In my experience, the NHS can be very introverted, and in some cases, insular. I worked for the NHS for over 30 years, but it wasn’t until I was running the hospital in Harlow in the late-90s and was invited to participate in a cross-community partnership for the town that I realised that this was the case. That partnership opened my eyes to the wider world beyond my hospital, and most importantly, to the community that we served.
I hope that things have changed since my “epiphany”, and I suspect that if I had worked in a different sector of the NHS I might have become more aware, more quickly. However, I’m not sure that my experience would have necessarily been substantively different.
Since my “Damascene Moment” in Harlow, I’ve been fortunate to work a lot with a range of organisations outside the NHS; local government and the voluntary sector amongst others. They all share the same frustration with the NHS: it has a strong tendency to engage only on it’s own terms, when it has a problem which it needs others to help solve. They are also taken aback at the level of ignorance, even amongst senior staff, of the world beyond the NHS.
If the NHS looks that way to so called “partner” organisations, what must it look like to patients and citizens? I am fortunate that I have had little experience of the NHS as a patient, but my experience with my family has brought home to me what a bewildering organisation it is to deal with. The care that my family have received has generally been of a high standard, but even with my “inside knowledge” of the service, it can seem impenetrable.
It has it’s own language and customs, and still retains many of the patronising habits that most other post-war public services have managed to shake off. If that is my experience as an assertive, well-educated, middle-aged, white male, what must it be like for others?
What makes the NHS behave in this way? Is it because it is a “national religion” (to use Nigel Lawson’s famous quote), and lacks the humility to “see itself as others see it”? Or is it due to size and inherent complexity; for our staff it is hard enough to navigate the organisation itself without trying to navigate the outside world. (I once described the NHS as being a bit like the Eden Project..). Most importantly, what is to be done to change this introversion?
There are encouraging signs. The shift of services from institutions to more local settings necessitates engagement with partners, and austerity is forcing the NHS to understand that this must be an equal partnership.
Even better, we are starting to understand that patients are both our customers (think “My name is..”) and our partners in delivering care and improving health, not just the grateful recipients of our beneficence! But for the NHS to thrive, the culture must change further; what should we do to accelerate that change?
John is an NHS manager by background, and spent over 30 years in NHS leadership roles at local and national level. John's now working as an independent consultant, coach, and non-executive.