It’s a fact

primary care training fasion

Do you pay much attention to fashion?  Trousers with turn-ups… in or out?  Denim jacket with faux-fur collar… in fashion, out of fashion, come-around-again-fashion?

Fashion plays a much bigger role in our lives than we realise.  Not just clothes… furnishings… places to go on holiday… somehow things just become fashionable.  

A car is a car but some, more fashionable than others and sell more.  Technology; a lap-top is, more or less, a lap-top but some are fashionable, others utility.

There are fashions in management.  Eileen Shapiro’s, ‘Fad Surfing in the Boardroom‘, is a book I’ve recommended before.  I’m doing it again, in the context of showing just how shallow most management crazes are and just how mercurial management is.

The vision thing, flat organisations, decoding corporate culture, open environments, empowerment, customer focus, the value revolution, TQM, reengineering… there’s a list a mile long.  

Most of it, in short, gobbledygook for, ‘ways to deliver what you intended…’

The latest is; old-power… new-power.  There is a theory, well, a ‘feeling’ at least, that the internet and all the rest, has created an infrastructure of access, equality and a freedom to participate.  The ability to have a say, shifting the fulcrum point of power.

The conference presenter’s new favourite slide, borrowed from a book by Heimans and Tims.  New words for old; 






The expectation; by the application of a new lexicon and a laptop, the people who once had the ‘power’ will watch it ebb-away, into a new dynamic of influence.  Really?  How?

Steve Jobs; Apple, symbolised a new democracy in corporate behaviour and a sensitivity to nuanced customer demand.

Jobs was audacious.  Exploited fashion and persuaded us to buy into a closed community.  Later a laptop; three times the price of other laptops and no keyboard… the iPad.  Fashion… no one needs one… we all have them.

As far as I can see Jobs had a grip, near strangle hold, on his business and new-power was old-power in drag.

Twitter and Facebook.  New-power?  Or, have they just created modern methods of communication?  

They accelerate messaging and that can impact on the powerful but the companies are just old style companies looking for the old-power of share value, selling advertising and flogging-off the pattern of our lives… called data, to keep old-power companies going. 

Air B&B and Uber?  Disruptive technologies, certainly, but their non-conformance makes them vulnerable when old-power uses the old power of the courts to curtail them.

Hugely disruptive Air B&B, banned in umpteen cities… as is Uber.  So much for new-power… it has none.  

Babylon, a ‘see-a-doc-on-yer-phone’, App.  Eight thousand people signed up.  A sign of new-power shifting the care paradigm?  

No, it will be defeated by a near redundant GP contract, predicated on buildings.  There’s no appetite for the demolition of the old-power vested in the GP contract, neither the buildings.  Expect no shift to a new consumer-power.

Where are the new-power leaders?  Not in the NHS.  Trust boards administrate the requirements of regulators.  Old-power.

They merely use a narrow repertoire of skills to deliver targets, financial balance and keep clear of made-up quality malarkey.  There’s no room to rebalance power.  Top-Down trumps bottom-up.

NHSI, NHSE… opportunities to rebalance new-power, lost in the mire of pounds, performance and politics.  The upshot; integrated care services which are district health authorities, rebadged.  Old-power reinvented.

Commissioning; ‘do last year again this year, for less money…’ clinging to old-power.  

The NHS intends to survive by innovation, new models of care, new-power but they are sucked into the culture of old-power, hierarchy, vested interests, commissioning and fear.  

Management is messy… isn’t it?

… but what we do know; an emphasis on problem solving, close to where the problems are, time and again, succeeds.  Sharing what good looks like.  

Trusting the people doing the job… that shifts power.  It works.  It’s not a fad, not a fashion.  

It’s a fact. 


Tonight, I’ll be talking with Dido Harding, chair of NHSI, talking about the role of regulators… and old power.

Follow @fabnhsstuff on Twitter and from 6.15pm watch the evening live and for free on the Periscope App.


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Reproduced at by kind permission of Roy Lilley.