Wednesday, October 17, 2007

A Bad Joke Gets Worse

What makes you think my Big Conversation is one-way?

Justine Walker, the NHS's current Nurse of the Year, has just left the NHS, citing "mistrust and fear". She says:

"We have a government saying it has talked to thousands of nurses and doctors, but it is not hearing what we are saying.

I am in favour of change in the NHS. But the impact of these reforms is grossly misunderstood by the government," she said. Staff were told to economise by using fewer needles and bandages while money was wasted on meetings of highly paid people, which never took decisions. "I leave behind a group of very unhappy nurses who have been put through the mill with constant reform."

And the Commissars' response?

"The health secretary has acknowledged that too much change can affect morale and this has to change ... that's why Lord Darzi is leading an unprecedented process of talking and listening to staff and patients."

Forget Big Conversations- this is an uprecedented process of talking and listening.

Understandably, Justine's had enough. Just like all the ex-NHS nurses who staff Tyler's local private hospital. And just like thousands of other nurses who give up on the NHS every year.

Do the Commissars think we're all stupid? Or do they actually believe it themselves?

It's quite possible they do. Whitehall experts and multi-millionaire management consultants having failed dismally, the Commissars really do think that by getting NHS staff to spend even more time in consultative meetings and filling in even more opinion survey questionaires, they will somehow find The Answer.

Last week, Tyler attended an excellent session at the Economic Research Council, listening to Eric Beinhocker talk about his outstanding book The Origin of Wealth (see here). We'll be blogging the book separately, but a key message is that the new economic thinking about how we get richer places heavy emphasis on evolutionary behavioural processes rather than intelligent design engineering processes.

And as Beinhocker highlights, evolution works through differentiation, selection, and amplification. There is no grand masterplan, and systems that work on that basis are systems that are doomed to underperformance and ultimate extinction.

Unfortunately for us, the Stalinist NHS is posited on just such a masterplan. And differentiation, selection, and amplification is about as far away from our top-down state healthcare system as human beings are from a lump of igneous rock.

How long must we go on losing people like Justine before our politicos wake up to that?

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