What did the Greeks do for management…
From 501 BC, every year, the Athenians elected ten individuals to the rank of strategos, one for each of the ten ‘tribes’ that had been created, part of founding democracy.
Strategos, we might call them ‘strategists’. At the time it was actually translated as ‘general’. The ten generals were equal to one another. There was no hierarchy among them.
And, my point is…
… these groups were the earliest example of what we might, today, recognise as an interim, or ‘regional authority’.
The recognition; a semi-autonomous geographical structure, providing an interface between head-office and the people, on the ground doing the job, makes a lot of sense.
Thank you strategos.
Regions are still used by banks, supermarkets and pretty well every national and international organisation I can think of.
Regions can help decentralise decision making, creating autonomy for the people actually doing the job. At the same time, they are close enough to the centre to create a direct line of accountability.
Regions are a good idea. The NHS used to have ten of them but they disappeared, only to reemerged as Strategic Health Authorities and then morph into STPs. They’ve gone…
… now we have about forty Integrated Care Partnerships, that are sort of strategos.
ICPs reflect the changes in the care the NHS provides. It used to be just episodes of care for people who were ill or injured. Now, the remit extends into health inequalities, population health and long term conditions.
The boundary between health and care is blurred.
Health, or lack of it, is so often the sum total of where people live, the environment, their income, education and work.
ICSs have huge flexibility to shape their future, collaborate and move closer to partners in providing and improving the health and life chances of the millions of people in their purview.
Key is the confidence they can build in the relationships with local authorities and others, for the provision of social care.
The design and systems of the ICSs are not templated and can be different, one from another.
I get the sense that the freedom to shape and form the future has flummoxed some and some are more ready than others. Covid has delayed their moving onto a statutory footing and the passage of the enabling legislation has been far from smooth… and still not completed.
Staffing them has been choppy and finding quality leadership, a bigger problem than you might imagine.
I think it’s fair to say, they have got off to a shaky start.
As someone who has witnessed what the years of ‘grip’ management did, this is a whole new approach. I wonder if they have really grasped just what an opportunity these loose formats are.
I don’t think the NHSE/I Board has, how to use them to get ahead of the game.
I can envisage saying to the ICSs, give me your recovery plan. Tell me how you are going to work within the local geography, to make a dent in waiting lists, how are you analysing the data, what are your forecasts.
Instead the DH has let contracts to consultants, for £millions, to do the job for them.
I can envisage saying to the ICSs, audit your workforce needs for the next ten years, let’s build a national picture and force the hand of HMG.
Instead, we are dancing around our handbags waiting for DH and HEE.
I can envisage saying to the ICSs, tell me how, working with social care will reduce admissions and speed up discharges. Talk to me about joint training.
Instead of hanging around for HEE.
I can envisage saying to ICSs, how will you become a digital-first service, what IT, for the management of healthcare and information, do you want.
Instead of a bobble hat making the decisions for them.
ICSs are an opportunity for the NHSE/I Board to re-establish itself as the national lead. Retrieve a sense of direction and control…
… and an opportunity for ICSs to play a big part in the strategic future of the service.
The NHSE/I board with little on display by way of values, governance or direction should recognise ICSs could be a powerhouse, the engine room of recovery but they will need a kickstart, a vision and confidence in national leadership. If they did but know it, ICSs can do more for the lacklustre NHSE/I board than the Board will ever do for them.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
