Policy Dilemmas for NHS Managers

The NHS is a big, complex, contested, noisy place. In addition to the Secretary of State, other Ministers and Mr Nicholson there are lots of policy makers, academic commentators, think tanks and political parties vying for the attention of local leaders.

Local leadership teams have the difficult job of agreeing on an interpretation of this ‘noise’ and then communicating (pretty much continuously) a reasonable coherent picture that helps everyone else see where their contributions are most needed.

Last years document Health Reform in England: update and next steps was a welcome contribution that I’ve talked about in this blog before.

It’s a Friday afternoon and life is already difficult so hopefully no-one will see this before Monday, but I still think there’s quite a lot of policy tensions, underneath the bigger picture, that local leaders still need to have a considered view on. Here’s 7 for starters.

Do you have any more?

Steve

www.stevepashley.co.uk

Comments

[dr m]

How about:

Wasting money by employing management consultants vs. saving money by not employing these parasites?

[Steve Pashley]

I imagine in most cases local leadership teams haven't actually made the decision to bring in 'turnaround' management consultants, rather they have been 'invited/imposed' by DoH/SHA as a result of a poor financial performance review or a large self-reported projected deficit - though I think they do have to pay most of the bills. See http://news.bbc.co.uk/1/hi/health/6137066.stm

[Jeni Bremner]

I don't understand the tension between localisation and whole system working - from the local gov side of the fence they would seem to be complimentary.

[Steve Pashley]

Hi Jeni,

Thanks for the comment. Yes, I agree the first one is not as clear cut as the others.

For all the others on the list it seems to me that the 'answer' is "you have to address both, at the same time, though not necessarily with equal vigour" - and that is why different groups of staff seem to be focused on addressing different, sometimes conflicting issues, at the same time. How a leadership team keeps all these balls in the air at the same time whilst also making progress on the strategically most important issues is a real challenge.

However, I agree, Localisation vs WSW need not be different from each other - it all depends on how you define the whole system at any given point in time I guess. Thanks for pointing this out.