The Devil is still in the Detail - It Always Was!

Next time you hear a politician on the BBC Radio 4 announce a new initiative, may I ask you to stop and ask yourself: "How will that be implemented?" You might be forgiven for thinking that the answer is not only straightforward but reasonably obvious. There are thousands and thousands of health service managers so the one thing we're not short of is people to actually "DO IT".

If only it was that simple.

The two primary ingredients for doing "it" are ability and money. That's not any old ability like the ability to whistle with your fingers (a skill I covet but to no avail). It's the ability to turn intention into effective action which delivers the benefits that have been promised. The money side is also fairly useful, otherwise it's a bit like saying "you can have a new car" when you know there isn't any money to buy it. Spend a day with NHS management and you will realise that their implementation skills are poor and their grasp of controlling money is poorer.

You are thinking I am being harsh? You may be thinking that it is easy to heckle from the cheap seats? OK then, consider the following: most financial targets are set well in advance of the financial year but the money needed to implement the action plans for these targets is usually quantified several months into the year. Quite often the actual budget is much less than managers were led to expect and the action plans have to be cut down. Why is there no resistance to such poor leadership? What would you do if your spouse/partner sent you out to buy the ingredients for a lunch for ten people and then, when you returned home with the shopping, told you that there was only enough money for five people? It's only possible in my world because for most NHS managers, it isn't real money. Their actions have no impact on there being enough cash in the bank at the end of the month to pay their salaries.

It is this same ethos that enables so many plans to be written that are quite simply unworkable. Timeframes that rely on staff working at a rate that is never achieved. Training made available when there isn't the staff to do the training nor staff to release to attend it. Tasks delegated to people who are somewhere else (e.g. seconded to some task force or other, or on long-term sick leave). It doesn't seem to matter, since after all, the plan was written and the box can be ticked. It's all a bit like the final days of Adolf Hitler down in the bunker, sending non-existent troops to defend land already lost.