Chris Lancelot on... The Inflexibility of the NHS

It is 1 July and it has been a difficult week: front-line staff are being laid off, 80 per cent of newly qualifying nurses are not expected to find a job, and one of our local hospitals is considering closing several core departments in order to meet its strict financial targets. This will change the hospital beyond recognition and hugely inconvenience the patients.

Today is also the ninetieth anniversary of the start of the Battle of the Somme: 20,000 British soldiers were killed on the first day alone.

At the beginning of the battle, the British Army was rigid: HQ was remote, communications difficult, intelligence poor, and most critically, commanders in the field wouldn't deviate from the centrally prepared plan.

By the end of the campaign, all this had changed: field commanders were free to make instant decisions in the light of changed circumstances and had learned how to make best use of emerging technology such as the tank, reconnaissance aircraft and the creeping barrage.

The NHS is currently run like the British Army on the first day of the Somme - huge, centralised, unwieldy and inflexible.

Although lip-service is paid to local decision-making, this is only allowed if rigid central targets have first been met, which in practice means no autonomy at all, because there is never any money left over.

A huge organisation like the NHS simply cannot be run centrally - local 'commanders' must be given freedom to react to local circumstances.

The NHS also needs better communications between managers and staff: this has to work in both directions if good decisions are to be made.

The National Programme for IT demonstrates a classic mistake. By preventing feedback from its end-users, it has minimised its effectiveness, making it a time-waster, rather than a help.

As an NHS worker, would you know whom to approach if you had a brilliant idea for saving money or reducing waste? Would you be certain that your message would travel higher up the managerial chain? If not, why not?

And what does this say about the NHS's ability to collect relevant information?

The Battle of the Somme was eventually won, but at enormous cost. Ninety years on, the NHS has still to learn the same organisational lessons.

Dr Lancelot is a GP from Lancashire.

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