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Culture and Breakfast (strategy wasn’t invited)

By Hilary Rowell, director, ZPB

Last week, we held our first ZPB breakfast briefing. This brought together a select group of clients, and others who work with the NHS in various capacities, to reflect on the government response to Francis.

Unsurprisingly, our discussion centred on the question of culture and change in the NHS. The criticism that the government response to Francis – or indeed the Francis report itself – won’t change the NHS culture was seen as a non-starter on the basis that ’you can’t change the culture from Whitehall’ (we may have borrowed that pearl of wisdom from Roy Lilley). Whilst it’s true that CQC appears more frequently than the words compassion, culture and leadership in the government response, this should hardly be surprising – regulation and legislation is what the government deals in. The real job of responding to Francis falls to the NHS itself.

Sharing our varied experiences of working with the NHS, I thought two interesting insights emerged. First, it is not uncommon in the NHS to find the presence of two deeply held but conflicting views: a desire for clarity, direction and answers (often from the centre or the top) alongside a desire for autonomy and the freedom to respond to local needs and problems. We see this at the frontline, through middle management and up to board level. Arguably, this goes right to the top with a Secretary of State picking up the phone to trust chief executives while pursuing a policy of greater independence for the NHS. Resolving this kind of dissonance is core to the culture change challenge.

Second, and related to the first, the spectacularly hard job facing the average NHS chief executive and board. They have to reconcile an array of regulatory, policy and legal requirements in order to provide their organisation with clear and coherent direction focused on quality and safety, whilst creating a climate that makes it easy for staff to ‘do the right thing’. Accomplishing this takes considerable skill, and should probably be more widely recognised.

From a ZPB point of view, it was a rare pleasure to bring our clients together – private and third sectors, large and small – all of whom share a real interest in and commitment to supporting the NHS.

* An obscure reference to the aphorism “culture eats strategy for breakfast” attributed to Peter Drucker. We ate full englishes.

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