The travails of the NHS… more accurately, the people working in it, continue to fill my inbox.
The stripped-pine truth… no one has a good word to say about regulation. Not that it is overbearing. Not that it is too nosey. Simply, its total irrelevance.
The people of the NHS come to work with nothing to offer but their commitment and skill…
… they are loved by those they help but are totally vulnerable in a system that neither cares about them, protects them, nor stands by them.
The regulator’s irrelevance nowhere more profound than in the relationships it has with the public they are supposed to protect.
Inspection has not made the NHS safer, regulation protects no one. Yet, we pour millions into systems that give us nothing in return.
Twenty years ago a paper was published;
Papering Over the Cracks? Rules, Regulation and Real Trust.
One of the authors was Ed Smith, who went on to become the chair of NHSImprovement… now defunct…. the organisation, not Ed!
The central theme… the role of trust;
‘… which is like oxygen, vital to human flourishing… unnoticed until it goes missing’.
The authors point out;
‘Trust goes hand in hand with standards in public and corporate life. When people don’t think they can trust companies to tell the truth, they are suspicious… ask for government regulation to protect consumers…’
The public are patently not protected by regulation.
Weary travellers lying on the marble floors of foreign airports will have something to say about the national airspace regulator, the Civil Aviation Authority.
Ed Smith argues gaps in trust are plugged by laws and regulation;
‘… regulatory attempts to repair trust in business will, over the longer term, undermine the true basis of trust… the intrinsic trustworthiness of companies and the people who lead them.’
Delete ‘business’ and insert ‘NHS’ and you could republish his work today, fresh as a daisy.
You can’t regulate for honesty (or efficiency for that matter) it all boils down to integrity.
If we agree regulation is like a transistor radio in a digital era, what do we replace it with?
Organisational integrity comes when people do the right thing.
Smith observes;
‘…one of the greatest temptations of regulation-oriented politicians is to set up new bodies, merge others… generally tinker with the institutional framework…’
Which describes the NHS we have now. The clamour for regulation, knowing it’s regulation that if it didn’t get us here, certainly didn’t stop us getting here.
Making the distinction between the honest mistake and competence is too fine when viewed through the lens of the regulator.
The two are treated as being the same which is why the truth becomes obscured.
This is not an argument for laissez-faire. This is a search for an alternative, based on the person.
Should we say on day-one of NHS induction, training; page one paragraph one;
- You are joining the most important public service our nation has.
- Today and every day, a million people will be in our care. As much as we might try, it is unreasonable to expect everything to go well. Mistakes will happen. We know you will not always get everything right.
- All we ask is that you tell us, so we can say thank you and make sure no one else makes the same mistake.
- That way we learn together.
Alas, the NHS instinct is to cover up, run for cover, circle the wagons. We know why… the instinct is for survival… and by covering up, too often the survivors come back… the revolving door spins again…
To borrow from Smith and invert his thinking;
- Trust as a vital ingredient is missing
- The public are losing trust in the management of the NHS
- Regulation undermines trust by substituting technical rules for moral principles
- Culture rests on rules when it should rest on integrity and behaviour
- The regulation-reflex creates a whole new dimension of problems
Smith wrote all this 20 years ago and since, organisational dynamics in the NHS have got and are getting worse.
To borrow a Chinese proverb; ‘fish rots from the head’.
The DH+ makes impossible demands on NHSE.
In turn they make impossible demands… like the pressures on ICBs, mainly mired in debt, to finding savings…
… to force the system to deliver more with less, with a broken workforce, a crumbling estate, in the shadow of political promises that cannot be delivered with parts of the workforce intent on industrial disruption that only the DH can resolve.
This is total madness and it is time it was said.
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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