Over the years I have attended several courses on leadership and management in the NHS.
During nearly all of these, and in the media, the NHS is frequently described as an "oil tanker". The suggestion being that it is large and difficult to change course.
In the last meeting I went to, I dared to suggest that actually it is more like an Armada. In particular I was thinking about Battlestar Galactica (2004). This confused and bemused people in equal mesaures, but eventually I got some heads to nod positivitively.
I think the Covd19 response allows some reflection on this and I will be putting in some influences from other sources, for example Julian Stodd, eg "A Socially Dynamic Organisation is strong, not through infrastructure and formal power alone but, rather, through its people and the overlapping social
structures that permeate it."
Which seems to me a paralell to the paraphrase I heard when I was young, "A church is not a building but the people who come together within it."
An armada is built up of many ships with different capabilities and different leaders, but one leader ultimately in charge. In BG there is a political element to its function, and , also a religious element. The BG metaphor is interesting as it can be scaled up or reduced to different levels, but for the following example I am going to take it as being within one healthcare area or CCG.
In BG, the main military vessel in the Battlestar Galactica, an end of life vessel that survives the Cylon invasion, gathers other remaining vessels, public and private, political, religious, commercial and leisure, and heads off to search for a new planet.
Within a local NHS structure, the main NHS hospital is the centre around other "vessels" gather - public, private, commercial etc. There is religious and political influence.
In BG a democratic political structure is set up to influence the direction of the armada. The military structure struggles with this, focussed on one aim, but then having to adapt to thinking about the religious, health and leisure needs to the people under its care. All NHS structures are constantly under political influence, directing which services get priority, whether or no this is clinical priority. This means the the NHS often strays into areas that are not about acute health care and influences, leisure, social and public health messages.
And when the need changes, the direction of travel, the organisational structues, the infrastructure and the people are all capable of change as has been shown in the last year, but more importantly is demonstrated with every new medical development, eg thrombolysis, stenting, CFTR modulators, intensive care, etc.
In BG the direction of travel gets wrapped up in mythology and religion, with every important decision or group meeting followed by the phrase, "So say we all," in an almost cult like fashion. Within every ship there are seprate groups, cliques, families and individuals, each with their own story and drivers.
Within the NHS there is a never ending strive to do our best by our patients and ourselves, the mantra "first do no harm" with other individual Trusts adding onto that other slogans such as "The patient first and always."
The armada can change direction. But some ships can change faster than others depending on the currents and wind. So, during Covid we saw some GP practises delivering vaccines to huge numbers of people. We saw some units quickly overwhelmed, and others see the tsunami approaching and adapt their hospitals to brace for impact. But were the hospitals that took the all the covid patients the quickest to adapt back to normal practices, or were they left too changed that they will never revert back on their orginal course? And is that a bad thing?
And we may see this with the new ICBs’s. Focussing change on a few specific areas of care that can be easily adapted. Eventually change will be rolled out to all areas, but some will take longer to be put on a new course than others.
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