Where next for transformation?


A national consultation on terminology for NHS planners is set to start in the next few weeks, to ensure that the forthcoming ten year plan for the NHS has sufficient rhetorical robustness and sustainability.

The Five Year Forward View set a new gold standard for NHS vision statements with its elegant prose and impressive neologisms.

Phrases such as “a ’factory’ model of care and repair” and “we have not fully harnessed the renewable energy represented by patients and communities” were rightly praised for their shimmering, almost transcendental beauty.

They were neatly juxtaposed with functional terms such as “multispecialty community provider”, which conveyed operational substance and weight; the steel reinforced concrete blocks on which the future would be built.

Fake views

The Five Year Forward View spawned other views – for general practice and mental health – while the absence of a forward view spelt almost certain doom for the sector concerned. Such was the fate of community services.

Social care attempted to produce its own, but failed to understand that a forward view is not just something you write, but something you dream. It must be bestowed by a higher being, not bashed out on laptops by the comms team over a bank holiday weekend.

An authentic forward view is touched by the hand of Simon and sprinkled with the tears of angels. If there is no birdsong in the sunny uplands and no rainbow, it is merely a document.

But now, as the support chassis of time, groaning under the weight of fading visions begins its stately progress to the archive, the NHS is confronted with the biggest challenge in its 70 year history: what to write next.

A national conversation about words?

Policy makers will need to wrestle with huge challenges, the greatest of which is that almost all the available words have been used before. The authors of the consultation document will need to decide whether to dig deeper into 1970s management textbooks or invent entirely new terminology.

Should “consultation” itself be abandoned and if so what should replace it? Is it time for another “national conversation”? How can we start a meaningful dialogue without a credible replacement for “meaningful dialogue”?

These are intractable problems that could derail the new plan even before the first draft appears.

With “view” out of the question and “plan” and “strategy” widely discredited, what are the viable alternatives? “A rough sketch”?  “A long, hard look”? “A jolly good stab at getting it right this time?”

Living with uncertainty

Until these questions are answered, NHS leaders will be living with uncertainty. Local plans, policy documents and a host of other communications will be on hold. Transformation programmes will grind to a halt while a replacement for “transformation” is agreed. All collaboration will cease until it’s clear whether we should be “fraternising” or “colluding” in future.

We may have secured a funding settlement for the NHS, but the real work is still to come.

Outlooks, aspects and vistas editor: Julian Patterson  


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