Last night I found myself actually crying tears of frustration watching “Can Gerry Robinson Fix The NHS? – One Year On“.
Don’t get me wrong, there was much in the program to gladden the spirit. Consultants and managers obviously were working together better. Lists were down, resources such as operating theaters were being well used. There was a real feeling that a lot of the energy drive and commitment from everyone to do a good job was being channeled constructively and with humor.
The real frustration came that real lessons of Gerry Robinson’s practical common sense enabling view of management still seemed to be fighting against the same command and control bureaucracies and artifical markets working in the background. There was an undercurrent that perhaps governenment would like hospitals to be less efficient because then they would have to pay out less money. That even if Gerry Robinson had been at the helm of the hospital full time he wouldn’t have been able to achieve much more than Brian James the current chief exec had.
- In one part you had a skilled and committed consultant, who had done a lot to try to improve the hospital he worked at, forced out of the NHS and into private practice because it was the only way he could be rewarded for effort. Surely any organisation should be able to see that it makes no sense to lose your best people because managers have no flexibility to reward staff – especially when the organisation as a whole then goes on to pay a fortune to pay the same person to do the same work within the private sector.
- In another you had resources being wasted on a huge new modern health centre being built, taking work away from the hospital less than 2 miles away so that the people of Rotherham had somewhere to go if they “felt a bit iffy”. There was no real feeling that even the people at the Primary Care Trust had any idea what the benefit of the project would be or the impact on the other parts of their own organisation.
- Finally there was the farcical wait for a new computer system. I might know very little about healthcare but I’m willing to bet that any system already more than 4 years late will never deliver real value, or at least nothing like the value of the money poured into developing it. Technology, business processes change too fast. You have a constantly moving goalpost tracking change, or people are working hard to build and test a system that will be obsolete before it arrives. There was no real feeling either that the people who are going to use the system were part of the process. Is it cynical to say that’s going to be a lot of lines of code and documentation that needs to be changed and tested when the customers finally see the finished product.
Originally regulation, government and management were words that implied gentle intervention in the running of a system to keep it working effectively. It can’t be too hard to see that when they are too heavy-handed they are going to result in the system slowing down or grinding to a shattering halt.
People want to do a good job, they know what is needed to let them do it. All they need is for managment and government to do is to remove the obstacles from their path. Lots of ideas come from the people doing the job when they have a real belief that people will listen. Some ideas are workable, others less so but unless you listen and try to make things happen you’ll end up trying to make work poorly thought out initiatives from above and any organisation will stagnate into cynicism.
This is a message that deserves to be screamed from every rooftop and through every level of every organisation. In something as vitally important to everyone as healthcare I would hope it would be shouted loudest of all. Yes its deceptivetly simple in theory and hard in practice – but that is no excuse for shirking the responsibility of making it work.
Good for you Gerry Robinson for airing the debate on public television. I just hope a lot of people listen.