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The plan to end all plans


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Thursday, 14 July 2016

The plan to end all plans

There are two ways to make the NHS paper-free by 2020. One is to sort out the IT but, as we observed recently, the prospects for that are not encouraging. The other thing to do is stop generating so much paper.

The dark satanic mills of Leeds and London churn out tons of regulation, guidance, reports, toolkits and resources, all of it well-meaning, little of it helpful.

Thousands of hours and millions of pounds are spent conceiving, debating, consulting upon, drafting, editing, fact-checking, quality assuring, approving and cascading endless pages of instruction and countless megabytes of infographics (the new name for pictures).

Supply and supply

This is an industry with two supply sides and no demand. The centre issues a national plan to the service demanding local plans. The service answers with a number of large documents striving to fulfil the requirements of the plan calling for plans.

These documents are designed to show that the objectives of the original plan have been partially digested. As no one actually understands what these are or what purpose they serve, the gold standard for a local plan is rapid regurgitation – the ability to swallow then bring back up something that looks and smells very like the original material.

Once the plans in answer to the plan calling for plans have been submitted, a secondary process called assurance kicks in. This is a polite term for the rejection of all but a few of the plans. Assurance generates a fresh round of documents in the form of guidance to help those below the line to make their draft plans fit for resubmission as final plans.

Final, that is, in the loosest sense of the word, as very few of these plans are destined for publication. Even fewer will be implemented or acted upon, not because the people working on them are idle or incompetent. It’s simply that they’re very busy working on their plans – plans for improving efficiency, streamlining services, curtailing waste, freeing up resources, eradicating paperwork and making better plans.

Heavily documented

In the unlikely event that a plan nears completion, the system takes self-preserving corrective action and issues a fresh call for plans. This is usually justified by a new policy imperative, by the failure to generate meaningful plans last time or simply by the fact that time is up and another planning round has started. The planning regime addresses the problem with a new, more compelling set of aims and a catchier title for the strategy, programme or initiative they are meant to complete.

Simon Stevens thought he could break this cycle by getting rid of the annual planning round. Spotting that the time it took to get plans written, signed off and underway was always slightly more than 12 months, Stevens came up with the idea of a five-year plan. A more realistic timescale would drive the box-tickers, the foot-draggers and the system-gamers out into the open, where they could be more easily picked off. Or so he thought.

Stevens underestimated the strength of the Grey Panthers, the We’ve Always Done it This Way Brigade and the Tell Us What to Do in Painful Detail Freedom Fighters. Collectively known as the Passive Resistance, this heavily-documented network of insurgents flees to the hills as soon as the tanks roll into their villages. They are armed to the teeth with laptops, spreadsheets and semi-automatic Powerpoint slidedecks – and they’re not afraid to use them.

Light touch

So you say you want a revolution? Well forget it. We’re not overturning anything without a decent local plan based on international best practice, an evidence review, a wide-reaching stakeholder consultation and one of those cartoons that covers a whole wall.

Stevens told the NHS Confederation’s annual meeting that it was time for the centre to stop spoon-feeding the service and clogging up the system with documents and processes that have become ends in themselves. It’s a noble ambition, but even now a large document is taking shape in Quarry House to tell us how to do what Simon says we should stop doing.

The era of light-touch planning will dawn with a draft Operating Framework for Self-reliance, Initiative-taking and Risk-free Barrier Removal 2016-21. 

Forward views editor: NHS Networks 


Steve Benjamin
Steve Benjamin says:
Jul 15, 2016 08:43 AM

Brilliant once again. I don't know whether to laugh because you have nailed it or cry ...because you have nailed it - there is no hope

Anonymous says:
Jul 15, 2016 10:24 AM

NHS banter - love it because it is so true