Editorial Thursday 20 June 2019: Executive tendencies
Baroness Harding is the highly executive and very vocal chair of NHS Improvement. She is saying many of the right things about the change of culture needed in the NHS, which is thoroughly welcome and greatly to be applauded. We must hope it will happen.
The Baroness is now seeing executive tendencies in other, specifically in Health Service Journal. Speaking at the NHS Confederation's conference in Manchester, Baroness Harding suggested that we are currently in an era of "trial by HSJ".
Why is this allegation and perception on the mind of NHS Improvement's chair just now?
A vital piece of context is the current takeover of NHS Improvement by NHS England, or as it's actually known, the NHS Commissioning Board. Amusingly badged as a merger, this logical consolidation of power into the NHS Commissioning Board under the absolute rule of the Sun King of Skipton House, Simon Stevens.
The 'merger' of these two national system regulators is becoming famous for its vivid internal tension. There has been no 20% reduction in the mapping of jobs for most of the merged senior management team. And staff at the middle and junior levels feel angry and highly disillusioned. There are obvious issues about the black and minority ethnic representation of these middle and junior level staff at high risk of redundancy.
Some see it as the worst-kept secret in the NHS that Baroness Harding would like to be in charge of the NHS, and therefore wants Simon Stevens' job. Her instincts are executive ones: she was indeed the chief executive of TalkTalk, during which time a significant cyber-attack saw customers' personal information leaked online.
Is "trial by HSJ" A Thing?
It is important to recognise that Health Service Journal enjoys a strong relationship with the operational, political and regulatory leadership of the NHS and wider care system. I've been writing for HSJ for as long as I've been freelance: not only my opinion but its bulging awards cabinet show empirically that HSJ goes from strength to strength.
Has HSJ's strength gone to its head? Is HSJ a funky new hybrid of judge, jury and executioner: the Judge Dredd of the NHS, health and care economy?
Um, no. I don't think there is any evidence that HSJ has turned itself into the wrong kind of headhunter, as Baroness Harding suggests.
Perhaps what Baroness Harding is covertly acknowledging is that the national system is currently extremely poor at dealing with either the need for appropriate support or the removal of senior leaders in the service. Too many chief executives are still experiencing a regulatory Death Star approach, and the culture is accordingly problematic.
The reason for the disconnect between good judgment about support or removal for local leaders is no doubt in part about the disconnections that occurred with the Lansley reforms' removal of the intermediate tier of management. Health authorities, strategic or regional, were not perfect organisations - but they had a proximity to and knowledge of local problems that the national regulatory system has not reliably reproduced.
HSJ understands its readers' logistical and political challenges perhaps better than it ever has. It does not go after individual leaders, but it certainly does go after wrongdoing or bad practice, as in