This is an interesting article at the heart of public services in our country. The post war settlement was one of centrally driven control and standards. The NHS completely epitomises this with a top down management style which has ebbed and flowed in terms of in terms of central diktat but has never really let go.
It feels that in late 2017 we are in a more Stalinist phase than in recent times but the questions are - does it work? Is it the right thing to do long term? I think the answer is ultimately No to both. 2018 is very different to 1948, a generation of NHS workers and indeed patients do not expect their life to be run in such a top down manner. Top down control stifles innovation and creative solutions. If the "centre" does not think the local leadership and teams are up to the job perhaps they should reflect very carefully on why that may be? Is it because the people don't have talent or ability? Or is it because for generations they have been slaves to a system which requires compliance and respect for hierarchy and doesn't value individualism and creativity. Ultimately the NHS will pay a heavy price for 1948 thinking to solve 2018 problems.
NHS bosses are using loopholes in law to slowly transform the NHS from an ecosystem into a big machine, which could lead to unintended consequences, notes Andy Cowper There are big problems facing the NHS. There are also real problems facing the NHS. Some are big but not real (privatisation); others are real but not big (health “tourism”). The problems about which we should care are the ones that are both big and real. One of the current big, real problems facing the NHS is this: we don’t seem to know whether we want it to be a big machine, or an ecosystem. Legislation dictates the latter, with dear old Lord Lansley’s market aspiring reforms in the 2012 Act and the as yet unrepealed 2003 Act which created foundation trusts