It’s an interesting conundrum. I have not seen a more compelling case for change in any other private sector organisation we have worked in yet during the last 5 years of white papers and other reports Future Purchasing have written for, on behalf of, and about the NHS there is still only limited movement in real terms versus the opportunity. In the meantime many of our private sector clients have identified opportunities, and done something about them. The gap between private and public ways of working simply continues to widen.
The machinery of government poses a massive challenge to achieving any kind of change and there is no doubt that the added complexities of party politics and our electoral system drive certain behaviours amongst Policitians and Leaders depending on where the country is in the electoral cycle. Some of which is understandable as every 4 years or so a big political shift ‘could happen’ meaning the ability to transform is really something that has to be set out at the start of the a new political term. This is a key issue as really the NHS needs to have a more long sighted vision and rise above the party politics, and the short termism that attracts the voting public, for the greater good of the nation.
That said there are many private sector organisations who have their own severe constraints but it doesn’t appear to stop them doing ‘something’ that takes them several steps forward. So why does the NHS struggle so much? Is it possible that the sheer size and scale of the NHS organisation and the opportunity may freeze people’s ability to actually do something and make it happen as the task could appear so enormous? No - most business executives understand this and know “Rome can’t be built in a day” – the key thing is to lay the first stone.
But are we making assumptions? Perhaps this is not as obvious to a public servant who has had a career of very specific public sector training, grounding and experiences? Or is it cultural - past experiences or an inherent worry of potential blame – might that account for it? Is it simply trying to bite off more than you can chew – and therefore failing to ‘eat’ anything? Or is it a lack of motivation at an individual level, perhaps as a result of poorly created targets? Or is it a lack of experience that it ‘can’ happen, of having seen change happen elsewhere so you just ‘know’ it can here too – differently, yes, but it can happen?
There are many intelligent people who work in and around the NHS , and many of them conceptually have the right strategic ideas and direction. Discussions are fascinating but perhaps there comes a point when folk need to stop talking and start doing. The facts speak for themselves – the pace of change is slow, too slow – and it’s frustrating to watch. Change Management – evolutionary or revolutionary – it’s a skill, for sure but it’s also a belief. Perhaps the question is: can people who have lived and experienced only one main employer such as the NHS or the ‘Government’ still believe they can make change happen?