The strategy unit report: Could the concept of failure demand help improve the NHS? demonstrates the truth of John Seddon’s repeated assertion: Failure demand is easily understood and easily misunderstood. Despite consulting John and his colleagues, the report’s recommendations ignored their advice.
John felt obliged to send a response:
I am disappointed by the report. While it is true that I, with colleagues, developed the concept of failure demand by working with it in the private sector in the 80s and 90s, we have extensive experience in the public sector, since 2001. You reference my 2019 book. As a matter of fact, the concept was first publicised in 1992, then, in books with public-sector examples, in 2003, 2008 and 2014.
As you pointed out, I often say it is easily understood and easily misunderstood. Your report falls into a common trap – we have seen this tried in many organisations. It recommends, in essence, to define types and address processes. It is to assume that today’s processes just need improving. Nothing is done to appreciate the need to change the system conditions driving the phenomenon.
As I and my colleagues, Ibrar and Hamish, explained in the consultation, failure demand is no more than a signal. The causes are systemic. The purpose of any intervention is to systemically eradicate failure demand and that will only be achieved when the system is reconceived to focus on value in patient terms.
We also explained that we have learned that the best means of beginning any intervention in the NHS is to study demand, in the first instance identifying the small cohorts of patients that consume a disproportionately large amount of capacity. They have been found in every NHS service we have studied. Knowledge of what matters to these patients leads to reconceiving the service to meet the patients’ needs. The consequences are an increase in capacity and a profound fall in the resources consumed across the whole system. Ergo significant productivity improvement.
What is revealed in the study phase is the causes are to be found in the industrialised design. Specialisation, fragmentation, standardisation, cost management, targets, pathways, protocols, tariffs etc. The current controls don’t control; they create cost.
You say that empirical evidence is limited, yet we have plenty. I’m disappointed you chose to ignore it and puzzled as to why you did.
On a separate note: Do any of the studies you reference include solutions that have systemically eradicated failure demand? Those that I’m aware of are only reporting evidence of failure demand. Not a good first step.
If this note engages your curiosity we would be pleased to discuss.
Sincerely
John Seddon
May 26th 2026