A genuinely new idea to cure the NHS

Recent government attempts to scapegoat GPs for the growing NHS crisis have impressed few people. The UK government is in a corner. Decades of pass-the-parcel and repeated failure to sort out the NHS means the chickens are now coming home to roost.

The NHS is teetering on the edge of systemic breakdown. Demoralised staff are repeatedly being forced to fail and politicians seem to be at a genuine loss what to do. This has all the makings of a social and political disaster.

I am going to suggest something that will, at the very least, ensure we can run the NHS as best possible with the money available. ('Funding' is the fashionable word). It is a truism that money is only as valuable as it is spent. Spent badly, vast sums can be reduced to nothing. Spent well, and the effective value of 'funding' can easily multiply. I do not dispute that the NHS needs more money but suggest that the NHS desperately needs to get more value from the money that it spends now.

The conventional Tory approach is to point out apparent waste and inefficiency in publicly managed services and implement the supposed magic bullet of privatisation. But if public sector management were up to scratch, this sort of plan would be offensive, not least, because profit would have to be paid for in any private sector involvement where public ownership would expect little more than break-even after necessary capital investment.

THE PROBLEM

 Successive governments have toyed with privatisation and endless reorganizations, supinely following instructions from large consultancies. These organizations know that getting it right, creating an efficient, productive management system is like turkeys voting for Christmas. Once the job is done, bang goes decades of lucrative business because the patient would be cured. Far better to keep the patient on super-expensive life support- far better the patient urches from one critical disease and complication to the next producing a raft of money generating consulting opportunities, ad infinitum. Meanwhile, this nice arrangement causes the deaths of countless people, unnecessary and costly privatisation, wretched demoralised employees and, now it seems, a major political nightmare. The rickety piano has stopped and Mrs May is holding the parcel.

THE IDEA

In the mid '90s I approached one of the big consultancies with an idea that will, in time, change the face of management across the World. In their offices in Shaftsbury Avenue, five minutes into the presentation I knew that they considered the idea with all the relish of someone expected to drink a cup of cold sick, washed down by a dose of flower water. I abandoned the project and IT development because an idea before its time is as hopeless as a wrong idea. Edison's adage that 'genius is 1% inspiration, 99% perspiration' is incorrect; timing is crucial. Da Vinci invented the differential and the parachute- a fat lot of good that did him or anyone else at the time.

The trick is better management but although the problem is pike obvious, virtually no progress has been made for decades. The reason why is obvious. The big consultancies have, for at least 40 years, sold the same old dull 'solutions' in one form or another whilst utterly ignoring a problem that, in private, virtually every manager and employee in large organizations admits exists. Rightly, they are too frightened to speak its name because blowing the secret, bringing it out in the open, teaching about it and using that knowledge to make things better would lead to massive change.

People feel insecure because they are corrupt, incompetent, have a wagon load of skeletons, or just because they fear worse will come their way. If the bills are being paid and they're jogging along feeling they know how things work and have allies to protect them, most people need change like they need a hole in the head. But the NHS has a gaping hole in its head... it is bleeding to death. Putting off change and playing the profit making games of the big consultancies is no longer an option. The NHS is close to massive breakdown and failure.

Like Alcoholics, the first step is to acknowledge the problem. The elephant in the room, in all the rooms of the NHS is internal politics. This gigantic herd is crushing the life out of the service as we pay for the results of a systemic poison that everyone knows exists but no one is willing to admit. The big consultancies are the most enthusiastic deniers, change hating vested interests in the NHS come second and all the staff forced to fail are too terrified to speak up. The fate of whistle-blowers is well known. To finger the cause of NHS failure would be as good as writing their own dismissal notices.

Quite a few readers will have stopped, by now, with a sigh. 'Same old, same old' they may think. Many will never openly admit Internal Politics exists. Others will say, because it is often very nasty, they are too grand, too virtuous or too pure to consider it. Some will be too frightened because they are aware of the danger. The most dishonest will either say it does not exist, that it is irrelevant or, best of all, 'it's a soft skill that cannot be taught.'

It does exist because the vast majority of staff will attest to this. Because it is nasty is the reason why it needs to be addressed, if only to be able to keep peers, superiors and others free from its clutches. The danger of talking about it will be removed once politicians are cornered by the truth. (The reason why this is being written). And, most delicious of all, internal politics, it's methods, the political structure and how to interpret it can be taught. I know because I have taught it.

The key is to unmask how information flows in an organization and see how this relates to the authority or standing of employees in the system. There are two structures:

The Plan of Organization (Organogram or Authority Structure)

The Information Landscape or Relationship Structure.

The way the two relate to generate informed decisions is where power comes from. The better the relationship the more power or bang for the funding buck you get.

Those posh consultants who threw down what they considered was a cup of sick almost physically ejecting me from their plush offices twenty years ago instantly knew the implications. Not, in a million years, were they going to abandon the vast money spinner they had developed. The idea of explaining to the government or any company how organizations actually worked was as good as committing commercial suicide. There's money to be made from bad management. They wanted to be fit and healthy; in their minds, the only way of doing that was to keep the likes of the NHS in permanent critical care, staggering from one crisis to the next.

I used to teach employees how to reveal The Relationship Structure so they could interview better. If you have been sacked or feel insecure, knowing the reason why vastly increases confidence and radically improves interview performance. Not knowing leaves them confused and often makes them appear weak and vulnerable to another attack... it makes them vastly less employable. Much to my pleasure, several of those I taught still keep in touch 16 years after selling that business.

You can see the system here: https://www.writerbeat.com/articles/2929-A-written-guide-to-reveal-company-politics-Yes-it-can-be-done  

One featuring illustrations and commissioned cartoons, inc one from Private Eye, is here: https://www.dhirubhai.net/pulse/20140604205331-61346214-a-written-guide-to-company-politics-yes-it-can-be-done

The NHS would get radically more value from existing money '(funding)' if it was managed better. The key to better management is not to reorganize and, yet again, muck around with the Plan of Organization or Authority Structure but to expose the hidden Relationship Structure for all to see. Blundering around knowing nothing about the Relationship Structure is akin to the havoc caused by long ago surgeons who had no idea of the existence of the nervous system or how it worked. The NHS on life support desperately needs rid of primitive profiteering practices of quack management consultant surgeons.

Transparency, making internal politics public, will totally change the nature of NHS management. Any necessary changes in the Authority Structure (plan of organization) could follow afterwards. The basic rule is that status is determined not by Authority but by Internal Politics as revealed by the Relationship Structure. Status should match the grade or authority of an individual. Where it does not, there are four solutions:

Dismissal or redundancy

Promotion

Demotion

Change the plan of organisation

This is a genuinely new idea. They don't come along that often.

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The Author, has worked his way up from lorry driver to management in road transport and has been a director of a Japanese language business publishing business.

He also owned a management recruitment business for 10 years. Latterly, he owned a Domiciliary Care business for 3 years, turning it round from melt-down to sell onwards when it became clear the UK government had no intention of attending to a growing crisis in that sector.

From early days as a driver in the Winter of Discontent in late '70s, working in the UK and abroad, an exceptional exposure to the worst and best of management has formed these opinions.