No beds today…

I have been outraged by media exposure misleading us all about the problems in the NHS. The media buy the Whitehall narrative; journalists have no idea what questions to ask. The narrative is ‘demand is rising’ (it is not, but failure demand is); ‘we have a problem with old people ‘bed-blocking’’ (while there are some, the greater problem with bed utilisation is people who shouldn’t even be there, people who are there longer than necessary and people who keep returning because the system hasn’t solved their problems – and the largest proportion of the latter are not old people).

And I’m astonished to see reports of whole teams of people (experts, thus super-costly) being stood down from operating on patients simply because there is no bed in which to put patients post operation. It is complete madness; what kind of mind would make beds a constraint in a health system? Of course the answer is a command-and-control mind.

The problem with the NHS is the industrial design; it is ineffective. The management factory is focused on efficiency and this undermines effectiveness. It’s a classic example of my aphorism: managing costs causes costs.

NHS hospitals have Bed Managers; an absurd idea. Despite the rhetoric, no one thinks about managing the purpose from the patients’ point of view. In our only published study on health we showed that managing purpose improved the service, halved the costs and, wait for it, released loads of the beds. Managing value drives costs out.

It’ll never catch on as long as the command-and-control management factory (politicians, policy-wonks, regulators, Department of Health and Big Consultancy implants) runs the show.

We have been thinking about running an event on how to study health and care systems. Once you see the things you need to see you (usually) get energised to do something constructive about it. The problem is that people who ‘get it’ will then have to fight against a regime that puts rocks on the runway… and this is not conjecture, we have had astonishing experiences of helping leaders study health and care systems only to find the leaders back away from the compelling evidence that they have uncovered in favour of complying with the wishes of the management factory.


Misunderstanding failure demand

A second recent cause of irritation is think tanks writing reports about failure demand in the NHS. As I often point out, failure demand is easily understood and just as easily misunderstood. Like their command-and-control counterparts in the private sector, these ‘thinkers’ attribute failure demand to people not doing as they should and processes not being adhered to. I wrote to one of the offenders, as they’d cited my work, pointing this out and saying that the causes are systemic. Command-and-control designs fragment, specialise and standardise work; the arbitrary measures (targets and activity) exacerbate the problem and it is these things that have to be changed to eradicate failure demand. I also offered to show them our work on understanding demand, the big lever, as that is the start of the route to effective design. They weren’t interested. These are think tanks, not know tanks. They too live in the world of the current narrative so what they ‘think’ has to fit.


Universal Credit train crash continues

The Work and Pensions Select Committee are, once again, looking in to the failure of Universal Credit. They provide a short summary of the things that worry them here:


The Committee is asking for evidence, so I have submitted a note reiterating what I’ve said many times before. The first difficult hurdle will be getting the large-scale IT system to work (90% fail) and the second impossible hurdle will be providing this high-variety service as ‘digital by default’ and I repeated my original offer to design a face-to-face service that would test the original hypothesis, which would cost buttons compared to the multi-millions being invested in the train crash. I’m not holding my breath.

But enough of the things that drive me nuts… I could go on, I often do…


Great progress in housing services

We continue to help leaders make great progress in housing services. Clúid Housing in the Republic of Ireland is the first in that country to establish a repairs service that delivers – in their words – ‘the right repair, first time, on time’. They describe it as an ‘innovative service… designed to meet our customers’ needs through a deep understanding of those needs’ and say ‘in its first nine months of operation it has delivered an exceptional level of quality and performance’.

These words formed part of their submission for an all-Ireland award, which they won, according to reports, by a country mile. I’m not a great fan of awards, but hats off to them!

On May 16th we are running an event on housing services featuring leaders who have crossed the Rubicon. For information and bookings visit:



The Vanguard Method and Beyond Budgeting

As part of our responsibilities as the UK partner of the BBRT we ran an event to illustrate how budget management is at the heart of poor service design and to chart the route we are taking to tackle it with our clients. Some of the presentations are now available on video, if you only have the time to watch one watch Jeremy Cox talking about people-centred services; it’ll make you say ‘gosh’:



Kittens are Evil

Was the title of a ‘little heresies seminar’ featuring people who share the view that ‘New Public Management’ has undermined public services and public servants, driven down effectiveness and exploded the costs. The contributions (including mine, no surprise there…) have been written up as a little book which I recommend:



The Vanguard Method and People-Centred Services

Module 1 of the next six-month action learning course on people-centred services starts on 16th, 17th and 18th May, in Buckingham. Regular readers will know that this work provides an enormous opportunity to improve people’s lives and dramatically reduce costs. If you haven’t read our Periodical on people-centred services, get it here.

Dates of future modules will be agreed with students on Module 1. Read more about the course here.

If you’d like to learn more about our people-centred services work, Jo Gibson and Brendan O’Donovan will be speaking at the Kingston University Department of Social Work and Social Care 2017 Annual Conference on March 24th. This event is free for public-sector workers. For more information and to book a place: http://dmtrk.net/20U6-4PVKI-69FLD3ED89/cr.aspx


Other Vanguard events

Information about our action-learning programme and the one-day introduction can be found here.


A date for your diary

I am going to present a Masterclass on June 22nd. It will cover the theory and practice of the Vanguard Method in public- and private-sector organisations. More information later.


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