The NHS is many organisations posing as one. It’s complex. Process beats outcomes.
NHS England (NHSE) is one of the many organisations in the NHS. Within NHSE there are seams – we’re still NHS Digital, we just happen to be inside NHSE.
The seams and organisational complexity mean that even if we attempt to build the right thing, the organisation can still treat it as foreign. Putting work into the hands of users is two jobs. Building the service and stopping the organisation from rejecting it.
This complexity rewards those who can navigate it. I suspect that leads to more complexity. There is a lot of talk of platforms and there are technical working groups, planning days, design councils, all aimed at reducing complexity. More processes create more processes. Teams get stuck.
Some process is necessary, especially when it comes to health. Service assessments do more good than harm. At least, I understand them. Other processes are less clear.
We’re all trying to do good, but it’s hard to know if we’re moving in the same direction. As underwhelming as it is, the 10‑year plan at least gives us something to coalesce around. Something to point at and agree on.
Navigating the organisation takes more effort and is harder to get right than designing the service that gets to users. It feels like working in a bucket of crabs. Everyone is trying to climb out.
The thing to remember is that we’re a crab too. We’re not stuck in traffic, we are traffic. I don’t want to pull the other crabs down. But from in here, all I can see is claws and legs – and when people push back on our work, I can’t tell if they’re pulling us down or building a crab ladder.