Department of Health & Social Care

Too basic


• Don’t make assumptions
• Ask questions
• Figure out who does what and why
• Spell out what you want
• Avoid sadness, drama and misunderstandings
• Be present and do stuff

Not the basics of life, or management, leadership, love or relationships.

They are… just the basics. What it all boils down to. Get them right and most of everything else flows.

Essentials, rudiments, principals… probably not. Maybe, foundations? Wise?


They are just a starting place.

Where we start, for instance…

… to unravel and fix the problem that we have our daily conversation about. The ‘thing’ that we’re interested in. The cornerstone of what makes us tick and different as a nation and a society.

What are we going to do about the NHS?

Rely on the basics; ask questions.

I think there are six. Why;

  1. …is there very poor strategic thinking. Nothing too clever or shrewd, but enough to stop the NHS getting bounced from one idea to the next. From one fad to another.
  2. … is no one on the lookout for what’s next. Workforce shortages, ageing population, deflections and changes in demand, the impact of a digital environment… all foreseeable but nothing properly attached, nailed on or connected. Who is asking what does the NHS look like in 10, 15, 20 years and why.
  3. … is there no strategic alignment with the social care system. In fact there is deliberate avoidance of the issue and catastrophic costs in delayed discharge.
  4. …are finances hand to mouth. ICBs have been born into debt, ‘winter funding’ comes too little and too late. No longterm investment strategy… no financial plan beyond a budget or a Parliament and an un-costed long-term workforce plan.
  5. …is there no risk alignment, between the myriad of arms length bodies that are involved in health care. The 126 organisations that have regulatory interest in Trusts, the layers of governance and regulators that costs a fortune and keeps the public no safer.
  6. … is there no oversight of major programmes… the ad-hoc ‘new building programme’, collapsing faster than the RAAC hospitals, digital and IT. All floundering.

Industrial unrest festers. Most Trusts are skint. Waiting lists are solidifying. No one has any idea what to do.

Maybe the answer is simpler than we thought ; ‘fix the basics’.

Next question. Who’s going to do it. Make it happen.

You might think it’s the job of NHSEngland…


You might think it is the DH+…

… no.

At a stretch you might think it could be the Health Select Committee or Parliament…

… no

How about the Conservative Party?


It turns out it is a shadowy group, who meet four times a year….

… as far as I can see, with all the transparency of a council bin-liner. They are the Department Board at the DH+.

Their role is to;

‘… bring together ministerial and Civil Service leadership with non-executives from outside government, who can provide independent support and challenge.’

They are an odd group;

Bully-Boy, plus the former chief marketing officer of the Conservative Party. The former Parliamentary clerk to Margaret Thatcher and John Major. A mathematician. A bloke from Curries, not the take-away… the discount-electrics shops. Recently joined, a former Trust boss and a handful of the usual departmental suspects.

What do they do?

Six things;

  1. strategy,
  2. horizon scanning,
  3. strategic alignment,
  4. finance,
  5. risk,
  6. and major programmes.

Sound familiar?

Yup… the six things we agreed that are the basics. The six points of failure. The six things that the evidence of history tells us, the Board have failed on.

Who is this Board accountable to?


What do they cost?


But I do know they have four subcommittees. Executive, performance and risk, ‘people’ and investment.

How many committees does it take not to get the basics right? You be the judge.

However you look at it, even with the most charitable evaluation, taking into account wars on foreign shores, international labour markets, global financial pressures, chaos in the Tory party and the price of chips…

… this odd-lot have nothing to be proud of. In fact you might deduce, they’ve failed, big time.

They have ‘overseen’ our NHS. Provided ‘independent support and challenge’, and…

… on their watch; the service still can’t be depended on to detect sepsis, guarantee safe births or get an ambulance to your house faster than a boy, on a bike, with a pizza.

Either this Board is a miserable failure or the whole thing is a vacuous talk-shop.

Do you think this Board has been a miserable failure? Should they hang their heads in shame, apologise to the public and quit?

I do…

… but maybe that’s too basic.

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