This isn’t the way to deliver the
Ten-Year Plan
People often ask me what MiP thinks of the Ten-Year Plan and if our members support it. I struggle to give a glass-half-full answer because of the circumstances in which the Plan has been launched. The government’s brutal financial reset and (unpromised) system change is bearing down hard on managers, their jobs, wellbeing and effectiveness. Throw in the imperative to cut hospital waiting lists and you have the real NHS strategic plan, now and for the foreseeable future.
To add insult to injury, this is framed as cutting useless bureaucracy and freeing up resources for the frontline, with the maddening request for managers not to take it personally. Guess what? Dedicated public servants, who know their work matters to the public, even if the public don’t yet, do take it personally. They worry about what’s happening to safety and the ability of the NHS to get back on its feet. They worry–managers are human beings—about their livelihoods and careers. And they worry about what will happen if the NHS fails at a time when its political haters on the right are running rampant.
This is the hard context of the Ten-Year Plan for our members.
Then there is the Plan itself, expertly dissected by a panel of experts in this Healthcare Manager article. More vision than plan, its inconsistencies and uncertainties inevitably create more questions that need answers. For me the challenge—identified by the original planners—was not what to put in plan itself, but to work out why earlier attempts to achieve the same shifts have failed. Why do we so often set a course only to row in the opposite direction? Have we answered that? Probably not.
But—deep breath—the Ten-Year Plan is the only plan in town. As a union we will try to influence and shape what happens next, paying attention to four interlocking areas.
Our members want managers and their teams to have the autonomy and tools to get on with the job and to be held accountable for outcomes, not micro-managed on inputs.
First, keep making the case that good management is vital for the Plan’s success and improving public satisfaction with the NHS. Our slogan is ‘good management eradicates bureaucracy’. Steve Black, who makes this case every week in the HSJ, draws an arresting, if dated, analogy with the Battle of Britain: it took 15 people working in different functions to put one pilot in the air. If we had focussed just on getting more pilots, as many argued at the time, we’d have lost.
Last November, Wes Streeting said he was ready to make the unpopular argument for NHS management. We can help him. We support getting on with implementing the Messenger recommendations, and an acid test for us is getting the right attention for the non-clinical workforce in the forthcoming ten-year workforce plan.
Second—and how’s this for an unpopular argument?—argue for investment away from the frontline. With money as tight as ever, this means difficult decisions, managerially and politically. For example: you won’t make HR a digital-first experience, as the Plan promises, unless you invest in systems and specialist staff, and you won’t accelerate digital adoption by clinical colleagues if you cut specialist digital teams (which we’re doing).
Third, demand cultural change. Our members want managers and their teams to have the autonomy and tools to get on with the job and to be held accountable for outcomes, not micro-managed on inputs. We agree the NHS should be the best employer and will help to create the promised Staff Standards—which must cover organisational change and diversity in new, meaningful ways.
Fourth, urge the government to focus on ‘how’ as much as ‘what’. Without effective organisation design, delivery becomes an exercise in wishful thinking. The Treasury-enforced pause in system changes is a chance to take stock and think again about how we actually deliver the Plan. If we don’t take this opportunity we risk another round of top-down re-organisation in a few years’ time and minuscule progress on the three shifts.
These four areas need fresh thinking and a willingness to act differently. It’s hard, bucking all the trends, but that’s what’s needed for the Ten-Year Plan to succeed. //
- Jon Restell is chief executive of Managers in Partnership.
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