I picked up a book recently co-authored by Colin Price, the essence of which can be found in this slide deck. One of the key points made is that if you are trying to transform the way you do things it is really important to have a clear narrative, a story which people can connect with.
A year on from the election I was beginning, tentatively, to believe I could tell that story. I was presenting to a group of our senior managers on Monday. I was repeating the story about the challenges health systems face worldwide, the fact that we had clearly identified the major themes we are tackling to meet that challenge. I was contextualising how the reforms and our approach would meet those challenges. I explained how developing and supporting clinical leaders in general practice was an opportunity we were seizing, as it built on the approach we have had since we were established over four years ago. I talked about the absolute need to deconstruct the PCT and build structures that delivered the changes in a professional and managerial mindset necessary to deliver the changes in behaviour so vital to maintaining quality, and how we would track and feedback implementation and the impact of those changes. I set out the timeline and the ambitious aspirations we have set. They have heard it before but telling and re-telling a consistent story is necessary to support successful transformation.
And then, later in the week, the prime minister gets up and I hear him say, “Whoa. The mental construct you have is not quite right. Let’s not rush this. Let’s involve more people and do consensus commissioning. The story we have told needs to change.” Meanwhile, elsewhere, at the same time, GPs were at a Pathfinder meeting where they were being told “push ahead harder, faster with the construct we have been working with since last year.” I can reconcile the inconsistency in these approaches. Of course we need to involve a wider range of professionals in commissioning. We already do. We can create a senate. We can do all the things asked of by the politicians and the chief executive of the NHS because that is what management does – it manages complexity – but the energy and time spent in telling that story, doing another director’s cut, detracts everyone’s attention and energy from what we really need to be doing – focusing on delivery.
Then, of course, we are still waiting for the feedback from the listening exercise. So, I might just wait a week or two before spending some time in the editing room.
Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire where there are 5,600 miles of road but less than 50 miles of dual carriageway.In April 2011 he was made director of commissioning and QIPP for the newly formed Lincolnshire PCT Cluster. There has, however, been no major change to the road network.