson Challenge back in the days of the last government.
Can that element of culture which says it's OK to take somebody else's idea and use it wholesale be moved in the NHS. Only time will tell, but in the meanwhile I'm going to try and find one or two direct learns from neighbouring organisations and see who blinks first in the game of chicken.

Leadership as Renaissance Exploration

Although the literature on leadership often quotes examples of explorers as good/bad/mediocre leaders it is less apparent that good leaders in lots of different organisations are actually explorers.

Granted very few use teams of Huskies to accomplish great feats of physical fortitude, but most are tasked with mapping the unknown, taking on challenges, seeking solutions all in lands which truly qualify for the appellation "Terra Incognita".

Once on the journey to these unknown lands the modern leader must combine a series of skills which are perhaps best related to the development of thought during the renaissance.

Mintzberg in his book Managing 2010, places the practice of management as the centre of a triangle bounded by Science- the analysis of systematic evidence, Art- creative insight and vision and finally Craft- practical learning and experience.  Leaders will recognise a similar trinity in their roles and if they are students of history the ideals of renaissance Italy will resonate strongly. 

So can it be said that leadership is renaissance exploration? Look to your leaders or co-leaders. Do they show that blend of science, art and craft that typifies the renaissance? Are they leading into new lands for the business?

Not every leader will have the style of Renaissance Exploration, few will have the experience and skill set to deliver such a style, but perhaps the odd one or two will thrive on the challenge of the unknown, demonstrate the trinity of skills balancing Art, Science and Craft and deserve the appelation Renaissance Explorers.

The end of an era?

As New Elizabethans we have seen many great things accomplished by our species. A moon landing, supersonic travel and the establishment of a healthcare system, free at the point of care are some of the great things achieved. However, it is unlikely that man ( the species) will set foot on the moon again in my lifetime, equally unlikely that a commercial supersonic airliner will be available in the next twenty years.
Both these two endeavours are of course extremely expensive, idealogically driven and beneficial to some elements of society, but the world has moved on, commercial air travel is moving towards a triumph of mass transit at lower cost instead of speed and luxury. The new Airbus A320 delivers the model required not Concorde. Of course the shift was helped by factors outside the world of aviation, not least the growth of high speed communication -the availability of teleconferencing means that the urgent face to face can happen without a trip on Concorde.
In the case of space travel, the high ambition was a political ideal, designed to secure an unassailable position in world history. Although great science was delivered on the back of the programme the cost and financial restrictions globally mean that the programme is no longer viable.

Apply that same logic to the NHS- the cost, the idealism are all possibly rendered obsolete by changes in society, the only factor missing is a viable alternative model to the current system.

Here's where it goes off the rails. The NHS is a complex system, akin to a living organism. There are certain rules about how such systems work, the current world view is that a bottom up clinically led system will deliver "the right thing" for the population. It is possible that it might work, but such an experiment will, as is the way with experiments, result in some failures before it delivers.

The question is whether the evolution of a politically founded, publicly funded healthcare system is able to be delivered rapidly through evolution or like the shift away from manned space flight and commercial supersonic flight, it may require a hard nosed cessation of one system, so another might flourish. Can we take this giant leap for mankind? Is this one exploration too far for the new Elizabethans? Only time will tell.