Keeping it simple

The NHS is a complex system, difficult to navigate for the initiated let alone the initiated. At the best of times understanding the roles and relationships within the NHS is difficult but at times of significant change they are even more mysterious. There is a fine dividing line between organised chaos and a complete shambles and the current reforms seem to be teetering precariously on the edge between the two. Add to that the need to find £20bn by 2014 and possibly as much as £50bn in the following 5 years and life gets ‘interesting’ for the leadership of our front-line NHS organisations.

At a time of complexity and turbulence there is even more pressure on leadership to make sense of that complexity, keep a focus on what is absolutely essential and communicate that clearly and consistently with their staff. In essence the senior leadership of a Trust is the buffer between the external chaos and complexity of the wider context and its insatiable demands and the reality of the challenge on the front-line. In the rising storm we need to navigate by a few clear reference points that staff can really engage with.
I would suggest that there are only four hard themes that matter:

  • Relentless in the elimination of harm – physical harm, mental harm, harm to dignity
  • Relentless in the elimination of waste – waste of money, waste of time of patients and staff, waste of goodwill
  • Relentless in the pursuit of innovation – innovation in the way we design and deliver the services of the future, innovation in the way we engage and empower patients and Carers, innovation in the way we think differently about our challenges.

And finally the one we seem to always to pay lip service to only



  • Relentless in equipping and supporting staff to deliver the first three with pride.

It this final one that exercises me most. Failing to equip our staff properly is like asking them to climb Everest in trainers. Or as an ex-soldier if feels like sending troops to Afghanistan without the right training and equipment. The damage that is done to the staff and the damage caused to the local context by struggling staff who are ill-equipped and trained is incalculable. Failure to give our staff the right tools, skills and support is inexcusable.
So my simple questions to you are these:



  • Are the people who actually have to make these changes happen and who will experience the impact of those changes, equipped with the skills, tools and support that enables them them to rise to the challenge, survive and indeed thrive?
  • Do you know what skills and capabilities you have already? Where is your talent and skills register?
  • Where are the resources you need to develop and sustain your staff’s capability and capacity to deliver the first three? Have you just made them redundant as part of your savings programme?