The Department of Health: A Deadly 'Delegocracy'

It was via the process of writing to David Nicholson to request a meeting to discuss the possibility of a Department of Health analysis of Dr Phillip Lee MP's hospital plan that I chanced upon the deadly organisational species of a 'delegocracy'.

It was via the process of writing to David Nicholson to request a meeting to discuss the possibility of a Department of Health analysis of Dr Phillip Lee MP's hospital plan that I chanced upon the deadly organisational species of a 'delegocracy'. You see to myself and others who have worked for blue chip corporations, it beggars belief that an individual who is an MP and a GP such as Dr Lee, could prepare a groundbreaking plan to change the NHS and yet there exists no expert project analysis team at DH level that can provide an unbiased opinion on its viability and thus aid its passage through Parliament. In fact, I received a reply from David Nicholson to the effect that it was up to the local authority to determine its own needs and that the DH had no opinion on the matter. And to add insult to injury, the letter contained a veiled rebuke of Dr Lee by stating that he drew up his plans without engaging the NHS! In fact, it was such an inane response from a strategic public authority that it gave the impression that their judgment had plumbed the depths to a point they'd dismiss advice from Einstein whilst delegating to a budgie, given half a chance. To put this mindlessness (and damn cheek, if the truth be told) in further context, let us consider the heroic efforts of Dr Phillip Lee MP and Miss Eva Kagan, his Parliamentary Researcher and healthcare strategic analyst, shall we?

Dr Lee is a busy MP who not only holds down a full-time job in Parliament, he also works as a GP on a part-time basis. Miss Kagan also works all the hours God sends to provide constituency and strategic research for Dr Lee. However, such is Dr Lee's and Miss Kagan's passion for their roles and for realizing their vision for a state-of-the-art NHS, they are willing to give up their spare time in the UNPAID analysis of healthcare needs in the Bracknell Constituency and furnish us with a vision of an innovative model which could be duplicated across the UK and save the NHS. The document is clear, concise, thoroughly researched and reminiscent of documents I was used to perusing in equity research - a world where healthcare experts such as Dr Lee and Miss Kagan are handsomely remunerated for their services. But such is the level of ingratitude (and irresponsibility) at the DH, they don't even look a gift horse in the mouth, they slap it. In fact, the DH seriously doesn't know which way its bread is buttered because this dismissive attitude does not encourage any other budding social entrepreneur in parliament to take up the pickaxe. And in a cash strapped NHS (and UK), it is insane to ignore the contribution of the likes of Dr Lee and Miss Kagan - particularly when their service is gratis. And to translate DH insanity into actual monetary terms, if Dr Lee and Miss Kagan's services were undertaken privately, they would probably earn c.£250 an hour.

In a blue chip company, on the other hand, such a document would be afforded due consideration at strategic level ie it would be reviewed by the Board and/or a group of experts. It would not be dismissed or farmed out to some site head in the middle of nowhere who probably has no greater strategic experience than that gained in his current role and whose uninformed, micro assessment will most likely be based on local self-interest, rather than the greater good. And tragically, it is as a result of this mad 'delegratic' environment that the Mid Staffs crisis developed.

Due to the disparity of NHS sites and the inherent lack of accurate lateral analysis, we can thus conclude that this system of delegation defies commons sense and is a danger to patients. I mean what EXACTLY is the DH's role if not to provide strategic direction? And to put this catastrophic failure of governance in the context of management theory, it was concluded long ago that a 'contingency' style of management is the correct formula ie the degree of hands-on/hands-off that suits a given situation taking all factors into consideration. And whilst a system of broken-down hospitals exists with its inherent lack of meaningful comparison across sites, then reasonably tight strategic direction has to exist. In fact, although bureaucracy has negative connotations, it originally evolved about 10,000 years ago to provide leadership to uncontrolled systems of operation and has been hugely successful. Therefore, until Dr Lee's plan materializes across the country and vital comparisons of like-with-like can be made, a reasonable level of bureaucracy does actually make sense. Put another way, the organisation of plates on the earth's surface stays neatly in position due to the pull of gravity and that is the very force that the DH should represent for health authorities and is so dangerously lacking.

In the meantime, all I can say is that I am very sorry all those people lost their lives in Mid Staffs but I can offer no words of comfort to the families because based on the spirit of David Nicholson's reply, their deaths truly were IN VAIN.

A petition for Dr Lee's Super Hospital plan can be found at:

Before You Go