I was fascinated to listen to Sue Slipman, Director of the Foundation Trust Network, when she said on The World at One, in regards to the hotly contested NHS bill that, “if there were no forward movement that the NHS would be in no man’s land.” This is because many of the provisions of the bill have started to be implemented and if the bill were to be stopped right now, many areas of the country would have partly dismantled the old structures without legislation for the new. They would find it difficult and costly to go back, but equally without statutory support to proceed with new commissioning groups.
Putting the politics of the bill aside, what can we learn from its presentation and implementation so far?
Firstly, while there is not much argument that there is a need to change to cope with an every more elderly population, more expensive drugs and treatments and a period of extreme austerity, there seems to be a massive argument about the need for the changes as proposed.
There are lessons that change leaders can learn from all of this:
1) Ensure there is a genuine need for change.
2) Ensure that you explain why the changes proposed will meet the need.
The other interesting factor is how professional medical bodies have turned, albeit very late in the day. It was always sold that Andrew Lansley, the Secretary of State for Health, was very chummy with the medical profession and would have them on side. This seems not to have carried on through the process of getting the bill passed.
3) Support for change needs to be explained to those affected, in ways that they see that there will be benefits to the service.
4) You need to anticipate that there will be some that reject any change and be ready to answer their objections.
Will regard to this “no man’s land” that Slipman spoke of, this is a situation that no one implementing change should ever get themselves into.
5) Only start making changes when sufficient people are in agreement to carry the changes through to completion.
That doesn’t mean you have to have everyone on board, but you do need enough people to be able to get to the end. The government should never have let commissioning boards be set up before the legislation was passed. If the bill is further carved up in either house and passed it will be a hodgepodge of its original form and if it does get dropped or defeated then where does that leave areas that have dissolved their Primary Care Trust (PCT)?
I think that this bill will now have to get passed in some form to prevent utter chaos in the many areas of the country that have partially implemented it already. But the whole situation teaches many lessons for leaders of change in all sectors and of all scales about support, implementation and timing of the changes they are thinking of making in the future.