Craig Dearden-Phillips: The basket-case NHS should heed three lessons from the third sector

The recent scandal in Mid Staffordshire NHS shows the NHS should trust people, treat them properly and lead them well

Craig Dearden-Phillips
Craig Dearden-Phillips

Shouting. Mind games. Gagging. Intimidation. I see a surprising amount of this in the public sector. Worst by far is the NHS, where I am often astonished by how brutal it can be. The Francis Report into the Mid Staffordshire NHS Foundation Trust showed the dark side of our remaining nationalised industry. The fact that this example is the tip of a deadly iceberg rather than a single 'rotten apple' indicates that the NHS must quickly learn from other sectors, including our own.

But how did the country get into a position in which basket-case NHS trusts are killing thousands of people? It starts - and ends - with command and control, a theory of management that has been all but abandoned in most successful organisations, but which is still the principal credo of the NHS. It stays in place because the NHS buck still stops with the Secretary of State - who, in theory, is still accountable for everything. This sounds logical and democratic, but the out-turn of this is that a whole system's management is built around the requirements of the ultimate customer - the state.

To his credit, Andrew Lansley, the former health secretary, recognised this and wanted to make the NHS independent - a bit like the BBC. But instead of quietly getting on with it, he created legislation that, hundreds of amendments later, left the NHS as centralised as ever. The result remains management by fear. Nobody feels properly in control of anything - not even boards and chief executives of NHS trusts. And so nobody takes full responsibility either. Managers look upwards, not outwards, and the buck gets passed endlessly.

So what can the NHS learn from the third sector? Three things. The first is that we are pretty good at trusting our people to get on with it. We recognise the positive effects of autonomy on the performance of our organisations. The second is that we treat people properly. Bullying does exist, but there is mindfulness about how to behave and our leaders are expected to model this. The third is active leadership - working with staff around shared goals, not simply monstering people when they can't or won't do as commanded.

Nowhere do you see the what-might-have-been better than in the spin-out social enterprises that have left the NHS since 2008 - 44 in all. Free from NHS control, these enterprises are now able to look outward to their customers rather than upward to the bosses they left behind.

One example is Chums, a community interest company launched in 2011 by Dawn Hewitt and 11 colleagues from an NHS child bereavement and trauma service, and now a 40-strong employee-owned social enterprise.

Being outside of command and control frees people to make a bigger difference. Things get better only when you set people free. This is the single lesson from the third sector that NHS commissars need to learn.

Contact Craig, who writes in a personal capacity, at

Craig Dearden-Phillips is managing director of Stepping Out and a Liberal Democrat councillor in Suffolk

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