A better role for OD in the NHS #3

OD in the NHS is a dumping ground for managerial problems. But it could be a place where persistent challenges get worked through – by people better qualified than external consultants to engage with the realities of the NHS. But there is a long way to go if NHS OD is going to be seen as the excellent consulting partner it could be.

The potential for OD is a long way from being understood by NHS managers and leaders, who tend to offload difficult people issues not to OD but onto HR; and when it is apparent that that issue extends beyond pay, rations, and misbehaviour, HR then dumps it onto the OD people in the company.

OD practitioners also tend to self-marginalise, which amplifies the way in which managers treat the practice, with many in-house disagreements as to the virtue and purpose of OD. For some, it is a management function that needs to be focused on the priorities of the business; for others, there is a seemingly circus-like feel to the work, with people using it to entertain the troops (OD as edutainment).

Why is this important to be considered at this time? Because the collective intelligence of the NHS is not being engaged with, and this is precisely where OD could add value.

Instead, because professional services companies spend a good deal of time and effort on building their credibility (even if that is somewhat illusory), senior leaders are transfixed by what they think such firms can offer. The internal OD teams in the NHS spend very little time on considering their credibility, instead merely responding to requests to do fragmented pieces of work.

As one NHS OD interviewee explained, even in large-scale change projects, OD tends to be thrown scraps, being allocated to sub-streams of work that tackle culture and leadership.

Now would be a good time to convene some conversations that allow us to look at the espoused and the actual in respect to OD practice. We have the potential here to explore how things are and how they could be. Alongside that, we can discuss what we say we do, what we do in practice, and what would give us joy to do. And it needs to be a dialogue that draws us together, generating enough unity in the community, rather than further polarising our professional differences.

In 2022, it is reported that the NHS spent £626mn a year on external consultancies. NHS England alone threw 83mn tax-pounds at these companies. When people discuss privatisation of our health provision, the focus is invariably on clinical services. However, it is in the field of leadership and management – where the service already carries a huge wage bill – that outsourcing is most apparent.

NHS OD is qualified to provide most of the services that are currently sold off to these private companies. And this is a resource for which we are all already paying.