I think it is fair to say this once great nation of ours is in a mess.
An ageing population… that politicians won’t recognise or make provision for.
A global shortage of healthcare professionals… that politicians ignore.
Crumbling infrastructure… politicians didn’t repair.
Industrial relations… neglected by politicians.
Climate change, public-debt, law and order, global population movements, wars, all of it overwhelming political leaders who have no experience and no idea how to resolve any of it.
Amongst the public, a growing sense of unease, decline in trusts and an exasperation with the whole fumbling, stumbling shebang.
Management by headlines. Deflecting attention.
Like focussing the nation on the meaning of the word ‘jihad’ (it actually means struggle) or sending threatening letters to experienced, NHS leaders, for a cheap headline.
Anything, rather than get on with the real challenges. Micro-managing is so much easier than governing…
• Identify what’s wrong,
• work out why,
• explain it to the public,
• decide on a course of action
• and deliver it.
How hard can that be?
Making long-term policies for the future. No chance. What’s done today is concerned only with the headlines for tomorrow.
Policy choices and trade-offs between the short-term and the long-run.
These are called inter-temporal choices. The choices we make, having a consequence for the future.
A parliament can’t last longer than 5 years… if it can’t be done and fixed in the short-term, it doesn’t get done.
Timing has a huge role to play in policy making.
Add to this, the toxic and unparalleled power that prime ministers have, to restructure departments of state and choose who will run them.
That’s how you end up with a cost-driven, chumocracy.
Blair established three new departments. I seem to remember Gordon Brown rearranging five departments. David Cameron allowed Lansley’s lunacy to cripple the NHS.
After the 2016 EU referendum, May announced two new departments. Plus, the merger of the energy and climate change and business departments.
Impact assessments, biz-cases, consultation, research, scoping… naaa!
The bigger the department the more difficult it is to focus on lower priority issues. Time-bombs, ticking away, that eventually explode. RAAC and wage restraint, for example.
Who runs the departments?
In recent years blind loyalty seems the only qualification.
The manoeuvres in the Labour Party, ousting Corbyn, leaving a Labour front-bench of ‘Starmer loyalists’, few of whom have any qualifications or experience for running leviathan departments of state.
The Conservatives have ricocheted through leaders and strained the concept of loyalty to beyond all known elastic limits.
Plato argued that democracy meant ‘rule by the ignorant’ or worse; ‘rule by the charlatans that the ignorant people fall for’. Ouch!
Trump, Brexit, Hungary, Turkey, Johnson… you be the judge.
Harsh? Well, elections don’t discriminate on the grounds of lack of knowledge or experience and are likely to amplify our prejudices and play to them.
Hence the popularity of populism at the polls… so to speak.
An alternative is described by David Runciman in his book, ‘How Democracy Ends’. It’s called ‘epistocracy’… rule by ‘the knowers’.
We are where we are because of the colossal failure, not of democracy, or politics, but by politicians.
In the US there are over 300m Americans who could become president but it looks like it will come down to a choice between a charlatan or the senile.
Here, the Tories have little prospect of a win and Starmer will arrive, unprepared, untested and under the impression that not being a Tory is enough. It’s not.
His team of novices can’t be worse than what we’ve got?
Don’t be so sure.
Silly-Boy Streeting has waged war on GP partners, insulted managers, is hell-bent on reorganising the NHS, all funded by taxation changes that are a mirage.
Expect five years of chaos.
Time for epistocracy? NHS England are the ‘knowers’ and they’re an independent, arms length body.
Is it time for independence in action? Time for the knowers to step forward.
Service leaders to agree and decide, independently and coalesce around what needs to be done and how to do it.
Take it out of the hands of the meddlers, amateurs and silly-people.
It’s time for the service to agree, amongst itself, a Plan for the NHS. Recovery, when, how and what it will cost.
Realistic expectations and performance measured and delivered.
Previous policies have all-but destroyed the NHS, its structures, its morale and ability to respond.
Politicians have served it badly and there is no indication the current crop will do anything but make things worse.
Tell the political parties and show the public;
‘… this is our NHS plan, this is what we promise to do for you. Our commitment to get the NHS back on its feet, back to where it belongs, so back it and back us’….
… and for us all, to vote for the party pledged to deliver it.
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.
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