John Humphreys was apoplectic when interviewing Ann Abraham on the Today programme. She has produced a report detailing several cases of appalling treatment of elderly patients in the NHS. How on earth can these wonderful dedicated NHS staff we keep hearing about allow such abuse? Ms Abraham did not try to give us any insight into how such things happened, merely echoing Mr Humphreys’s anger.
Not long after the interview there was a rather interesting counterpoint in the sports report. Garry Richardson was interviewing the trainer of one of the horses killed at Newbury over the weekend, asking him about how he and his staff felt about the whole thing. This was clearly designed to bring on the normal outpourings of emotion that are now the expected face of public grief. Such a a beautiful horse; a real character; we’re all devastated; we need answers….and so on. Instead all he got was, more or less, just a bad day at the office and life goes on.
That would be a more helpful attitude in the NHS case. Whatever Mr Humphreys and Ms Abraham are suggesting, it really isn’t hard to reconcile the dedication of NHS staff to systematic abuse of patients. It’s what Richard Adams in Hitchhiker’s Guide to the Galaxy called the “SEP field”, which guarantees a cloak of invisibility. SEP stands for Somebody Else’s Problem. Anybody who has worked in a large organisation is familar with the idea of bad things happening while everybody involved is convinced they are doing a highly professional job.
The SEP field arises from the way we organise work, splitting it up into separate bits for which individuals can take responsibility. We only look at our bit. Bad things happen between the bits. The first reaction is to blame management, who are supposed to be making sure the whole thing adds up. And the quickest and easiest response for management is to make the process yet more complicated by adding in more bits, with checks and controls. That’s how they tend to behave when people get outraged. But it doesn’t really help, because the main problem is complexity; nobody wants to take wider responsibility because they don’t understand what’s going on.
This is an old problem, and solutions should be familiar. You simplify processes, empower staff to act outside their normal remits, and engender team-working attitudes. Simple but hard. It means telling people comfortable with their narrow jobs, who think they are doing wonderfully well, that actually they are part of the problem.
But for NHS managers that should be another day at the office. We, the public, should be encouraging them to be braver. Instead we stoke up the outrage, and even start suggesting the NHS doesn’t need managers at all.
The NHS needs better leadership at ground level. We should be demanding it. Perhaps we should even ask ourselves, as Jeremy Laurance does in the Independent, whether our beloved NHS is capable of ever managing itself properly ever.