The wisdom of crowds

Politicians are queuing up at the party conferences to proudly pledge which bits of the public sector they’ll axe in the race to cut government spending.

Norman Lamb, Lib Dem health spokesman, told his conference last week that he’d scrap strategic health authorities (SHAs), saying they have no place in a decentralised NHS.    The Tories have already made this a policy, so they’re going to have to come up with some fresh ideas to trump the Lib Dems when they meet in Manchester next week. Abolish SHAs and bring in public flogging for NHS managers, perhaps?

Even Labour are getting in on the act, with health minister Mike O’Brien this week calling on SHAs to ‘justify their existence’ at his party’s conference in Brighton.

The wisdom of crowds

Some recent focus group work I’ve been involved in suggests that SHAs – the ten regional NHS headquarters across the country – are a good target for politicians seeking vote-winning cuts.   Some respondents were vaguely aware of SHAs, but virtually none knew of their regional SHA or what it did.

When respondents were given the official description of the SHA’s role (to provide strategic leadership, support and develop local NHS organisations, and hold the local NHS to account for delivering on its promises to local people) some were reassured to know of its existence, but many were highly suspicious of the ‘management speak’ of the description.  Many associated it with over-paid, box-ticking, bean-counting, brainstorming managers. None, understandably, said they would be interested to find out more about it.

On the evidence of our focus groups, no-one is going to mind SHAs being scrapped, and to many it would sound like a good idea.  But does that mean it is the right thing to do?  The NHS is one of the world’s largest, most complex organisations.  It needs exceptional management, a strong infrastructure, detailed co-ordination to make it work, and make it work efficiently.  SHAs should be at the heart of leading the cultural change that is needed to release the massive efficiency savings that everyone wants to see.  And does anyone seriously think that patient care would improve if nurses and doctors had to carry out more essential management functions themselves?

That efficiency savings are there to be made is not in doubt.  In any organisation there is duplication and waste.  When the organisation is as big as the NHS, the potential savings are huge.  But there’s no reason to think that removing these influential but relatively small bits of the management structure is going to make savings on anywhere near the scale required.  

However, as the focus groups showed, it’s a very easy sell to the public. Management is a dirty word in the NHS. The claim, from a few years back, that the NHS had more managers than beds was wrong on many levels.  By counting porters, receptionists, and anyone else who didn’t provide hands on patient care as managers, it was a very misleading claim.  It was also grounded in the false assumption that more beds equals a better health service when, in fact, fewer sick people, needing fewer beds, is a much better indicator.  But regardless, it stuck.  Many more people still believe that false claim than accept the fact that the NHS spends a smaller percentage of its funding on management costs than the US healthcare system.

Many public bodies need to get much better at telling a clear and compelling story to the people they serve and the stakeholders who they work with. Not just about what they are doing, but why they are doing it and the value it brings.

In the case of SHAs it may be too late to stop David Cameron lighting the blue touch paper of his ‘bonfire of the quangos’.  But, popular, as it might be, he may well end up with his fingers burned.