The silly side of innovation
By guest blogger JEF SMITH
At the first session of a conference at the King’s Fund I was listening to a senior civil servant from NHS England speaking about empowering service users. As her talk progressed, I became increasingly irritated by the strident, at times almost violent, tone of some of the words she was using.
“Transformation” was the least of it. We need, she said, “a massive system shift”. What we must aim for is “cultural change at pace and at scale”. There was more, much more, in similar vein. If you had followed her advice you would stop doing practically everything you have done up to now, humbly repent your sins, and start all over again in a completely different direction. The mood was revolutionary, the message no less than a call to arms.
When the time came for questions, I asked why central government is always telling us that what is required is radical change, to the extent that when we achieve one set of reforms we are immediately encouraged to demolish what has been gained and build something wholly new. (The structure of the health service and social care’s regulation system come to mind.) I quoted back some of her words and phrases, and I hope – but actually without too much confidence – that I interpreted her attitude in response as suitably chastened. What was certainly impressive, however, was that several people came up to me throughout the day to communicate how much they agreed with my comment. It’s clear that I had touched on a raw point which resonated widely.
Pondering this incident later, I asked myself why, if my view had been so widely supported, others seem not to be prepared to express it. The answer, I fear, is that the rhetoric of radical transformation and constant innovation has so comprehensively overtaken the upper reaches of the health and social care sector that most people are simply afraid to challenge it openly. The problem starts with ministers who, for perhaps understandable political purposes, need to headline the shabby state things were in when they came to the job and how the painful but necessary changes they are about to introduce will magically improve matters to their great personal credit.
Civil servants, academics and other sector leaders then faithfully mirror that tone and those down the scale pick up and repeat the language for fear of being seen to be out of step. The effect on front line workers, those actually in day-to-day contact with service users, however, is seriously depressing. To many indeed it must seem as if what they are doing is pretty much always wrong.
The topic of the conference which prompted all this was how to get greater service user participation into help and treatment systems. This is an area in which considerable, if incremental, steps have been taken over recent years; think of processes like consultation, partnership, empowerment, collaboration, even co-production, all of which, to be fair, the day’s later platform contributors explored extensively. Wise managers should surely protect their staff from windy pseudo-revolutionism; praise for steady progress is much more appropriate.
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