Jaws in Space – Johnny Marshall

The skies outside Quarry House were so exceptionally dull and grey, Angela’s Ashes (1999) without the happy ending!, that even the thought of discussing the proposed final governance around CCG authorisation lifted my spirits! Only recently, I had chaired a session on Beyond Authorisation at the NHS Confederation conference at which the upbeat focus was all about CCG authorisation being a developmental means to a transformational end. The delegates heard first hand of two great examples of just that occurring in Newham and South Devon & Torbay. Now I was facing the hard nose reality of statutory accountability. My Stockholm Syndrome pained me slightly.

On the one hand, the NHS CB will clearly need to have assured itself that placing billions of pounds into the hands CCGs is not akin to Other People’s Money (1991) meets One flew over the Cuckoo’s Nest (1975). On the other hand, a clumsy approach could threaten the intended developmental nature of authorisation and, as a result, risk snatching defeat from the jaws of victory by signalling Groundhog Day (1993) for the NHS.

If the authorisation process runs smoothly then CCGs and the panels responsible for assessing them should reach a shared position on a CCGs state for readiness and need for future developmental support. But then again, governance arrangements aren’t really designed with things going well in mind. It was never going to be a less bureaucratic process than expected. Some first wave CCG leaders are reporting it has been more work than they anticipated but of value in their development to date.

Throughout the authorisation process, I have a hunch that we should not lose sight of the fact that whilst we might build panels that are expert in authorisation, there is not, as yet, a sufficient wealth of expertise as to what constitutes excellence in newly forming CCGs for this to be an absolute assessment process. Whilst an evidence based approach clearly has merit it should not tie us to the past and successful innovation is usually spotted by most of us retrospectively as a result of the outcomes of the innovation, unless perhaps you are a venture capitalist! I wonder if we should have some of those on the assessment panel … on second thoughts … The Towering Inferno (1974) on the Titanic (1997) during Independence Day (1996) compounded by an Outbreak (1995) springs to mind!

The authorisation process is intended to be developmental by nature, as we all need to be open to new learning. As the authorisation process runs its course, we should consider building in that new learning for both assessor and the assessed, disseminating learning both prospectively and retrospectively. My gloom was momentarily lifted as, on paper at least, it too seems that an effective balance between these two tensions may not be beyond us.

The very real challenges that the staff recruitment presents to NHS CB were up next and ensured that the rest of the agenda could only get lighter. There is a self-obvious need to staff the organisation at pace but alongside what seems to be a genuine aspiration to forge a new organisation that values and engages its staff right from the outset, setting the tone for the rest of the NHS. Rather like a Need for Speed (in the planning and due out 2014) on The Job (2009) without going Back to the Future (1985). My Stockholm Syndrome niggled again as I wondered whether need always triumphs over aspiration.

Whatever the outcome it is clear that it will not be perfect and, if judged on that basis, it will be deemed a failure. Ultimately, the aspiration will be judged by the behaviours that result from it. It would seem that the very senior manager positions will be crucial as they seek to develop and cascade the values of the NHS CB throughout the local area teams. The culture they create will not only dictate the immediate pace of change, but probably well into the future.

To Be Continued (2008) …


Apparently, in Hollywood one of the key skills in pitching a new movie is being able to sum up its very essence in one sentence. Jaws in Space was not the pitch to describe the CCG authorisation process but for Alien (1979). The best attempt I have witnessed so far in applying this principle to Clinical Commissioning Groups comes from Gary Belfield, at a recent Westminster Forum, when he drew a parallel between the establishment of CCGs and the film Big (1988), starring Tom Hanks. You remember … the film in which the teenage boy wakes up one day in an adult’s body etc. …! I think it had a happy ending, but not before further transformation!

If you think that you can come up with a one-line pitch, then answers on a tweet please, to @marshall_johnny #CCGpitch


Categories: BlogsDr Johnny MarshallHomeNews