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Why progress is holding us back


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Friday, 16 September 2016

Why progress is holding us back

The answer has been staring us in the face. It’s not lack of change but change itself that’s the problem.

Transformation is expensive, complex, difficult to measure, takes much longer than anyone thinks and has more syllables than change. There is no evidence that it is necessary or achieves any of the outcomes claimed for it.

What happens if you keep trying to transform things? The empirical evidence is that they get worse. The case against change programmes is pretty damning. Since the NHS started more of them, we have seen GP shortages, rising demand, falling morale, hospitals running out of money, ageing populations, people getting fatter, children taking up smoking, Brexit, Donald Trump and so on.

The one thing we haven’t tried is not changing.

Chris Hopson, head of NHS Providers, which speaks for hospitals, probably thought he was being helpful this week when he claimed that new care models were not a three to five year project but a five to 15 year marathon.

Not helpful at all, Chris. We all knew this but didn’t need it pointing out. As Simon Stevens appears before committees of MPs doing his Oliver Twist routine, the last thing he needs is you warning that extraordinary funding could be required over the next three parliaments.

What Mr Hopson should have said is that the more transformation you attempt, the bigger the mess you make.

Post-transformational thinking turns all this on its head. It says things immediately get better when you stop trying to transform them.

The results can be spectacular. Not only do you eliminate the significant extra cost of the programmes themselves, you also avoid the unwelcome side-effects of progress. For a government permanently under attack for its plans to privatise, auction off or break up the NHS, turn it into a theme park or tax haven for US mega-corporations, or knock down hospitals to make way for new grammar schools, the message that “we have no plans at all for the NHS” is a potential vote winner.

The cost benefit analysis for post-transformationalism is compelling. Compared to vanguards for which there are never any credible numbers, the sort of non-initiative we’ll see in future offers a fabulous payback. We asked a health analyst to do the sums.

Zero (progress) divided by zero (cost) equals infinity. That’s a handsome return on investment, whichever way you look at it.

In short, we have been getting it spectacularly wrong for years. There is only one way to save the NHS now.

We need to stop trying to respond to the challenges of the future.

Forward views editor: NHS Networks


Acknowledgement: Thanks to Adam Gowland for some of the ideas in this article and to Tom Dewar for the ROI formula. 

Philip Coulthard
Philip Coulthard says:
Sep 16, 2016 12:57 PM

Reminds me of Cowslip in the Warren of Snares, Watership down. Change is inevitable and to deny it would be to act as Kanute. If you dont wish to work with large corporations, expand and encourage growth of social enterprises which are best structured for managing chaordic situations. There is a place for Heirachial structures but a balance should have been reached long ago which both Labour and Conservatives have failed to reach.

Charis Croft
Charis Croft says:
Sep 16, 2016 01:23 PM

This isn't satire, this is just simply true... (save the infinity benefits)

Julian Patterson
Julian Patterson says:
Sep 16, 2016 03:54 PM

For the sake of those I may need to suck up to in the near future, I would add an "allegedly". A full and frank confession about the infinite benefits line is below.

Mathew Griffiths
Mathew Griffiths says:
Sep 16, 2016 01:37 PM

Excellent post Julian, but zero divided by zero is undefined, not infinity...

Aware I should get out more.

Julian Patterson
Julian Patterson says:
Sep 16, 2016 03:51 PM

Thanks, Mathew. I'm not a mathematician by any stretch of the imagination, but I was warned about the problem of dividing a non-number by itself. I decided to ignore it. Poetic licence, or something.

Nicholas Jefferies
Nicholas Jefferies says:
Sep 16, 2016 05:04 PM

I seem to recall in 2010 an aspiring Government promised the electorate "no changes for the NHS". And then control-freakery took over and that was a corner that had to be p*ssed in... And isn't a number divided by itself just one? Perhaps the unity towards which we strive...

Julian Patterson
Julian Patterson says:
Sep 17, 2016 10:23 AM

Aspiring governments say the funniest things. Someone should make a heartwarming prime time TV show about it. See above for disclaimer about the maths.

Anonymous says:
Sep 19, 2016 12:56 PM

thank you Julian for your continuing wry comments - I so enjoy them. Today we have no medics so if our clients would oblige by not having a crisis it would be very much appreciated

Anonymous says:
Sep 19, 2016 12:56 PM

thank you Julian for your continuing wry comments - I so enjoy them. Today we have no medics so if our clients would oblige by not having a crisis it would be very much appreciated

Colin Hingston
Colin Hingston says:
Sep 29, 2016 08:52 AM

Pithy and astute as ever.
Slight disagreement: Brexit? Bring it on, I say.