Dear Bob

At a recent conference Bob Ricketts from NHS England shared his frustrations at the pace of change in the NHS. This is my open letter to him in response.

Dear Bob

When you spoke at the Kings Fund conference last week, you made your frustrations clear. Why aren’t we transforming  care faster and with larger scale projects? Why isn’t someone pulling together a record of who is doing what so that people don’t have to reinvent the wheel? Why are we not evaluating as we go?

I share your frustration and, like you, know that the changes we need are among the most complex possible: changing services while continuing to run the old, turning around long established ways of doing things, the emotiveness that health and social care services bring, the many staff and professional groups, the political and media scrutiny. This is not like rebranding a hotel chain, or rolling out a new computer or finance system in a multinational, or changing the business model for an outsourcing company. Even a small change project is people’s lives, health, care, communities and livelihoods. We should not do ourselves down. You and I and all who those who have held a senior position in our sector are very used to juggling the sorts of issues that others find hard to imagine.

“If we really want transformation we have to slog through the hard stuff”

I believe we have also become complacent about the sums of money involved. A comment at a social event recently from a very experienced private sector chair stands out for me. He was expressing his delight that one of his latest companies (a well known recent entry high street retailer) has reached a turnover of £125million. That, in our world, would be a small District General Hospital. The chief executive or chair of such a hospital may well be overlooked in the list of great leaders of the NHS not, as my friend, made a Lord.

Just as we should always be listening to people who use services and their carers, I know you also strive to listen to those people you are there to support – the commissioners on the ground. I am not one of them but I am working alongside them.

With their permission, I will keep writing to you about our experiences and will add a few of my own. It will not be the evaluation you might read in a learned journal, but some honest reflections from the frontline. I promise it won’t be a positive gloss of victims in a cruel bureaucratic nightmare who would be achieving great things if only The Centre would leave them alone. Well, there might be a little bit of that.

I can say without any doubt that every locality has good people with great ideas and vision. Yet change is not just a good idea; it is not a triangle, a set of steps, a house. Change is day in, day out hard work. Benjamin Bratton, Associate Professor at University of California summed it up well “If we really want transformation we have to slog through the hard stuff”.

I see a large part of my role as helping people to be brave, to hold their nerve in the face of many obstacles. As you said yesterday, some things will work, some won’t. Please don’t jump on a snippet you hear that reinforces a view you already hold. Please don’t jump to conclusions. Be open and listen. There is a lot to hear.

I’ll write again next week.



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