Next year the NHS turns 70… conference organisers are busy.

A lot of the programmes focus on NHS sustainability.  Give them a miss…  one paragraph will do;

‘The NHS is sustainable for as long as we want to pay for it.’

Sustainability comes to light because the NHS is struggling.  Why… in 2010 the post-banking-crisis Coalition Government cut public expenditure.  Social-care budgets were shredded and ever since the NHS has had, all but, flat-line funding.

The up-shot; it looks like we can’t afford the NHS.  We can.  The rest of Europe can, we can.  Get back to EU averages and there wouldn’t be a problem.

An ageing population?  That’s not new.  Providing the economy is working, with plenty of young people with jobs, we’ll be OK.

I know, it looks like we will be giving EU families the heave-ho but hopefully the numpties in the Cabinet will come to their senses.

There is nothing wrong with the NHS system.  Universal care though redistributed tax-funded resources.  Pretty well everywhere I go people say, I wish we had your system.

There are places where outcomes are better and access faster but that is a phenomenon of management and structures, not the system.

The real question; not is the NHS system sustainable… its is, is the management approach sustainable.  The answer… no.

By management approach I don’t mean the grand upheavals we’ve gone through.  Despite their best efforts the NHS is still open for business.

I mean the management techniques.

What we know about management, how to run large organisations is based on what we learned from US corporations like Ford and GE; efficiencies, planning, strategy, structures, grip, workflow, budgeting; mainly the lexicon of the car industry.

Industries aimed at deskilling the workforce, de-complexifying manufacturing and producing high quality goods at the lowest price  .… techniques used by the NHS for as long as I can remember.  Even now we are downgrading graduate training for nurses and hoping technology will supplant the need for human intervention.

The industrialisation of health care is one of the reasons it may not survive another 70 years.  We need a new direction; 70+Management.

Moving from old-industry to a higher purpose, where goals are not just productivity but have a social significance.

For 70+Management, running hospitals with the techniques used to run factories will be a no-no.  Hospitals, because of their size, and GP practices, because of their proximity, have to be run as a community.

They are staffed, largely, by people from the community who are entitled to know much more of what is planned and happening.

Most of our communication strategies were learned for the personnel departments of factories; notes in wage slips and management news-letters every-so-often.

We tell ourselves, because newsletters are in emails, or on the web, it’s ok.  Wrong.

For a highly skilled, committed workforce only the immediacy of communications they experience outside work will do.  Horizontal communication, hourly, is not too much to ask.  What’s happening now.

Wrapping existing services around our ‘customers’ is convenient for us and requires no thought.  We kid ourselves, putting the patient ‘at the centre of what we do’ means job-done.  Wrong.

70+Managers will start with the patient and the very best service imaginable and work backwards, a step at a time, reconstructing pathways.

The speed of change, expectations and opinion forming means experience counts for less than experimenting.  Distributing the authority from where the financial investment decisions were made to where the emotional investment is made, in front-line care.  Valuing the contribution of the person not their position.

70+Managers will rebalance fear and trust.  Regulators bring fear and nothing more.  Transparency, sharing best practice, showing what good looks like, brings trust.

Creating a democracy of information that compares performance and shows us where the best is and how to do it, is a new paradigm.

Think what the NHS could look like if we had spent the last 17 years helping it to do better, instead of inspecting and finding fault.

70+Managers recognise leaders seldom have formal authority.  Bosses are almost never leaders.  There are administrators and fall guys.

Management guru Garry Hamel talks of communities of passion, truth, love, justice and duty.

I think the NHS is ready-made for the 70+Manager.


Roy Lilley