If you’ve got kids and you are in the bedtime reading phase, I bet you’ve done Goldilocks and the three bears.
If you are a gramps or a nanna, it is probably in your repertoire.
You’ll know the story…
… the young girl who breaks into a house, wrecks the joint and eats the porridge. Some is too hot and some too cold, finding one that is just right is the focus of Goldilocks’ attention.
Well, welcome to the NHS. Not a bedtime story but something of a nightmare.
Like Goldilocks, the NHS is trying to get the porridge that is healthcare, just right.
Too hot… in pursuit of a ‘national service’. Standardise everything. Avoid anything that has the hint of a postcode variation. The upshot, a one-size-fits-all service that actually fits no one… but is easy to manage.
Too cold… localise everything and you’re back to the postcode problem. Where you live defines what you get, or not. A press, full of stories about the have-nots and chaos.
The Goldilocks Paradox; the NHS’s structural juggling act: stay national, act local, and somehow keep the porridge of management ‘just right.’
Never was this dilemma more clearly expressed than in the first version of the Model Integrated Care BluePrint.
The document says it was developed by a group of ICB leaders from across the
country, representing all regions and from systems of varying size, demographics, maturity and performance…
… and it shows.
Nothing written by a committee is ever any good. Consensus is satisfying but clarity works. This is far from a working document.
An attempt to define what a good ICB looks like, framed against the need to reflect local health status, organisational maturity and equalise outcomes…
… across a nation where there is huge variation in the lives that people live, their circumstance, health, wealth and deprivation status…
… and at the same time get the ‘national’ into the National health service…
… create a shape and form that can be managed and in someway groomed, shaped, bribed or bullied into delivering against national priorities…
… from the centre.
Mathematicians cannot square a circle neither can NHS leaders serve the nuance of the local needs of people and the whims of transient politicians at the centre.
The weekend-whim, to take a wrecking ball to NHSE, with no planning or thought as to its impact, was not to end duplication.
That could easily have been dealt with at the DH+. It’s so that Streeting can run the NHS from a desk in Whitehall.
You can be equally sure that whatever is left of the ICBs when the mergers and mayhem phase is over, they’ll want to preserve an independence.
The Goldilocks Paradox. Porridge; not too hot, not too cold. For the NHS, operational freedom; not too much, not too little.
The document is mercifully short, just 20 pages. ICB have seen responsibilities reduced but want to take back procurement of IT (bonkers), manage data (beyond them), form strategic partnerships (aka cost shifting), carbon reduction (bring money), estates (bring more money)take over GP IT (really!)…
… the work of the Brothers Grimm.
High level ‘strategic workforce planning, development, education and training, will be a job for the regional teams. How many of them?
Dunno.
There’s some flimflam about being nice to people who are going to get the sack.
A nod to the complexity of the landscape; operational pressures, reorganisation and admits the whole piece of work might end up in the bin as no one has any idea what additional madness might be in the 10 Year Plan…
… which is late. Looks like it’ll be a nine and a half year plan. If this looks like putting the cart before the horse… it is.
The BluePrint confesses;
‘… [The 10YP will].. set out more detail… [of]… the wider system architecture and clarify the role and accountabilities of trusts, systems, and the centre of the NHS.’
This is not a BluePrint. More a Periwinkle Plan. A delicate blue with a touch of lavender.
It is pointless. There is only one certainty in the whole document. In the diagrammes, to be found on pages 5 and 6.
- DH+… assuring performance
- Regions… the performance management of providers
… and that’s it.
Whatever the shape of ICBs, their responsibilities, whatever their size. However big they will be, merged, taken-over or crashed together. Regardless of their ambition or variation…
… it’s all about performance.
‘Performance’ that the periwinkle plan leaves undefined.
The message is the same old, same old; ‘do what yer told‘, because there is a golden rule in the health service…
… he who has the gold, makes the rules.
The DH+ and our great leader has the gold and will make the rules…
… the rest is just a fairy tale.
-oOo-
Have the best weekend you can.
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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