Services are changing. Commissioners are changing. Organisations are fighting their corner.
Much of how the system develops and transforms will depend on the actions of the leaders within the organisations.
Leaders at all levels are faced with choices, however the nature of the choices is not labelled or rational. The actors within subsequent decision frameworks also find themselves coping with world changing outcomes.
An example of things to come include consolidation of specialist surgery such as vascular surgery. Right now across the country various hospitals are vying to become vascular centres, treating complex cases, making a difference to patients lives.
Unfortunately the various organisations who have a stake in the dealings don't always act rationally.
On the face of it shifts in service which should be clear, based on good data, good analysis and good procurement/ commissioning of the service appear to be being made slowly.
Unfortunately that apparent clear process masks some aberrant behaviours which are not professional, organo-centric and motivated by values other than patient care.
There is no easy solution to address these behaviours, they must be recognised, identified, and possibly named. Individuals need to be engaged, their damage and apprehension recognised and they must be engaged in a vision and journey to the future.
Easier to write than to do.