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Editorial Wednesday 13 February 2013: Inspectors all round! NHS culture, leadership and the psychology of military incompetence

Health Secretary Jeremy Hunt's speech to the Reform conference yesterday was a well-delivered mixture of the thoughtful and the analytically confused.

Presentationally, Hunt gives good speech, as both this and his presentation at the Kings Fund's annual conference last November showed. The 'not being Andrew Lansley' effect remains evident as a plus.


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Bonfires of red tape are always fun, albeit generally quite hard to manage.

But Mr Hunt's decision in the Q&A to concur with an idea for a 'chief inspector of primary care', on top of the PM-announced chief inspector of hospitals,  raises other issues.

Would we not, for example, therefore need a chief inspector of social care?

Mr Hunt suggested so: "On primary care we need to think about that. The one part most right for early charge is the residential care home sector … It is easier than a hospital to go into a residential care home and smell the coffee. Ask whether it cares for people, talk to residents and families".

And of course, in these enlightened parity of esteem, we must also have a chief inspector for mental health. (We are cutting bureaucracy all the while.)

Traditionally, the next step after this is for campaigns by lobby groups for each and every clinical condition to become so special that it really must have its own chief inspector.

Step forward, chief inspector of podiatry, chief inspector of rheumatology and chief inspector of dentistry. Unless you want to be known as the callous-bastard Secretary of State who doesn't care about (insert name of clinical condition suffered by friend or relative of newspaper columnist here).

And if those, then surely we will also need a chief inspector of self-care? Mr Hunt did reference a line from that other Mr Blair's dystopian classic 1984 in his speech. Big Brother is watching you self-care.

The logical corollary of all of which would be that we then need a chief inspector of chief inspectors. It all gets a bit meta- ...

On The Psychology Of Military Incompetence
The following panel featured an ex-military speaker discussing what military strategic approaches to NHS reform might be.

This reminded me of one of the two books on management anyone really needs (the first is Machiavelli's The Prince).

The second book is Dr. Norman F Dixon MBE's 1975 classic On The Psychology Of Military Incompetence.

Dixon's broad central tenet is that organisational incompetence in military hierarchies arises not from a lack of technical knowledge or theory, but rather from personal inadequacies that prevent someone in a leadship role from making appropriate decisions under pressure.

It is a study of the authoritarian character, and its need to rise in an hierarchy.

Citing the book, I asked the panellists whether its description reminded them of NHS culture, and indeed of any senior NHS leaders. The looks on the faces of Mark Britnell and Charles Alessi - two of the panellists - were well worth seeing.