Victoria Atkins


By the time you read this, Number 22.5 (BB had two goes at the job) will have had time to read through the pile in her Red Box…

…and know everything there is to know about the NHS, the current state of play and what the issues are.

Based on her wide experience of never actually ever running anything, her in-depth understanding of organisational dynamics and industrial relations…

… she’ll be ready to take on the responsibility for the nation’s biggest employer and the government department that touches the lives of pretty well all 60m of us…

… dare I say cradle to grave…

… fix the strikes, sort out the funding deficit, make sure no one dies waiting, clear-up Bully-Boy’s wreckage… and leap tall buildings with a single stride.

I’m not hopeful.

I do hope that she will not try and compensate for her inexperience by having the ‘vision-thing’.

If NHSE take my advice, they’ll send her on an extended national tour of hospitals, virtual wards, paediatric units and do the one thing that Bully-Boy could never do… let them get on with running the NHS.

Taking on any new job if you are experienced and qualified is daunting.

Doing it with zilch of either will either lead to a total meddling disaster or a harmonious, benign, protectionist role, managing external boundaries with the likes of the Treasury.

Managing priorities is part of a new job.

How often do we hear people say they have ‘five priorities’. This usually comes from the David Brent school of management. People who haven’t quite mastered the English language.

To be clear, priority means…

‘… prime concern, a fact or condition above all others and the most important consideration…’

Take yer pick;

• ICBs drowning in debt
• Shortfall in funding following strikes
• Social care on its knees
• Domiciliary care sector broken
• Strikes and the threat of more
• Dilapidated estate, some parts actually dangerous
• Management of the system with the use of technology and data analysis next to impossible… hosptials with no EPR, scant interoperability, out-of-date systems
• Primary-care overwhelmed… working at the outside edge of what’s safe, no prospect of increasing capacity
• Improvements in secondary-care productivity proving impossible
• Unachievable carbon reduction targets
• Nurse recruitment falling
• Poor industrial relations with reports of bullying commonplace

… and a whole lot more I’m sure you could add.

If you Google, ‘managing priorities’ you’ll find pages and pages of 3 Steps, 5 Steps, Apps and ‘how-to-do’ ideas…. including something called the Eisenhower Matrix.

Mostly, they don’t work.

If you look at my list you’ll see they can all claim to be priorities. If you’re in IT, you’ll say ‘us’! If you’re in estates, you’ll shout ‘me first’! That’s because the NHS has no clarity about its actual goals.

What it’s trying to achieve? Apart from muddle through.

The NHS constitution? No help. It’s so full of motherhood and apple-pie it could have been written by Mr Kipling.

You’d struggle to find anyone who’s read it. Overlay that with Trust’s 215 mission statements and you have a pile of uselessness.

NHSE has 20-odd pages of priorities, key tasks and essential actions, including ‘transforming the NHS for the future’… gimmestrength.

We don’t have a system in place, for prioritisation…

… just a lot of conflicting guidance and wish lists. Add to that the distraction of the day job, running to catch-up.

The NHS is a place where, many times, prioritising isn’t possible because prioritising involves saying ‘no’… and ‘no’ is often not acceptable.

Where everything is important, systems and processes should be in place, to avoid ‘priority’ but most NHS systems have been overwhelmed.

That gives way to the ‘urgency effect’ where urgency is pursued over importance. Urgent is part of the NHS everyday and everything is important to somebody.

Priority? There is a way; figure out whose priority?

Every specialty, department, worker, organisation will have their claim to priority.

To untangle the NHS priority pile we need to find one that chimes with the politicians, the public and the people in the system.

There is one…

… it’s waiting lists. Waiting is linked to pretty well every part of the Service… flow, capacity, discharge, workforce, estates. It’s the stripe in the toothpaste.

It’s a political promise, a public priority and our people’s mission.

If I was the one with the Red Box, I’d want ‘the waiting list’ deconstructed.

Just who’s waiting for what and where. Some a simple on-line conversation, through to multiple appointments for clinical complexity.

I’d only spend a pound, make a change, do something new if I could demonstrate it would, in some way bring people quicker to whatever it is they’re waiting for.

It’s not numbers in the absolute that’s important, it’s the direction of travel and the trajectory.

Create the time and space for the NHS to deliver..

… step back and watch the numbers fall.

… step forward and take the credit (It’s what politicians do!).

It must be the priority that everyone would buy into.

Come to work for not just the what and why of the shift but being part of the Wow! as the numbers come down.

Crystal clear focus, galvanising effort and the will to succeed.

It’ll take leadership.

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