A softer centre

NHS England and NHS Improvement have announced a major strategy shift from central control to a new “light touch” and supportive approach to management.

The move is designed to address concerns that hierarchical management structures and an obsession with control are impeding change.

In the new regime, dubbed the Soft Centre, out go command and control, assurance, operational guidance, mandatory reporting, inspection and all other forms of micromanagement. In come trust, sympathy, friendship and complete freedom for NHS organisations to run their own affairs as they see fit.

NHS England and NHS Improvement are to work together more closely, but a formal merger has been ruled out.

Here to help

“Think of it as a loving co-parenting arrangement between an unmarried couple living in a nice part of north London,” a spokesperson said, adding that the two bodies would present a unified front under the brand name NHS Here to Help.

Among other changes, STPs will become Someone to Turn to Partnerships, whose main role, much as it is today, will be to provide somewhere for lonely, hopeless people to meet, have a hot drink, chat and make new friends.

The changes come in the wake of a major review of health policy by Mary Berry. Her report, Nicer Together: It’s so important that we all get along, makes a number of recommendations for improving NHS strategic and operational management. It also includes a recipe for cheese scones that has already been widely adopted by CCGs.

Please yourself

Judgemental terms such as "failure regime" are to be avoided as are aspirational terms such as "success regime", which may make people who continue to fail feel inadequate. “If we must have regimes – and to us the very word has totalitarian connotations – they need to be as inclusive as possible,” said the report’s authors, who suggest “branding that encourages ownership without coercion such as ‘your NHS, your way’.”

The report also says: “For too long we’ve been telling people what to do and it isn’t working. From now on the message from the centre will change from ‘do as you’re told’ to ‘do what you like’. NHS bodies will be asked to do their best and not get too hung up on the details.”   

Formal guidance will be replaced by helpful suggestions and top tips. Commissioners and providers will be encouraged to do something else if they have a better idea. Control totals and other financial targets, the source of so much unhappiness for vulnerable people such as finance directors and chief executives, will be scrapped.

Do your best

“No one will be penalised for trying their hardest. Everyone knows how easy it is to let the bills mount up when you’re running a hospital. Our role is to help people who have got into financial difficulties to get their heads above water again,” said new head of NHS Here to Help’s confidential financial planning and debt management helpline Lord Carter.

Under a light-touch assurance regime, the centre will ask for information only on a need to know basis. “If we don’t need to know, or you don’t think we’ll like the answer, then don’t tell us,” said Here to Help’s chief executive Simon Stevens.

Reporting and monitoring is to be simplified. “We expect chief executives to check in once in a while for an informal chat about how things are going, but if they’re too busy, we’ll understand. They probably have better things to do than talk to politicians,” said Jeremy Hunt, who went on to announce yet another change of name for the recently rebranded Department of Health and Social Care, which is to be renamed the Department of Love.

Minister of love

The department’s logo will now include the ubiquitous heart symbol, which will also become a permanent fixture in NHS branding. “Everyone loves the NHS and since we stopped throwing money at it, we’re increasingly finding that love and silly slogans are pretty much the only thing keeping it going,” said Mr Hunt or “Hello, my name is Jeremy” as he insists on being known from now on.

Dramatic changes are expected at the Care Quality Commission, which will become the We Really Care Commission and move into a purely advisory role. Inspectors are to be replaced by customer advisers, whose role will be to encourage a spirit of improvement through self-worth. They will call hospitals and ask “What are you most proud of in your organisation today?” while GP practices can expect to be asked “Are you being your very best self?”

We really care

Ms Berry said that the current rating system was divisive and bad for morale. Nobody wants to go to work for an organisation that has been branded “inadequate” or “needs improvement”, she said.

We Really Care advisers will treat all providers as “outstanding” regardless of the standards of care they aspire to or the quality of service they deliver. “We’re all special in our own way,” Berry said.

Editor: Julian Patterson


Reproduced at TrainingPrimaryCare.com by kind permission of Julian Patterson.