An independent review and temporary traffic lights…

Driving home after a meeting with the leader of a modest-sized business, the Badger joined a slow-moving traffic queue on a semi-rural road. In the distance, he could see that temporary traffic lights letting through just two or three cars at a time were the reason for the queue. As vehicles inched forward, the Badger’s thoughts wandered back to the meeting that he’d just left. The business leader, an unusual character, was struggling with delays and spiralling costs on a long running project, and with getting his project staff to change their long-standing, comfortable, ‘it’s too difficult’ ways of working. The leader wanted to find a way of overcoming this challenge without completely destroying their good personal relationship with their staff.

At the start of the meeting the leader’s demeanour was initially one of quiet desperation, but this changed to one of relief and enthusiasm as the discussion progressed. The Badger suggested getting an experienced, independent outsider to review the project and produce a report that recommended actions to be taken. This provoked some fruity language signalling that there was no desire to pay someone who’d swallowed an MBA handbook to author a report that told them what they already knew! Undeterred, the Badger persevered and pointed out that a review and report by the right independent person would provide the objective, dispassionate, and tangible ammunition in black and white to force the changes needed to reduce cost. After all, this is a common method in major businesses, public sector organisations, and government departments. The leader had a ‘light-bulb moment’. They realised that a written report would be a useful vehicle for deflecting the ‘blame’ for changes more towards the independent reviewer than themselves!

As the car reached the front of queue at the traffic lights, the Badger wondered why this supposed leader hadn’t thought about the merits of an independent review and report themselves. The Badger’s attention, however, quickly moved to the highway work being performed, namely the clearance of compacted leaves and vegetation from a 20-metre stretch of the paved footpath running alongside the carriageway. There were three panel vans, a trailer, one worker chatting on his phone in a van’s cab, one worker using a mini-bulldozer to scrape leaves from the footpath and put them further back on the verge,  and one worker using a portable petrol-powered leaf-blower to blow looser debris from the footpath onto the verge. It must be cheaper, the Badger mused, and healthier for the workers, more fossil-fuel efficient, and less impactful on the climate if this work was done by two men with one van, a wheelbarrow, a shovel, a rake, and a broom. The Badger smiled; an independent review of working practices is surely needed!

Observing the NHS…

Opening bleary eyes at 5:30am in a hospital ward bed to see the smiling face of a PPE-clad nurse wanting to thrust swabs into your nose and throat for a COVID test is an interesting start to the day! This test marked the start to each long, visitor-free, in-patient day that would eventually end around 10p.m. at night.

Patients were not allowed visitors until their stay surpassed five days. After that, one person could visit for one hour, but only once in every subsequent five-day period. No one grumbled. Instead, the Badger and fellow patients used video calls from personal smartphones or tablets to maintain contact with loved ones. The absence of visitors meant we experienced and observed ward operations performed without distractions, and we habitually shared our remarkably consistent primary observations during the quiet troughs that speckle an in-patient’s day.

Firstly, there was unanimous respect for doctors, nurses, and the ward staff who kept things shipshape (many of whom work 11 hour shifts with just a 30-minute unpaid break). Secondly, we observed that although the NHS is slowly transforming to the digital world, there’s still too much paper-based activity constraining efficiency. One nurse commented, ‘If someone borrows your drugs form before I get to you, it’ll take me half an hour to track it down’. Thirdly, we observed that nothing happens unless a busy doctor says so and signs a piece of paper, which they rarely do promptly. Telling a patient in the morning they’re being discharged, and then telling them in the evening that the doctor’s been busy and has gone home without signing the discharge paper is incredibly annoying and systemically inefficient!

There was also a consistent view that debates about NHS funding, a staple for media reporting, are red herrings because there’s much the NHS can improve itself that needs will rather than money. Its own Long Term Plan shows that it knows it must transform from a way of delivering health services that’s still locked into a model largely created when it was founded in 1948. It just needs to progress faster.

Finally, like most transformations, we observed that it’s the people and working practice issues of change rather than technology that is the biggest challenge. Transforming the NHS, the biggest employer in Europe and the world’s largest employer of highly skilled professionals with a headcount of 1.35 million, over half of which are professionally qualified clinical staff, is undoubtedly a massive task. It’s akin to reengineering a giant A380 plane full of passengers while it’s in flight, but it has to be done for the service to be sustainable. Even with its observable flaws, inefficiencies, and transformational strains, we all felt safe, in expert hands, and hugely proud that our country has the National Health Service as part of the bedrock of life across the population.

Hinkley Point C and the Marble Arch Mound…

The recent BBC television series ‘Building Britain’s Biggest Nuclear Power Station’ about the building of Hinkley Point C on the UK’s North Somerset coast was enthralling. Television cameras not only followed people building the station, but also gave an insight to the engineering, processes, professionalism, and diligent attention to detail that they follow at every step of the build. The Badger found the sections covering the ‘Go/No Go’ decisions for a) pouring nearly 1000 lorry-loads of the correct specification of concrete for the nuclear island foundations, and b) installing the first ring of the reactor containment building, impressive and reassuring!

Normally we see little of such readiness and decision-making processes on major programmes and during his career the Badger was involved in numerous post-mortems of programmes that suffered from poor Go/No-Go readiness and decision-making disciplines, especially with regard to opening up to ‘live’ operations with end users. A failed major programme activity or a failed introduction to use with end users can often be traced back to poor Go/No-Go professionalism with decisions based on poor status information, poor risk assessment, and commercial or political priorities. It is, therefore, reassuring to see that things are being done right with regard to every aspect of readiness with Hinkley Point C.

The recent opening of the Marble Arch Mound in London, however, is a different endeavour. It’s recent opening before it was ready not only led to some ribald laughter in the Badger household, but also lots of derision on social media and in the press – see here, here, and here, for example.   Westminster City Council’s ’s CEO must have felt highly embarrassed at having to apologise via a statement on the Mound’s website that it hadn’t been ready for opening to paying customers. The Badger knew little of the ‘The Mound’, a phrase that seems apt for a horror story, before the tsunami of recent coverage, and so he explored further in a more objective frame of mind.   

The motive for building the ‘The Mound’ was to get people back into the shops, theatres, and restaurants of London over the Summer, and there’s nothing wrong with that. It’s a temporary structure costing ~£2m of council taxpayers money that’s only in place until January 2022. It apparently fails to deliver what was promised.  On absorbing its history, the Badger felt that while the motive was laudable, the concept of ‘The Mound’, the way it was marketed, and its delivery were likely flawed from the outset. The Badger’s conclusion? ‘The Mound’ is a reminder that not every idea is a good one, not every delivery meets expectations, and not every decision is the right one.  It’s also a reminder of human fallibility which is, of course, something which cannot be countenanced at Hinkley Point C where everything must be perfect.