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How do you feel about the NHS? – Ed Smith

In the latest in a series blogs focusing on Sustainability and Transformation Plans (STPs), Ed Smith, Chair of NHS Improvement, explores some of the key questions that need be asked in order to take the right approach to planning.

I always think that a really good question to ask someone is “how do you feel?” It’s a different question to “What do you think?” because it goes to the heart of an emotional response which encompasses thinking but in the right “climate” elicits a richer and deeper response. I feel that this is an important part of our approach to Sustainability and Transformation Plans (STPs).

What are your feelings when you meet as a collaborative team focussed on patients and the public in your local health economy? Are those feelings aligned with the incentives and targets which are the focus of the organisation you belong to? How do you reconcile the ambiguity when you feel they are not and plan to meet both sets of needs?

How do you feel about spending time and effort on the medium to longer term when much of the health service is in short term operational mode? Do you join meetings to win (and for whom are you winning) or to be a systems leader who will accede to the bigger prize on offer for the system rather than any individual organisation?

How do you feel about the role national bodies and others are taking to support you and align their roles and interventions to make the STPs a strong and effective piece of architecture to deliver better and more efficient health and care?

I hope these are not daft questions that are quickly skated over in the urgency of timeframes, budgets and pressures of other short term operational activities. If they are brushed aside then I suspect we may have some plans, but won’t have the feeling that they are deliverable nor that they are really owned both in the head and in the heart of the NHS.

The question about “how do you feel?” reminds me of a close colleague who presented me many years ago with his take on the three most important human emotions-fear, greed and pride. How do these play out in our NHS?

Fear is a nice stick to beat people with but we know it doesn’t work as a motivator and even more so when the workforce is more vocationally oriented and mobile, as it is in our health and care service. Sadly it can be overused as a reflex of command and control bunkers.

Greed is clearly one that may work in some sectors of our economy and with a few people but I doubt it’s the principal human emotion that drives over a million people in our NHS to get up and come to work day in day out.

So let’s get to pride. Explaining what pride as a human emotion might mean could be: doing a good job; being respected by colleagues and commentators; helping people who need help and who recognise that’s what you spend your days doing; being thanked and thanking others; being proud of the place you work, of the colleagues you work with and of the collaborative spirit that surrounds your organisation in serving our public’s needs: being really proud of our social purpose.

So if we think that pride is an emotion which is more likely to be the motivator of a vocationally driven health and care workforce, how are we all doing? Are we, as leaders, creating the oxygen in the system to allow pride to flourish in the face of the overheated and stressed health service? What will we need to do differently to deliver in the years ahead?

We may think we have the answers in documents and in speeches but do we feel those answers can be delivered? What we might pay attention to at all levels is whether we have Sensing Thinking People (oh STP!) to fuel the engines of pride and extinguish the purveyors of fear?


Ed SmithEd Smith is the Chairman of NHS Improvement, Non-Executive Director for NHS Property Services, and the Lead Non-Executive Director for the Department for Transport.

Ed is also the Pro-Chancellor and Chairman of Council at the University of Birmingham, a Member of the Competition and Markets Authority panel and is a Member of Council and Treasurer of Chatham House.

He was the former Global Assurance Chief Operating Officer and Strategy Chairman of PricewaterhouseCoopers (PwC). Before retiring he had a successful 30-year career with PwC, holding many leading board and top client roles in the UK and globally as a Senior Partner.

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