Having not been at FDG for a few weeks, I returned to Quarry House feeling slightly apprehensive as to what the mice might have been up to whilst I was away. Clearly my Stockholm Syndrome was so well under control that I was developing megalomaniac tendencies, or perhaps just a little more personal insight! The agenda and attached papers ahead of the meeting contained a paper on Organisational Development within the NHS Commissioning Board. Now I know that for some of you simply putting the words “organisation” and “development” in the same sentence as “NHS” and “Board” counts as an oxymoron! Fortunately, the paper was well written although perhaps with a predominantly technical focus. However, this is not necessarily a bad thing in itself as there is a pressing need for NHSCB to give existing staff the support they need … NOW!
“Delays have dangerous ends.” Reignier, King Henry the Sixth
The question on everyone’s lips was … but is the strategy sufficiently compelling and exciting to demonstrate to the staff and the outside world exactly what is going to be different about NHSCB in comparison to previous central forces in the NHS? Now usually this would have been my line, but on this occasion, it felt more like an out of body experience as I watched things unfold in front of me. Clearly this line of questioning was being driven by The Board of NHSCB, who seem determined to establish a clear identity from the outset. However, support for this degree of transformational change within FDG seemed real, and those in attendance clearly bought in to this at both an emotional and intellectual level. The question is … can they pull it off?
“Friends, Romans, countrymen, lend me your ears; I come to bury Caesar, not to praise him” Mark Antony, Julius Caesar
The first challenge is perhaps to avoid slipping in to an acknowledged NHS mind-set of failing to differentiate between strategy and planning, it’s called “strategic planning”. In itself, it might sound quite harmless but in a new order defined by devolvement and enablement if you can’t separate the two then you might just as well tell everyone what to do! Whilst people have written lengthy books on the subject, in a nutshell the strategy should identify the problem, what it is you want to achieve, and broadly speaking what you might do about it. You need to be able to tell the story.
“An honest tale speeds best, being plainly told.” Queen Elizabeth, King Richard III
The second challenge picks up on one that the NHSCB has already set itself: actions should speak louder, and earlier, than words. In the new devolving NHS, where partnership and relationships will become an increasingly important success factor, should the NHSCB develop an OD plan in splendid isolation, or should it identify opportunities for collective development and learning across the commissioning system? The answer at FDG was resounding support for the latter. The sooner that this approach is visible externally, the greater the prospects of success.
“In such business action is eloquence, and the eyes of th’ ignorant more learned than the ears.” Volumnia, The Tragedy of Coriolanus
The third challenge is one of internal reflection by the rest of us. By “us”, I mean all who are part of the commissioning system but are not part of NHSCB. It is akin to seizing the opportunity that presents itself to break free from your captor without being paralysed by your own personal Stockholm Syndrome. Remember Dave Brailsford’s prophetic words from my last blog? Many of us have been part of, and even party to, NHS organisations in which the governing bodies have perhaps had a greater focus on plans and “doing things right” rather than strategy and “doing the right thing”. There is clearly mutual benefit in considering organisational development of our own organisations in tandem with NHSCB.
“Men at some time are masters of their fates: The fault, dear Brutus, is not in our stars, but in ourselves, that we are underlings” Cassius, Julius Caesar
The remaining challenge from FDG was pulling all this together in time for the next NHSCB Board meeting on Thursday 20th September. Whilst the NHSCB organisational development strategy might not be top of your reading list, it will allow you to peer straight in to the heart of the organisation and make your own judgement about what level of change is really afoot.
“… we know what we are, but know not what we may be.” Ophelia, Hamlet
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Dr Marshall your sole focus seems to be ensuring that GP commissioners’ perception of the NCB is different from their experience of PBC; you seem wholly unconcerned at the very likely (to quote the NCB risk register) prospect of widespread organisational failure by an under-resourced NCB being unable to effectively commission primary care and other services.
It’s really very disheartening to see you being so blase about such a major concern when there are thousands of PCT staff waiting both to find out if they will have jobs at the NCB and if there is going to be anyone left to do the important work they know needs to be done. Please take a step back and consider the risks of what is being done here.
Johnny – some insightful comments which highlight that OD should be transformational and not just about transactional restructuring. The NHS does not have a good track record of investing in the former which can take years and not just months, and requires a high level of specialist transformational change support which is so often lacking. We always smile at the common NHS phrase ‘ we’re just moving the deckchairs around on the the Titanic’ but behind that lies a long history of NHS policy makers and senior managers under valuing the place that true OD plays in achieving implementation of complex change plans.
Working with over 30 CCGs means that we often play an important OD role helping them to network and share learning and ideas. Facilitating appropriate buddying arrangements across CCGs to avoid repeating work and to learn from other’s successes and failures. Surely this important cross CCG change management role this should be a function of a national OD plan?
Many CCGs have developed some excellent OD Plans as they plan their journeys to Authorisation and Beyond. Integral to all of these is the need to develop a culture and the capabilities to enable collaborative working with the public, with other CCGs, with Providers, and with key stakeholders, one of whom is the NHS NCB and its regional infrastructure. These have been submitted to the NCB as part of the authorisation evidence. Perhaps, the place to start is to identify the common themes and the contribution that the NCB can make to enable CCGs to develop their desired culture and style of working ?