I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail



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Festival of Governance 2016
I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail”

Abraham Maslow (1962)


The aim of this document is to capture my personal thoughts after attending the GGI Festival of Governance in order to inform positioning and actions of EHFF. It represents my own views, not EHFF’s

Background


Dr Marius Buiting, Chair of EHFF, invited me to present on design principles in healthcare at the second meeting of the European Healthcare Managers Association’s - Health Futures Special Interest Group on Monday 26 September 2016. This meeting was kindly hosted by GGI in their headquarters in London. A separate report of this meeting is available on the EHFF website.

GGI Ltd


GGI Ltd is a successful consultancy based in London; the company was established in 2009 and trades as the Good Governance Institute. “GGI has been established to support better governance practice and to ensure organisations develop a focus on leadership and strategy” (http://www.good-governance.org.uk ). It has 30+ staff and associates; core customers of the business are an impressive list of NHS organisations in the UK but recently GGI Ltd has branched out into other public sector areas such as Higher Education. Since 2015 GGI organises the annual Festival of Governance.

2016 Festival of Governance (http://www.festivalofgovernance.org)


I attended the morning part of GGI’s Festival of Governance 2016 at the prestigious Royal College of General Practitioners in London. It provided a combination of key note; forum discussion; exhibition of sponsors and afternoon workshops and was well attended by 150+ people.
Proceedings started with a presentation of the 2016 Good Governance Award to Sir William Wells. Later in the morning he launched the GGI’s white paper on “The future of the NHS” of which he was a contributor (http://www.good-governance.org.uk/wp-content/uploads/2016/09/Finalversion_The-future-of-the-NHS__MDWWreviewed-1.pdf) .

Lord Baron Kerslake of Endcliffe, Chair, King’s College Hospital NHS Foundation Trust provided the Key Note address on “Creating the new landscape for change”.


Later in the morning Lord Kerslake was a member of the Festival of Governance Questions Panel facilitated by Simon Fanshawe OBE, Director, Diversity by Design. Other members of the Panel were:

  • Angela Rippon OBE, Journalist and presenter

  • Professor Jaideep Prabhu, Professor of Business and Enterprise, Judge Business School, University of Cambridge

  • Caroline Clarke, Chief Finance Officer and Deputy Chief Executive, Royal Free London NHS Foundation Trust

  • Andrew Corbett-Nolan, Chief Executive, Good Governance Institute

“The future of the NHS” White paper


This document was drawn up after a breakfast seminar with ten experts of health and social care including two former Secretaries of State for health. It was interesting to note that this document repeats what members of the EHFF community and many others had identified several years ago: without offering any solutions. It states that “The current system is broken and that without implementing radical whole-system transformational change, the NHS will not be sustainable in to the future. The NHS is a national monopoly that has become inefficient, resistant to change and closed to new ideas. The absence of forward thinking about the future challenges facing health and social care in England is bordering on complacency
The document highlights the external pressures on the health and social care but fails to explain why ‘the system’ was not able to adequately deal with these pressure. There is no attempt to explore the role of ‘governance’; it would be relevant to know if the current crisis occurred despite ‘good governance’ practices and what the role of governance is in dealing with the huge challenges. Furthermore, the document fails to offer constructive advice on ways forward. Recommendations such as “we must find a long-term funding settlement for the health and social care system” are in my opinion too superficial and not helpful. “Introduce more competition” is proven to be counterproductive. “Reward outcomes rather than activity” was already the basis for Andrew Lansley’s policies leading to the 2012 Health and Social Care Act! It is interesting to note that the word ‘innovation’ does not feature once in the document.

Overall impressions


I found the Festival a surreal experience because I noticed how people were not dealing with the hugely complex challenges that they were faced with.
Whilst not denying the severity of the crisis in health and social care, GGI felt it was still appropriate to celebrate good governance as a principle. However, in my opinion important questions regarding the role of governance were not asked or addressed e.g.


  • What was the role of governance leading up to the current crisis?

  • Did the crisis occur despite ‘good’ governance or due to ‘bad’ governance?

  • What is the role of governance in ‘going forward’?

It was interesting to note how Caroline Clarke in the panel discussion built on the metaphor of the landscape that was introduced in the Key Note, by stating that the ‘house was on fire’ but she was contented to focus on landscape design (rather than saving the people in the house and understanding the cause of the fire). Caroline went on to explain how the Royal Free London NHS Foundation Trust bought in the services of external consultants to advice on dealing with financial pressures. Angela Rippon demonstrated to be a strong patients’ advocate and challenged why this knowledge gained and paid for by the tax payer is not readily shared with other NHS organisations.


Implications for EHFF

Not only have we acknowledged the crisis earlier than some parties, we are also now attempting to explore strategies and solutions for sustainable and equitable health and social care. In that context the EHFF design initiative is very relevant: based on the ‘trinity’ of innovation (vision – design – leadership) we are trying to get support to develop equitable and sustainable healthcare. We are finding it hard to get support because our message is honest and uncomfortable – we need to deal with huge complexities. Our challenges are:



  • How do we communicate with ‘rabbits’?

  • How do we get our uncomfortable message across?

  • How do we get support for our design initiatives?

Management is doing things right; leadership is doing the right things.”



Peter F. Drucker
Prof Daniel Steenstra 16.10.16
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