In a recent edition of Health Service Journal (HSJ), the former CEO of the NHS Confederation, Mike Farrar, described the Service as both ‘a large rational organisation and a small village.’
The context of the comment was the need to change behaviours in order to bring about a concept known as ‘enhanced recovery.’
Enhanced recovery is another of those health service Holy Grails – this one is about a package of measures, including ‘optimal nutrition’, to reduce length of hospital stay, return the patient more rapidly to a normal life, and reduce costs. It may surprise some that enhanced recovery is not regarded as the norm (what we do, rather than what we aspire to do), but that is another matter.
What interests me here is the idea that organisations are like small villages. We deny this reality at our peril.
The paragraph I have highlighted went on to explain: ‘To change behaviour it would be necessary to operate in the irrational – emotional – space.’
Of course it is! But how sad that this even needs to be stated! In the NHS we have created a rationalist model of reality, one that sees data and not people. We have created a bureaucracy to measure and monitor, to police and plan, to cajole and control and have long since lost sight of why. Bureaucracy is now an end in itself rather than the means to an end.
Nurses now need degrees, but now need to be taught how to care too.
My sister-in-law, a teacher, has a pupil who is a consummate carer. She volunteers several hours a week in an old people’s home. She loves it and is loved by staff and residents alike. But she will not get her Maths GCSE and will therefore never qualify to nurse the people she currently helps to look after. What does that say?
I am not arguing for a 100% touchy-feely health service, just a recognition that the system is about people. It is not a train set for politicians and mandarins to play The Fat Controller.
If improvement or ‘transformation’ in the NHS is to be achieved then this will only happen through people who are motivated and united in a common purpose, not through data or targets. These should be the slave to decision-making, not its master. People make the difference, for good or ill – and it’s understanding and motivating people that will deliver the outcomes the health service needs.