Masters in Health Management

Masters in Health Management
‘Strategic Thinking’

The task will take you beyond strategic management of single organizations because it is about providing strategic advice to Government. The scenario is as follows:

It is 2015 and there has just been a general election and David Cameron has been returned with an outright Conservative majority of 20 seats – confounding predictions of another coalition government. The NHS is performing better than expected given the disruption caused by Andrew Lansley’s health reforms. However any success has been overshadowed by the constant flow of bad news stories about the NHS in the media and the polls show the public has conflicting views about their health care system. The NHS is still cherished as a national institution but there is a growing sentiment – particularly in the south – that the NHS is broken beyond repair.

As you might imagine the NHS is not a happy place. There are continuing rumbles of discontent from the professions and the unions, big service changes are beginning to occur with many services moving to community settings and thereby reducing the sustainability of local hospitals. Recently 15% of the nation’s multi-speciality acute hospitals were pronounced both economically and clinically ‘unsustainable’ by the NHS England. The need for a 20% reduction in health spend has been largely accepted by the public but they are disquieted by the lack of meaningful integration between acute hospitals and community services, between physical and mental health services and most of all between health and social care. Public confidence in and trust of GPs is falling fast as it becomes clear that parochial interests are preventing them reorganising their practices to provide more local services and better access for patients. Politicians on Health and Wellbeing Boards (especially those in the metropolitan ‘city regions’) are beginning to use their powers to directly influence health care commissioning. In places where there is good political leadership this has produced some significant benefits in terms of system productivity and public approval.

The PM knows that the new government – voted in largely because of the revival in the county’s economic fortunes – has to ‘do something’ about the NHS. In a recent speech at Cass Business School he announced that it was ‘time to restore the public’s faith in the English health system’. He said that he wanted to ‘retain the core values of the NHS – universal access and services free at the point of delivery’ but because the Government has
to fulfil it election promise and reduce public spending he was ‘willing to contemplate radical
changes to the system.’

The ‘Strategy for Real Programme’ has been developed by Professor Laurie McMahon as a basis for classroom discussion. The exercises and cases contained in it are highly realistic but any exact parallel with reality is entirely co-incidental.


Through private polling he knows that the public are so fatigued by what has been happening in health that they are willing to accept – even welcome – change, as long as access and quality are maintained, there are no unmanaged cuts in service and that they do not have to pay higher taxes.

In a move designed to demonstrate that he sees the future of the NHS as more than just a party political football, the Prime Minster has appointed Alan Milburn as his Secretary of State for the NHS for two years so that he can carry through the changes. Alan had a similar job under New Labour when he introduced competitive markets, patient choice and independent foundation trusts. He has a reputation for independence of mind and for being politically tough and capable.

The Prime Minister has told Alan privately “The old NHS is over – it’s history. There is no way we can patch it together now. We need a new start for the NHS – an exciting and innovative approach that will get the health system out of the mess it is in, renew public and professional confidence and deliver the savings – in time for the run up to the election in

Drawing on your own experience of health system dynamics in the UK or elsewhere – what strategic advice would you give to Alan Milburn?


1. Read the case very, very carefully. It is full of clues. Remember that you are advising a
Minister not writing a general essay for X University!

2. You will need to describe the context in which this is happening and the position of the principle stakeholders. What you learnt from the classroom discussions might be augmented by research. We will look for evidence of a structured approach to your search. There is a great deal of material available but because it is a current issue, do not expect to find too much in referenced journals.

3. If you treat the NHS as if it were a single organization you will be able to use recognised strategy tools to assess the situation and serve as the basis of your recommendations. However this approach has weaknesses.

4. Remember that strategic management is about implementation so not just making strategic decisions. Understanding the power and interests of stakeholders – you will need to advise
on how your strategy might best be introduced.
Programme Assessment Criteria
Module Assessment Criteria

1. Presentation: was the work professionally presented, clear, the right length and correctly referenced?
Harvard referencing.

Appropriate use of paragraphs – this is a report. Arial 10 font, 1.2 line spacing, one line space between paragraphs, no indents.

Bullet points may be used to summarise and present analysis. Ensure that you have an explanatory paragraph commenting on the significance of any such list. Be careful not to overuse bulleted lists.

Try and include tables, charts, analysis, models etc or a précis version if these are too large in the main text.

2. Scope: was the range of literature and research and tools and models included/considered in the assignment appropriate?
Analyses major provider sectors (Primary Care, Secondary
Car, Social and Community Care).

Considers a range of strategic insights into health system dynamics in the UK and or elsewhere. Includes tools such as PEST, SWOT, Scenario Analysis, Force Field and some new tools/models from your own research of strategic thinkers such as Mintzberg and other leading lights in the field.

3. Critical Analysis: was there applied and critical use of literature/research, tools/ models, in detailed sections of the work?
Considers perspectives of the key stakeholders.

Applies analysis combined with systems dynamics insights to make recommendations.

Considers scenarios, identifies implementation priorities and considers contingencies and mitigation options.

4. Integration: did the detailed sections fit together well and form a coherent whole with a clear beginning, a clear ending, and continuity of logic throughout?
Recommendations should clearly relate back to the objectives for your reformed healthcare system and your analysis. Good structure and clear signposting by referring back occasionally to remind how the recommendations support the revised objectives or reflect key aspects of your analysis would help make this clear to the reader.