Great leaders…


Right now, it would be wrong to underestimate how fragile the NHS really is.

The money doesn’t add-up, demand is rising and there is no real way to stem it… the causes are way beyond the purview of the NHS.

The NHS balance sheet is fudge and fiddle and has, already, been bailed out.

Make no bones about it, there is an a very real workforce crisis for which, in touching distance, there is no plan to fix it.

On top of all that, we are facing, what is turning out to be, a much bigger reorganisation than many envisaged and an obligatory switch to providing some services with technologies that the professions, by and large, have previous eschewed.

This is not going to be easy. No one has tried to do all this, before.

If I may, I have given myself permission to make some observations.

Customarily, at times of change, the NHS turns to management consultants. Is this the time to bring them in?

If you’re asking me, the answer is no. They will be on the same learning curve as the rest of us. They’ll learn on the job and give you the bill.

Is the management of change an art or a science?

My answer is neither and both. People love change if they think they are in charge… that’s all I know. That makes it common sense and kidology.

I have said it twice already this week and I’m about to say it again. There is no one in the NHS that knows how to deliver the scale of evolution and change we are about to be challenged by.

Anyone who tells you different is either a fool or a liar.

Unpicking the HSCAct 2012 with no legal or regulatory frame work is a nightmare job.

Dismantling vertical STPs, CCGs and federations, replacing them with a new landscape of horizontal care systems and networks means people letting go power, the ego maniacs losing control and the rest of us coming to work wondering what happens next.

Stepping into the vacuum will be a new set of power hungry maniacs and egoists, telling us they know what they are doing.

They don’t. No one person has the answers but everyone, together, might figure out what to do.

This is no time to expect the boss to be right. The smart ones will shut up and listen.

Expect a cascade of guidance.

Remember, it will be written by people who have never done this before and whose job depends on doing it.

The guidance will be unrealistic, punitive and mostly junk, shoving responsibility on people down the food chain who have no prospect of delivering the time-lines or objectives. Teflon guidance.

Strategic plans will rear their ugly heads.

Only the NHS bothers with them. They are sad, embarrassing documents that no one reads and a huge waste of time and money. They are based on planning and as there is no one alive that can plan for ten years, have nothing to do with them.

Conference organisers will sell you tickets for meetings about change-management.

Don’t waste your money. Management is about change. Without it, we could get by with administrators.

There is likely to be a resurgence in people with Organisational Development in their title.

They are mainly failed HR people, or training managers who took a job title instead of insisting on a pay-rise. Avoid them.

Other people to avoid are the negativists, nay-sayers, the politically correct.

The yes-men and women who will tell you what you want to hear, and those who will agree to anything as long as they get home on time.

Right now we need a healthy dose of cynicism. Skeptics who will say; ‘really… tell me that again.’ They may be a pain but they will save you a lot of suffering in the long-run.

People who can doubt-with-a-purpose. They are rare and that is why the NHS has so few really great leaders.

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Reproduced at by kind permission of Roy Lilley.