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Left hand, right hand, the middle and…

Way back in 2012/13 someone had the bright idea to fragment the NHS.

I think the thought process came down to lets throw everything up in the air and see which way things land.

Part of that included splitting responsibilities between the Department of Health, NHS England and the HSCIC (now called NHS Digital which is a different story entirely).

People said then there was a massive problem with that because you could have 3 organisations providing advice on the same subject and it could all be slightly conflicting.

People said that it would mean that it would be harder to find someone to take responsibility and be accountable.

Under the old system you knew that if the Department of Health gave advice or instruction you followed it whether you agreed or not – it was national policy.

The reality is that we were right (and “we” means the majority of people who were not policy makers and did the real job of providing a direct service).

Can you find someone to take direct responsibility – No.

Can you find someone that is prepared to facilitate a coordinated approach across health and social care – No.

Are the Department of Health, NHSE and NHS Digital talking or working with each other – No.

The CMA Order linked to private health care in the NHS is an example. Another government department has decided on the usage of the NHS Number and the NHS has NOTHING to say about it.

Trust are left to make sense locally about something that goes beyond their remit.

As it stands all 3 are so inward looking you might as well think that everyone else is just a nuisance to them.

They have never realised (I will not say forgotten because I do not think they ever really worked it out) that their decisions and actions have to be operationally relevant and that their reputations are dependent on how the rest of the world sees them.

Even if they do issue guidance it is now so wishy washy that you might as well do without.

The message is everything – it has to look good and that is all that is important. Whether it means or says anything is an entirely different matter.

The left hand, the right hand and the middle do not know what they are doing because they are in their own worlds.

Everyone else has to be an octopus to compensate.

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