In July, a new government arrived with a familiar promise – a fresh ten-year plan, due later this year. For the NHS, it lands on ground that has barely stopped moving. The current health plan is little more than a year old. Integrated care boards have only recently absorbed a wave of mergers and deep cost reductions. And now their boundaries are to be redrawn again, this time to align with new local government footprints by the end of the decade.
Much will be written about what these changes mean for structures, budgets and timelines. I want to write about something else – the people caught in the middle of it all.
It is easy, from a distance, to treat reorganisation as a matter of boxes and lines on a chart. Up close, it is nothing of the sort.
Behind every one of those boxes are people. People who have already been through repeated restructures and are now bracing for another. People who have reapplied for their own jobs, watched valued colleagues leave, and held fragile services together through months – in some cases years – of uncertainty about their own future.
I have the privilege of working alongside many of them. What strikes me, again and again, is their commitment. They keep showing up for patients and for one another while the ground beneath them is redrawn and redrawn again. That is not a small thing to ask of anyone. Asked repeatedly, over years, it becomes something we should not take for granted.
What I find harder to understand is how easily this human reality can escape those making the decisions. Each reform can be argued for on paper. But paper does not capture what it is like to do demanding, important work while wondering whether your team, your role or your organisation will still exist in eighteen months. It is difficult to think of many other sectors where we would ask so much of people, so continuously, and expect performance to hold.
There is a tendency to treat staff morale as a soft concern – something to be managed with a supportive email and a wellbeing webinar. It is nothing of the sort. Morale is the difference between a workforce that adapts and one that quietly burns out.
People under sustained uncertainty do not stop caring. But they do tire. Experienced staff, weighing another round of upheaval, decide they have given enough and step away. The knowledge they carry – built over years, much of it never written down – leaves with them. Those who remain absorb more, with less, for longer.
None of this shows up neatly in a reorganisation budget. But it is every bit as real as the redundancy payments and the rebranding, and considerably harder to recover once it is gone.
And this is the part that should concern everyone, whatever their view of any particular reform: the effects do not stop with staff.
When experienced people leave, referrals take longer to navigate. When teams are dissolved and rebuilt, the informal relationships that once smoothed a patient’s path across services have to be rebuilt too, from scratch. When those who understood a pathway are gone, mistakes can creep in at exactly the points where continuity used to protect against them.
None of this is anyone’s intention. No one designs a reorganisation in order to slow down a cancer referral or fragment a frail patient’s care.
But intention is not the same as consequence.
The patient waiting for their referral to move does not experience the org chart. They experience the delay, the repeated question, the sense of falling between services that no longer quite join up.
If we ask a workforce to keep reorganising while also keeping waiting times down and quality up, we should at least be honest that these aims can pull against one another.
Stability is not a luxury that sits alongside good patient care. Increasingly, it is a precondition for it.
I do not pretend to have an answer to the politics of all this. The pace and sequencing of national reform sit well above anything a single organisation can influence.
But not everything has to be left to chance.
Some stability can be built, quietly and locally, into the way services work – so that when people do move on and structures do change, the essentials survive them.
A referral pathway that is well designed, clearly documented and embedded in the systems clinicians already use does not walk out of the door when an experienced colleague retires.
The good practice it encodes – the right information, captured once and routed to the right place – persists through a merger, a boundary change or a change of government. It becomes part of the institution rather than the private knowledge of the person who happened to hold it.
That will not make reorganisation painless, and it is no substitute for treating people well through it.
But in a period where so much is in flux, the things that carry knowledge safely from one structure to the next are worth protecting – not least because they are among the few things that do not have to be rebuilt every time the map is redrawn.
So, this is less an argument than a plea.
As the NHS enters yet another period of change, the people delivering care deserve to be seen – not as roles to be moved, but as the experienced, committed professionals holding the whole thing together.
They have shown remarkable resilience. They should not have to keep proving it indefinitely.
And patients, in the end, are safest when the people who care for them are supported enough to do it well.
Interested in how well-designed referral pathways can help preserve knowledge and good practice through structural change? Get in touch – hello@dxs-systems.co.uk
