This is a really important piece of work from Alison Turner and colleagues at The Strategy Unit. https://www.linkedin.com/posts/antlerboy_failuredemand-valuedemand-nhs-activity-7463154305286615041-BbQk what if a large part of the public sector productivity crisis is actually the machine metabolising its own fragmentation?
This is a really important piece of work from Alison Turner and colleagues at The Strategy Unit.
What I think they’ve identified – carefully, and without turning it into another managerial slogan – is that a surprising amount of NHS ‘activity’ is actually the machine metabolising its own fragmentation.
– A missed referral generates another appointment.
– A delayed pathway allows deterioration.
– A fragmented handoff generates another assessment.
– A carer becomes an unpaid care coordinator because the institutions can’t coordinate themselves.
– And then all of that shows up in the metrics as ‘productive activity’.
That’s the genuinely uncomfortable bit.
The report’s strongest insight is not just the existence of failure demand. People working in public services have recognised versions of this for years. It’s that our systems often can’t distinguish betwee value created and activity generated because value was not created earlier.
So a system can look busy, efficient, even ‘productive’, while actually generating recursive demand through poor design.
I also really like the distinction the report makes between:
– transactional ‘fix me’ problems
and
– relational ‘help me’ situations.
Those are not the same thing- as John Mortimer nailed clearly in feeding in.
Some failure demand is genuinely technical: booking failures, duplication, process defects, missing information.
Some is relational and systemic: thresholds, fragmentation, defensive practice, organisational boundaries, lack of continuity, people falling between services because nobody can hold the whole picture.
And the trap – increasingly visible across public services – is trying to solve relational failures with more transactional machinery.
– More triage.
– More categories.
– More portals.
– More routing and signposting.
– More standardisation.
– More automation of the boundary between person and institution.
Sometimes that helps; sometimes it simply industrialises failure demand.
The report is also refreshingly honest about ambiguity. It resists turning failure demand into a target or a simplistic metric. Good. Both because the moment it becomes a performance regime, people will optimise the appearance of reducing it rather than the reality. And because, if you do it right, the boundaries need to keep moving as you improve.
Underneath all this is a bigger question. What if a large part of the public sector productivity crisis is not primarily about insufficient effort, but about systems generating avoidable loops, escalation and compensatory work because they are poorly aligned with how human lives are actually lived?
Very much worth reading.
Link to report https://www.strategyunitwm.nhs.uk/news/failure-demand-route-success
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