This week I attended a 24 hour 'simulation'. Sounds a bit rude doesn't it? Alas it was a 'game' looking at health and social care in 2012 in 'Crafton', a fictional city in central England. 50 of the UK's top people in the field, all of us 'in role'. I was very excited to be going, it sounded like it was going to be a ball. Worth 24 hours away from the business.
Was it worth it? Well, a bit. But perhaps my expectations were too high. What felt like it should have been a creative exercise felt like a bit of a technocratic conversation captured, I felt, by the mindsets that helped get us into the mess we're in today: a highly bureaucratised, professionally dominated, managerialist approach which costs a fortune while delivering very mixed results.
The triple-whammy is well understood: shrinking resources, a changing NHS and a social care time-bomb. The answer, broadly speaking, is a new settlement between citizen and state, personalisation of resources and a massive pooling of budgets in the public sector. This would see rapid shrinkage of acute health services and much more investment in the community sector so that people could help themselves and each other a lot more easily. 'Difficult' people and families who currently absorb tens of millions in every area on a plethora of public would have much less spent on them - but with better results. Preventative projects would forestall all sorts of problems before they became expensive.
The challenge at the moment is that most resources are deployed in ways that are difficult to unpick. Dis-investing in stuff that exists is very difficult, especially when those services contain highly qualified, relatively powerful people. Having seen this group work, over 24 hours, on Crafton's issues - I came away depressed. The group didn't seem to have a sense of the potential of people do to far, far more for themselves and each other. Nor did they grasp the importance of political and civic leadership in making the debate. At times, I felt I could be at any gathering of top managers over the last few years. Lots of talk of 'pathways', 'flows', 'joining-up' and so on. Often very technical and based on the idea that bureaucracies are highly improvable.
I shouldn't be too critical. These are people who are in the front-line, managerially speaking, and I respect them. They are bright enough to earn plenty of money if they chose to. Most have commitment oozing from them. But I came away depressed. It might have been me. I wasn't exactly full of ideas myself - but I just felt outside the culture, like having to speak in a second or third language. Perhaps I am just not really part of that world. Yet I do meet people, all the time, who are on my wavelength, just not that day.
Next time I am asked on a 24 hour simulation I may just simulate being too busy.
2 comments:
You have really captured my own view that in the complex roles/jobs that exist in the NHS with all the focus on measures/indicators/standards we have lost sight of the one thing which in these difficult waters gives us a raft on which to float - never underestimated the power of the human spirit and dont; focus on what people can;t do focus on what people can do
Thats disappointing because i have found that when simulating people ordinarily come up with creative solutions (unfortunately its usually the very ideas they wouldnt dare implement in reality, but no matter...); whether the process identifies creativity or just how unwilling people are to change and throw off the blinkers is debatable. My own view is that the bureacracy we have created has virtually conditioned public sector managers and senior people to restrict their expectations (because of... we cant do that because of this...its impossible with our structure to do this...what about the legal implications?...). This in turn quite naturally leads to a 'lets cover our arses and just get through it' culture which isnt useful in this particular economic situation. Generally speaking the public sector has made its own bed by conditioning its workforce to make decisions after consulting a handbook and stringently following 'due process'. Its a sad but true opinion of my reflection on having worked with some of these androids for many years.
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