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There is much to welcome in We Are the NHS: People Plan 2020/21 – Action for us all, published last week by NHS England, such as its commitment to flexible working, apprenticeships, adequate rest time and facilities for staff, and more.

Even so, the report left me thinking that it might have heralded the kind of culture change I believe is required if its whole logic had been predicated on a paragraph in section 4, New ways of working and delivering care.

Referring to how NHS staff responded to the challenge of Covid-19, it states:

“Successes in teams were made possible by good communication, high levels of trust, distributed leadership, and rapid decision-making, as bureaucracy fell away and people felt empowered to do what was needed.”

“Teams also blurred sector boundaries, with greater collaborative working with colleagues in social care.”

“We must all now build on this momentum to transform the way our teams, organisations and systems work together, and how care is delivered for patients.” (We Are the NHS: People Plan 2020/21 – Action for us all, p.32.)

To build on that momentum means enabling and supporting those teams and organisations to maintain and strengthen the relationships needed to co-create solutions with the communities and individuals they serve.

The People Plan begins with this sentence: “Our NHS is made up of 1.3 million people who care for the people of this country with skill, compassion and dedication.” (We Are the NHS: People Plan 2020/21 – Action for us all, p.5.)

However, many of those professionals find their ability to give the people they serve the full benefit of their ‘skill, compassion and dedication’ is continually frustrated by organisational and systemic obstacles.

Matt Hancock, MP, Secretary of State for Health and Social Care, says he is committed to changing that. In his Future of Health Care speech on the day the People Plan was published, he said:

“In the heat of the crisis we saw a shared understanding:

  • that accepted truths or ways of doing things had to be challenged if they didn’t help
  • that the needs of the patient mattered more than the silos between institutions
  • and, crucially, that we value the contribution from everyone on the team.”

Yet England’s response to the Covid-19 crisis has been undermined – particularly in relation to the crucial test and trace arrangements — by an evident assumption that central government and its chosen corporate contractors know better than local communities, authorities and professionals.

As Mr Hancock noted: “Done best, the centre sets clear tramlines, and holds the frontline transparently to account for delivery. … We need a framework that encourages local initiative in service of the overall goal.”

Inbeed, but in practice it is not words that matter but the power dynamics behind them, and although I believe that at one level Mr Hancock means what he says, his government continues to undermine confidence that it does so.

Mr Hancock also announced a “Bureaucracy Challenge”, stating that “every new proposed regulation or process” should be questioned as to whether “it makes sense given the realities of modern, integrated healthcare”. He added:

“This means inviting everyone who has to work under this bureaucracy, from the most eminent Royal College president to the most junior healthcare assistant, to tell us what they think should be scrapped or improved.”

At first glance, this seems to be consistent with Mr Hancock’s earlier points, but actually it subtly contradicts them because of its underlying assumptions about distribution of authority.

Rather than asking people how to make ‘working under this bureaucracy’ better, why not turn this relationship on its head by expecting the administrative apparatus to serve and support the professionals rather than command or control them?

Of course, Mr Hancock is right that some rules and regulations are necessary in the context of a national democratically accountable framework, but they should be as few, simple and concise as possible, defining clear and reasonable goals, values and boundaries of authority.

On that stable basis, the ‘commitment, skill and dedication’ of the 1.3 million people employed by the NHS — and of the even larger social care workforce — will create solutions in collaboration with the individuals and communities they serve.

There is a wide credibility gap between the aspirations outlined by Mr Hancock and the People Plan and the reality on the ground. It won’t be closed by telling people what they already know. It does require listening and responding to what they need.

 

Image source: pg 14. ‘WE ARE THE NHS: People Plan for 2020/21 – action for us all’