Chris Lancelot: Parkinson's third law is the NHS in a nutshell

Everyone knows Parkinson's first law - 'Work expands to fill the time available'

- but he also devised two more. His third law interests me the most because it is so relevant to the NHS: 'Growth leads to complexity, complexity to decay.' Not only does it diagnose the problem but it cogently explains what to do about it.

As we all know, the NHS is ultra-complex. There is a bewildering mixture of organisational arrangements: directly managed units, foundation trusts and public-private partnerships; a plethora of rules, directives and incentives; and for GPs, different contractual obligations onto which DESs and LESs have been added piecemeal.

In addition, when the DoH becomes aware of a specific need it may well introduce additional measures - such as those for screening for chlamydia or immunising against swine flu. Alternatively, ministers may concoct politically-driven projects which sit uneasily alongside existing structures.

Indeed, so many different plans have been introduced that they can get in each others' way. Not only that, but it becomes impossible for healthcare workers to remember all the incentives, directives and extra resources that might apply to a particular patient's needs.

The whole system is too complex - and it doesn't work. Parkinson wouldn't be at all surprised. The underlying problem is that everyone is trying independently to fix their own small area, oblivious to activity elsewhere. Duplication, contradiction and confusion abound.

The solution for any over-complexity is to step back and see the big picture - then get that right, refining the overall structure until it is as simple and effective as possible. Only then can specialised or local initiatives be added without causing duplication or unnecessary complications.

Complex organisations are inefficient, expensive and exhausting to work in. At the beginning of a decade of austerity for the UK and the NHS, both politicians and the DoH would do well to revisit Parkinson's laws if they want to improve NHS productivity while simultaneously cutting costs.

Complexity is the problem, simplicity the solution.

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