Christmas often sees media outlets list various people's books of the year. I've had an eclectic 12 months enjoying publications ranging from Asako Yuzuko's food and feminism novel Butter to Giuliano Da Empoli's chilling polemical memoir The Hour of the Predator.
But If I was buying books for the high-ups in NHS England and the Department of Health and Social Care I would recommend Adam Kahane's Power and Love.
I might accompany the gift with a Dickensian card depicting an emaciated ICB CEO holding out an empty plate and plaintively asking for more.
Kahane is a Canadian-based writer whose books reflect his experience as an internationally renowned facilitator and conflict mediator. The essence of the book's argument is that power without love becomes reckless and abusive, leading to domination and fragmentation. Love without power becomes sentimental and anaemic, resulting in stagnation and ineffectiveness.
Kahane's thesis was in the back of my mind when I spent some time recently drawing up a proposal for Whitehall. This explored a process which I called ‘convene and commit' – to bring local NHS leaders together with colleagues in care and the voluntary sector and other public services.
The process would be based on three full days (and a lot of work between) aimed at developing a clear action plan to start to transform local services and then maintain the momentum over time. Not only would the process enable local partners to deepen relationships, develop shared visions and allocate responsibilities, but it would be observed by national and regional NHS England officials and partners from the Confederation and think-tanks. These observers would offer material support to grow the local ambition and accelerate change.
I am certain we need to invest in something like this in a select group of promising places, and by doing so through this develop proof of concept around different and more productive models of care. The reason is simple: the current central model of change is unlikely to succeed.
Take the future of ICBs. At a recent event, national leaders were asked by ICB colleagues (who have been through successive rounds of deep cuts and – for most – mergers) whether the bodies had any future. In essence the answer is ‘yes', but only if ICBs are very tough strategic commissioners. The expectation is not only that ICBs will decommission what are seen as low-value services but that they will insist on services and pathways costing what they should if run as efficiently as possible, rather than what they cost now.
These are worthy and necessary ambitions, even if setting them will require ICBs to develop new competencies, insights and skills as they downsize and restructure. But while the case for getting best value may seem obvious from a technocratic point of view, especially in view of high variations in costs, that does not mean it will be straightforward.
Clinicians, and more importantly patients, do not always agree that the service they provide or receive is low value. While cost variations need to be addressed, they often reflect differences in local context and assets, for example the state of NHS facilities and equipment or challenges with staff recruitment.
Tough commissioning will involve hard choices, and being open with the public about it is not something the NHS has been very good at. The danger is that we see a repeat of previous failed attempts at putting commissioners in the driving seat to shape and scale of NHS services. Namely, that providers, patient groups and other interests push back, that local and national controversy is generated and that when the chips are down national leaders fail to back commissioners. The overwhelming lesson of the history of commissioning in the NHS is that in asking ICBs to drive change through contracts, we are setting them up to fail. The fact that we will be trying to do this in a context of very limited budgets simply underlines the point.
This is why the ‘power' of strategic commissioning must be allied to the ‘love' of building purpose, trust, strong relationships between partners.
Matthew Taylor is chief executive of the NHS Confederation
