Big Changes In The NHS – But Where’s The Institutional Memory?
The NHS is experiencing another wave of ‘reconfiguration’, with a focus particularly on NHS Trusts and who runs them. But has there really been a shift from public sector thinking to the modern management of a complex part of the knowledge economy? On present evidence, opportunities to encapsulate hard-won insights into the organisational aspects of the health service are probably being lost.
The wholesale reconfiguration of the National Health Service, and particularly of Strategic Health Authorities and Primary Care Trusts, is now well underway. Public consultation finishes this week, and already some appointments are being progressed actively, albeit on a provisional basis.
This is probably not the place to go into the ins and outs of the basic argument – the bigger debate about the health economy is being conducted across the country and in Whitehall. What engages me more particularly is the essentially non-political issue of how much recognition is being given to the management of knowledge across this vast swathe of our public sector activity.
Is ‘institutional memory’ sufficiently acknowledged?
Whilst nealy all normal NHS employees are guaranteed jobs for a period following the intended reconfigurations, this arrangement does not extend to non-executive board positions. Indeed, the intention is now being taken forward to appoint new non-exec. posts not only through competition between existing post-holders, but with appointments being opened up to all comers – at a time when already many current non-executives will fall by the wayside anyway.
Yet non-executive directorships are the very roles which are intended to hold to account, and support, executive directors in their work. The risk is therefore that experience built up amongst non-execs. over the past few years since NHS Trusts have come into being is about to be lost, almost as soon as it has been developed.
This raises serious questions about how institutional memory and expertise amongst NHS non-executive directors is to be safeguarded. Where’s the knowledge management?
Public sector or significant knowledge economy?
Little visible effort seems so far been made to bring together in recognisable form all the aspects of high-level experience and skill which will take forward this current wave of NHS reconfiguration. Just as at last there is an emerging real understanding by non-executive directors of their crucial role, the chances are that it is to be lost again.
This is a quite separate issue from that of the general merits (or otherwise) of current moves to reshape the NHS. That debate is critical, but it is not the one we are addressing now. What we have here is a public sector health service which still sees itself as run on the basis of aspiration, rather than as a serious element of the knowledge economy, with all that implies for the management of skills, resources and the like. The preservation of institutional memory is a management, not a poltical, issue.
Introduce all the changes in structure that you wish, but alongside these must be a clear and formal recognition and management of the knowledge and skills, of themselves, within the health service. This is what modern management of complex organisations is fundamentally about, and it has to apply as much in the management of the health service as it does in any commercially-led set up.
Trying to bring (appropriate) ‘business’ attitudes into the health service is fine – though there are probably plenty of high-level people already there who have good ideas about this. But for success in the immediate future NHS organisations will need to protect and formalise their institutional knowledge right now; and the arrangements in place at present for moving on don’t make that easy.