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Is it Vision We Need or is Execution the NHS Problem?

Everyone says you need vision. Vison is the thing that inspires, guides, drives and succeeds. You can do courses, study great leaders, read and meditate upon it. But vision is what we need: individuals, organisations, society.

Or is it? Is vision enough? Is vision even the starting point?

Nigel Edwards of the Nuffield Trust made a startling, yet when you think about it, obvious point in his interview in the Guardian this week. Yes we need vision in the NHS. In fact we are rather good at it. We don’t need more, what we need is the ability to make the vison happen. We are not good at turning strategic ideas into operational plans.

He presents an image that those of us who have spent any time in school playgrounds will get. The NHS is struggling to make things happen.

He says “execution has always been a problem. It’s like eight-year-olds playing football: everyone chases the ball.”

We can all recognise the picture. Clinicians, managers, practitioners, commissioners all being very busy, embracing the vision and committed to making it happen. But the hard work and long hours do not always make a difference. The same problems come around again and again; we might call them something different each time, but we all know what they are.

So how do we break the cycle? How do we move from vision to enabling the change that might make the vision a reality? Edwards is a little vague - which is fair enough as the point of his interview was to advertise the Nuffield health summit! But he does say that it is about relationships, not technical skills.

It’s a fair point. The 8 year olds in the playground will not become a better team quickly simply by learning more dribbling or tackling skills. But if they start to understand their place in the team, their role in the structure, the interdependencies that exist, then they have a chance.

In other words, we need to see a strategy; we need everyone to understand a goal and be very clear what their task is to ensure success. Mapping networks [NS1] sounds technical and dull, but is often the first step in achieving the change needed.

So yes, let’s not ignore or downplay vision. But vision always gets the applause! Let’s focus as well on the tough day job; the change management; the staff engagement; the policies and the governance. Maybe not sexy, but they make things happen.

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