Patrick Keady

Sir David Nicholson announces a major review of NHS strategy in England. Thank goodness!


NHS Strategy and Parliament

Sir David Nicholson announced yesterday, a major review of NHS strategy in England. Thank goodness !

While some will argue that the review could lead to more uncertainty about objectives, this is of course true.

One of the key outputs from the review will be to decide if those objectives are still relevant to the NHS in England as it approaches its 65th birthday.

In an interview with HSJ, Sir David said that “the idea you could have one model in a sort of Stalinist way driven from the centre seems out of kilter really with the kind of NHS we want to create.”

Having been involved in strategy development in the NHS in England and elsewhere, here are my initial thoughts on how the revised NHS strategy can help to ensure that the NHS in England moves into a better place after the results of the review are implemented.

The revised NHS strategy needs simplicity.

Take for example, the story that is often told about a day when President John F Kennedy visited NASA at Cape Canaveral.  While he was being guided around the site, he met a Domestic.  Good morning Ma’am” said the President.  Good morning Mr. President” said the Cleaner.  What do you do ma’am”.  I’m helping to put a man on the Moon”. 

It would be helpful if everyone working in the NHS could give an equally succinct response to the simple question, “what do you do?”.

Nicholas Burroughs helps to explain simplicity.  He is credited for saying “simplicity should be found in the execution, not the meaning”. In the NASA example, the vision was to put a man on the moon.  In terms of simplicity, the NASA strategy was all about making sure that man walked on the moon.

Reviewing the NHS strategy will inevitably be a design process. Burrough’s quotation is well-regarded in the design community and I believe that after the NHS vision is revisited, simplicity can helpfully be one of the cornerstone of the NHS strategy review.

So that the revised strategy achieves simplicity, it would also be helpful to have just one strategy, instead of the many (sometimes conflicting) strategies that we have at national, local area team, CCG and provider levels.

Having just one strategy will help to discourage the instincts of writing intricate and beautiful complexities that are likely to make things unnecessarily complex and not particularly understood.

“Trust the results, not the conclusions”. This quotation comes from Linus Pauling, the only person to single-handedly win two Nobel Prizes.  Pauling discovered that his colleagues tended to base their conclusions on their own belief-biases rather on the results. There are examples in the NHS and elsewhere, of individuals and groups who have a tendency towards developing conclusions rather than putting their efforts into improving results.

Do you like this post? What are your views on the forthcoming review of NHS strategy in England?  Please add your thoughs below.



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2 thoughts on “Sir David Nicholson announces a major review of NHS strategy in England. Thank goodness!

  1. Profile photo of Patrick KeadyPatrick Keady Post author

    Thank you for your comments Tricia. I agree that a lot of time and money has been spent already. Although it seems that it could have been spent better. For example, putting GPs at the centre of commissioning is a good idea, provided their perspectives are listened to and CCGs don’t go through a series of mergers after the next general election.

    Targets have helped improve the service over the last 10 years although there have been downsides too. While I am generally pro-targets, they seem to be overly focussed on process (4 hours, 18 weeks etc) and not on outcomes i.e. did the patient survive, was he/she safely discharged on time and able to get back to living the life he/she wants to lead and so on.

    The timing of the review is interesting – before Don Berwick reports – perhaps he has already suggested some radical changes.

    My hope is that what you say, what patients’ groups say, what CCG GPs say and what others say – will be reflected in the review. As will the reflections of Don Berwick and Robert Francis.

  2. Tricia woodhead

    Why have another strategy other than addressing the findings of the Francis report and Don Berwicks follow on guidance . We have spent enough time and money already on this distraction let us implement what we all,know now.
    1) AIM is patient centred well being and best outcome, 2) HOW would we know we had go there, clear evidence in measures we have and engagement we have not yet got that safety and all components of quality are improving , continuously 3) WHAT should we do to get there, stop reacting so fast it leads to the tunnel vision , build clinical committees to address safety improvement as a priority not a secondary item, include patients in all decision making. Trust each other and stop encouraging the seeking of power and using language that creates conflict and not collaboration

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