It is not the sugar in the coffee that makes it sweet it is the stirring.

‘NHS leaders’ idea of change always seems to involve a restructuring where a lot of people have to reapply for their own jobs’

Stirring it up is part of my recipe for successful management. By stirring it up I mean agitating for change. Change has got a bad reputation of late, probably because it is seen as top-down: the government’s transformation of the NHS, the modernisation of the civil service and senior managements changes in the way services are delivered.

Agitating for change at work use to be botto- up. I don’t just mean unions pushing for better pay and conditions. I can remember when team managers were always pushing for change; they had lots of ideas for new services and just wanted the freedom and a little money to pilot their ideas. In fact, a lot of radical stuff went on under senior management’s radar.

Even when the cuts agenda meant management efficiency drives required changes, most of the ideas came from the front line. Change really only became a “bad thing” when it was to save money rather than improve services.

Not radical enough

NHS leaders’ idea of change always seems to involve a restructuring where a lot of people have to reapply for their own jobs, a group of well paid senior managers take generous redundancy packages only to reappear in another senior management post in the NHS, and the disruption distracts every one from patent care.

Leaders are only interested in strategic changes, a shift to community services, the centralisation of specialist services into centres of excellence, a restructuring to support commissioning, and an all singing all dancing computer system.

Simple changes like non-discretionary national minimum staffing levels on wards, increased number of consultant posts for A&E and the pharmacy being adequately resourced so patients don’t spend all day on the ward waiting for their medication before they can go home – these are dismissed as too expensive and not radical enough. Except, of course, they would facilitate better quality care, less bed blocking and fewer repeat admissions.

But that might mean we don’t need a top-heavy commissioning structure or all those competition lawyers.

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