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You can find the current article at its original source at https://www.theguardian.com/commentisfree/2018/may/23/nhs-suffering-repetitive-change-injury-ministers-reform-mania
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| The NHS is suffering from repetitive change injury | The NHS is suffering from repetitive change injury |
| (2 months later) | |
| During the past few decades, people working in the NHS have noticed the rise of a puzzling yet dangerous new syndrome. It cannot be found in any medical textbook, but the symptoms are more obvious each year. They include delusional behaviour, stress, memory loss, anxiety. Unlike most syndromes in the NHS, this doesn’t infect individual patients. It contaminates entire organisations. The experts call it: repetitive change syndrome. | During the past few decades, people working in the NHS have noticed the rise of a puzzling yet dangerous new syndrome. It cannot be found in any medical textbook, but the symptoms are more obvious each year. They include delusional behaviour, stress, memory loss, anxiety. Unlike most syndromes in the NHS, this doesn’t infect individual patients. It contaminates entire organisations. The experts call it: repetitive change syndrome. |
| It was first noticed by two professors working on different sides of the Atlantic. In Sweden, Nils Brunsson, of Uppsala University, had spent decades trying to understand how public sector organisations worked. He and his team spent years following the fate of reform programmes in city councils and railways and standard-setting bodies. They noticed a puzzling pattern: the media would point out some serious failings in a government service; politicians would cry out that something must be done; civil servants and consultants would come up with a plan, announced with great fanfare; the plan would be passed on to managers; and the politicians and consultants would make hay. | It was first noticed by two professors working on different sides of the Atlantic. In Sweden, Nils Brunsson, of Uppsala University, had spent decades trying to understand how public sector organisations worked. He and his team spent years following the fate of reform programmes in city councils and railways and standard-setting bodies. They noticed a puzzling pattern: the media would point out some serious failings in a government service; politicians would cry out that something must be done; civil servants and consultants would come up with a plan, announced with great fanfare; the plan would be passed on to managers; and the politicians and consultants would make hay. |
| The Swedish railways would spend five years trying to become decentralised, and the next five becoming more centralised | The Swedish railways would spend five years trying to become decentralised, and the next five becoming more centralised |
| So far, so good. But everything would change when the plan started to be put into practice. Problems would appear and, after a few years, people would be disappointed. Negative headlines would return. And once again politicians would be on the airwaves declaring something must be done. They would hire more consultants, and the cycle would begin again. | So far, so good. But everything would change when the plan started to be put into practice. Problems would appear and, after a few years, people would be disappointed. Negative headlines would return. And once again politicians would be on the airwaves declaring something must be done. They would hire more consultants, and the cycle would begin again. |
| Brunsson and his team concluded that public sector organisations were doomed to repeat “routine reforms”. For instance, he noticed that the Swedish railways would spend five years trying to become more decentralised, and then spend the next five years becoming more centralised. He saw this pattern of swinging between centralisation and decentralisation repeated over the previous hundred years. The only thing that changed was the pace of reform, which became quicker: instead of reforms every five years, it was every two years, then every year. | Brunsson and his team concluded that public sector organisations were doomed to repeat “routine reforms”. For instance, he noticed that the Swedish railways would spend five years trying to become more decentralised, and then spend the next five years becoming more centralised. He saw this pattern of swinging between centralisation and decentralisation repeated over the previous hundred years. The only thing that changed was the pace of reform, which became quicker: instead of reforms every five years, it was every two years, then every year. |
| On the other side of the Atlantic, a professor at Columbia Business School in New York noticed a similar pattern in the private sector. Eric Abrahamson charted the rise and fall of such management ideas as total quality management in US corporations. He noticed the way executives consumed the latest management idea and teenagers bought jeans was similar. Executives would jump from one fashionable management idea to the next with little thought about the cost or consequences. Along the way, they would employ costly consultants and announce disruptive reforms. But no matter, executives were often rewarded with jumps in share price and fatter pay packets, irrespective of the outcomes of their reforms. After some time documenting this pattern, Abrahamson concluded that many firms fell victim to what he called “repetitive change syndrome”. | On the other side of the Atlantic, a professor at Columbia Business School in New York noticed a similar pattern in the private sector. Eric Abrahamson charted the rise and fall of such management ideas as total quality management in US corporations. He noticed the way executives consumed the latest management idea and teenagers bought jeans was similar. Executives would jump from one fashionable management idea to the next with little thought about the cost or consequences. Along the way, they would employ costly consultants and announce disruptive reforms. But no matter, executives were often rewarded with jumps in share price and fatter pay packets, irrespective of the outcomes of their reforms. After some time documenting this pattern, Abrahamson concluded that many firms fell victim to what he called “repetitive change syndrome”. |
| Between 2010-11 and 2016-17, health spending increased by an average of 1.2% above inflation and increases are due to continue in real terms at a similar rate until the end of this parliament. This is far below the annual inflation-proof growth rate that the NHS enjoyed before 2010 of almost 4% stretching back to the 1950s. As budgets tighten, NHS organisations have been struggling to live within their means. In the financial year 2015-16, acute trusts recorded a deficit of £2.6bn. This was reduced to £800m last year, though only after a £1.8bn bung from the Department of Health, which shows the deficit remained the same year on year. | Between 2010-11 and 2016-17, health spending increased by an average of 1.2% above inflation and increases are due to continue in real terms at a similar rate until the end of this parliament. This is far below the annual inflation-proof growth rate that the NHS enjoyed before 2010 of almost 4% stretching back to the 1950s. As budgets tighten, NHS organisations have been struggling to live within their means. In the financial year 2015-16, acute trusts recorded a deficit of £2.6bn. This was reduced to £800m last year, though only after a £1.8bn bung from the Department of Health, which shows the deficit remained the same year on year. |
| Read a full Q&A on the NHS winter crisis | Read a full Q&A on the NHS winter crisis |
| While these two professors were developing their theories, the British public sector was rapidly being infected with the disease – nowhere more evident than in the NHS. In 2001 a professor from Yale University called Theodore Marmor spent a year in England studying the NHS, and found a system swamped with new fashions. He observed that “fads are soon abandoned without much regret, with promoters escaping chastisement for their prior hyperbole. Managerial gurus shed failed models easily and embrace newer fashions promiscuously.” | While these two professors were developing their theories, the British public sector was rapidly being infected with the disease – nowhere more evident than in the NHS. In 2001 a professor from Yale University called Theodore Marmor spent a year in England studying the NHS, and found a system swamped with new fashions. He observed that “fads are soon abandoned without much regret, with promoters escaping chastisement for their prior hyperbole. Managerial gurus shed failed models easily and embrace newer fashions promiscuously.” |
| Close to two decades on, little seems to have changed. In 2012, the then health minister, Andrew Lansley, announced a massive reform of the NHS. He hoped decentralisation would do the trick. By pushing spending power down to groups of GPs, he aimed to overcome the ills that he thought blighted the NHS. When these reforms were actually implemented, they proved to be difficult and often led to disappointing results. | Close to two decades on, little seems to have changed. In 2012, the then health minister, Andrew Lansley, announced a massive reform of the NHS. He hoped decentralisation would do the trick. By pushing spending power down to groups of GPs, he aimed to overcome the ills that he thought blighted the NHS. When these reforms were actually implemented, they proved to be difficult and often led to disappointing results. |
| My plea to the next health secretary: don't restructure the NHS again | |
| Five years on, we are starting another cycle of routine reform. Another plan is about to be announced, more consultants will be employed. Meanwhile, NHS staff are likely to be worried about how another wave of reforms will affect their working day. They are likely to worry that it will simply mean more insecurity and more distraction from their actual job of caring for sick people. Perhaps they might repeat the words of one senior clinician who had just been through the implementation of a “lean management” initiative: “There’s lots of lip service to new ideas, but they can’t actually happen. You get lots of kneejerk reactions. They go for the next big thing, but soon it’ll be something else.” | Five years on, we are starting another cycle of routine reform. Another plan is about to be announced, more consultants will be employed. Meanwhile, NHS staff are likely to be worried about how another wave of reforms will affect their working day. They are likely to worry that it will simply mean more insecurity and more distraction from their actual job of caring for sick people. Perhaps they might repeat the words of one senior clinician who had just been through the implementation of a “lean management” initiative: “There’s lots of lip service to new ideas, but they can’t actually happen. You get lots of kneejerk reactions. They go for the next big thing, but soon it’ll be something else.” |
| But many are likely to think yet another round of reforms would be absurd. And they are right – a recent study suggested that when organisations are seized by a “logic of absurdity”, they are extremely committed to a course of action they know has a low likelihood of success. NHS staff are like Sisyphus, condemned to roll a rock to the top of a mountain, knowing full well it will only roll back down. Those who work in the health service will endeavour to introduce these reforms knowing that they will only be reversed after the next change in the government’s positioning. | But many are likely to think yet another round of reforms would be absurd. And they are right – a recent study suggested that when organisations are seized by a “logic of absurdity”, they are extremely committed to a course of action they know has a low likelihood of success. NHS staff are like Sisyphus, condemned to roll a rock to the top of a mountain, knowing full well it will only roll back down. Those who work in the health service will endeavour to introduce these reforms knowing that they will only be reversed after the next change in the government’s positioning. |
| • André Spicer is professor of organisational behaviour at the Cass Business School in London | • André Spicer is professor of organisational behaviour at the Cass Business School in London |
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