Reduced budgets are producing some interesting approaches to the necessary decisions to be made.
A recent visit to the Blackberry Clinic in Milton Keynes showed me one of them: it turns out that the local PCT, having to cut budgets by a substantial percentage, had gone for the simple approach – stopping all treatment in the last couple of months of the financial year, no matter what stage patients were at. The first cutoff came for referring patients from GPs, the second a few weeks later when treatment itself stopped. It meant, of course, GPs handwriting letters to take straight into the clinic on the last day, desperately getting people in ahead of the deadline.
It's a similar situation to that being considered in North Ayrshire – if the education budget's too small, make the school week four days instead of five and raise the starting age to six.
In terms of the Cynefin framework, both strike me as being at the extreme of simple responses to making necessary cuts. Many other organisations (and probably other areas within those organisations mentioned above) are taking a more complicated approach – analysing, streamlining – but staying within the current structures and bounds. Still working on the premise that these things are predictable.
A complex approach might offer something new – but requires a shift in thinking. It offers, ultimately, the potential for substantially new ways of providing services with fewer resources. It is not, however, entirely possible to predict at the start of the process precisely how the service will be provided at the end – it requires a degree of perspective shift that can be uncomfortable and a willingness to trust early on – it demands courage of those leading an organisation.
The best place to start is small for many of these projects, of course. Develop the tools and attitudes needed for radical complex change in niches where it can provide major benefits, but where the difficulties will not impact too strongly on either people or reputations. With the learning that those early projects bring, it becomes a more confident and straightforward act to start on more significant projects – where the impact and the payback starts to show.
There is potential to take the cutbacks and develop very different delivery services – but trimming away, whether done at the most basic level or after much analysis, is unlikely to bring those benefits.