Who owns demand?

Reduction in demand is a stated aim of most transformation programmes in the public sector. Yet do we all believe it's our collective responsibility to achieve it?

In the debate about whether health care can be left to market forces and run as a business, it is ‘demand’ that stands out as the key differentiator. In all other businesses you strive to increase demand for your product or service. In health and care at macro level we aim to reduce it. Every transformation programme has reduced demand in its set of goals.  Many initiatives have been launched but success in stabilising or reducing demand have been modest if at all.

On a recent assignment, I was struck by how forcefully the NHS providers believed that “Demand is a commissioner issue”. This phrase was oft repeated, even when we were talking about intensive services where the providers have a powerful role in prevention of crises. At first I thought that this was specifically a NHS provider position but then I heard the exact same phrase from a private health provider. So maybe we have just got used to it in NHS funded services.

What fascinated me was the attitude of not for profit partners in another alliance. In their eyes, going back to a commissioner or funder to ask for a contract to be reopened would be commercial suicide, even if the pressure was coming from increased demand. They are used to being in a truly competitive environment and such action would affect their chances of keeping or winning further work.

Jeremy Swain of Thames Reach tells the story of a contract they won several years ago for homelessness services. In the early days of the contract, crack cocaine became increasingly available and there was an explosion of numbers of homeless people. They went back to the funders and said they could not cope with this unexpected increase and could they discuss additional resources. The funder sent them away with a firm “No”. Jeremy says it was absolutely the right thing to do. He and his colleagues had to completely rethink the way they were approaching the problem. They did this and managed to achieve the outcomes they had been set.

We all develop accepted ways of working and ‘group think’ over time. It’s inevitable. This is why I believe that the most potential for transformation comes when you bring together people with different experiences and skills who will challenge each other’s expectations. Collective ownership of the problem and addressing it from different perspectives is more likely to be successful than resorting to well-worn, not very successful, paths.

If reduction in demand is a shared aim then demand is everyone’s business.

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