The real reform of the National Health Service

Above everything else, man is a social creature. Deprived of contact with others, a man will become demented in four days. All organisations — in government, business, religions and interest-groups — become saturated with what can be called modern-day hunter-gatherer groups. There’s always a pecking order within them, sometimes unobtrusively, sometimes very obviously. In very large, pyramidal-type organisations all the groups that comprise them also tend to be layered in terms of influence and power.

The big problem in organisations with many layers is that the leaders of every group — the managers — tends to seek the survival and prosperity of his own group rather than the organisation as a whole. He therefore will tend to manipulate or even falsify information that’s flowing up or down the pyramid in the interest of his group. The organisation soon starts to become badly inefficient.

In the last 50 years, many of the largest businesses have learned to cope with this by lateralising as many of its groups as possible and making them largely self-managing. This is something that the National Health Service will have to do sooner or later or otherwise maintain its present heading for disaster.

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