Thursday, 21 September 2017

What's wrong with the NHS? Bureaucracy - that's what's wrong

Let me introduce you to the Bradford and Craven Integrated Workforce Programme's workforce strategy (this will be referred to as the IWP so often you'll forget what it stands for at some future point). The IWP - Integrated Workforce Programme - reports to the Bradford and Craven Integration and Change Board (ICB) and "aims to work collaboratively to address the commonly identified system wide workforce challenges..."

OK so far? The ICB and the IWP that reports to it works in the context of the Five Year Forward View and the Five Year Forward View Next Steps for Sustainability and Transformation Partnerships (STPs) and the work of these STPs will be delivered through new Accountable Care Systems across the Bradford District and Craven. Part of this delivery cross institutional boundaries and there is an Integration and Better Care Fund Narrative Plan 2017-19 for the Bradford District.

In amongst all this there are "a number of national, regional and local drivers and associated service strategies and plans..."

Five Year Forward View sub-strategies (GP Forward View, Mental Health Forward View etc. etc.)
West Yorkshire and Harrogate STP (WY&HSTP)
Better Health Better Lives (part of Bradford Council - BMDC - plans)
Bradford District and Craven Health and Wellbeing Plan
Bradford District Joint Health and Wellbeing Strategy
North Yorkshire County Council's Health and Wellbeing Plan
Home First Plan
Children, Young People and Families Plan
CCG Primary Care Strategies

This list is preceded by the word "including" which implies that there are perhaps some other plans and strategies not referenced.

In order to "support the delivery of the transformation agenda" there are a "number of collaboratives" which include:

Local Workforce Action Board (LWAB, WY&H)
West Yorkshire Association of Acute Trusts (WYAAT)
WY&H Mental Health Partnership
'Team Bradford' Employers Conference
Bradford Health and Care Education, Employment and Skills Partnership (BEESP)

Apparently the IWP will "ensure alignment with these enablers" and will "work on the footprint deemed most appropriate in facilitating realisation" of the plans. (Takes a deep breath).

There are some workstreams including plans for a West Yorkshire National Skills Academy Centre of Excellence for Support Staff Development and plans for a new medical school in Bradford (apparently the University has to have permission from the NHS or the government to train doctors something that further underlines how stupid this whole system has become).

Somewhere in all this soup of bureaucracy and management mumbo-jumbo there's perhaps some good work going on. The difficulty, however, is that reading the reports reveals little but an enormous and costly bureaucracy directed, in this case, to answering the relatively simple question "how do we improve the quality of our workforce, reduce turnover and meet future needs." Multiply this 'collaboration' across all the UK's myriad health bodies and the result is uncounted millions in taxpayer cash splurged on a pyramid of acronyms, plans, strategies and (new one to me this) narratives.

The NHS doesn't work. And it's only the persistence and creativity of front-line staff (most of the time) that stops the bureaucracy completely preventing anything happening at all. This isn't about funding - most cash will likely, as we've seen with Better Care Fund, result in more new bureaucracy. Indeed what is clear from any encounter with the management of the NHS is that the organisation is at its most creative when it comes to inventing new and ever more complicated systems of bureaucracy.



Anonymous said...

Surely "the University has to have permission from the NHS or the government to train doctors" has been the case since at least 1858, when the GMC was created with power to oversee medical qualifications (via the authority of the Privy Council).

Alex said...

The NHS is undermanaged if anything. Statistical process control, the foundation of bad old scientific management, tells you so much about it!