Behind most of Monday’s Q and A was a rarely heard whisper concerning the efficacy of the very nature of a plan. For many the questions were, “If the NHS is going to achieve all these things, won’t we need even more money?” and, “If we’ve got enough money won’t we need a lot more staff than we have?” and, “Unless we get much more money and many more staff, surely the plan won’t work?”.
A few felt a weariness with grand plans and a worry that they will be just ‘wish lists’ and that all the money and staff in the world won’t turn them into action.
And behind these anxieties there is something very fundamental.
Plans don’t work
So if this plan is going to work hundreds of thousands of staff and millions of people are going to have to do things differently.
You can have much, much, more money and many more staff but if people won’t work differently not a lot will change.
And I suppose change is the one of the clear aims of the plan. This long-term plan argues that the NHS and social care and prevention services will all have to work differently. This is not a plan for simply more of the same but for working differently.
So to answer the question, “Will the plan work?” – we need to answer the question, “Will this plan get all those staff and members of the public to change how they work in and with the NHS?”
A first reason for optimism is that the plan does recognise that this is what it is trying to do. Of course, there is a recognition that staff are, at the moment, working very hard (too hard?) and this really does need recognition. But the aim of the plan is not just to add a few thousand more staff to supplement the way in which all current staff are working. Doing that would just get even more people working very hard (too hard?) in 5 years from now.
To stop that from happening people need to work differently, but will this plan help that?
If you want people to work differently you need an argument that explains why they should.
On Monday’s Today programme (BBC Radio 4) Simon Stevens introduced the plan. He was given longer on the programme than most senior Ministers. What was different about this interview was that he possessed an argument. Even more importantly, he was capable of deploying that argument in public when questioned about it.
(Note that there are two meanings to the phrase “Having an argument”. One means possessing an argument (you have an argument) and the other is deploying it (having an argument with someone else). Lots of people do the second (have an argument with someone else) but don’t in fact possess an argument. And many people possess an argument but are not good at arguing it with someone else).
Simon knew why he was doing what he was doing and one felt that even if the questions had gone on for hours he would have had layers of answers demonstrating how these seemingly different bits fitted together into an argument.
Considering the last few months of interviews on the Today programme from politicians on all sides, you couldn’t help but notice that when an interviewee has an argument, an interview is a very different process.
So the plan, a series of pages with words on them, does contain an argument for change. It gives reasons why hundreds of thousands of people should work differently.
Given how few plans actually have arguments (lots of lists, targets and organigrams – but not really an argument) this is genuinely a big step towards being able to say the plan will work.
But the argument needs to articulate a local passion for change, not just on the Today programme but in staff meetings and in millions of consultations. And to achieve that we need to turn that argument into a story.
I’m not sure that stories are what the leadership of NHSE/I are good at, but one way of doing it would be for someone to listen to the Today programme and translate how it might become a story for change that will impact on the lives of all those people. If they can see themselves in a different story they will work differently.
So, plans don’t work, people do.
And wise plans articulate their intentions in terms of the working lives of those who will have to implement them.
Then plans work.