An Analysis Report on N

Student Name: Carso Tamble Eta

MANAGING CHANGE

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Table of Content

Introduction-------------------------------------------------------------------------------------------------2

Internal and External Analysis of the NHS Business Environment---------------------------------3

A Reflection on the NHS Speculated Crisis (True/False) --------------------------------------------

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Strategies for Addressing the NHS Crisis---------------------------------------------------------------

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The Role of Leadership in Managing the Change-----------------------------------------------------6

Conclusion--------------------------------------------------------------------------------------------------6

References--------------------------------------------------------------------------------------------------7

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Introduction

Scotland’s National Health Insurance is the country’s umbrella institution responsible for the
design, provision, and management of all public health services for the Scottish people. For
nearly a century now following its establishment in 1948, the NHS Scotland has served this
duly almost seamlessly delivering to Scotland’s now over 5 million people access to quality
health services and in effect, living up to its fundamental principle of “public healthcare
delivery at the point of need” (Severin & Dan, 2022).

However through the decades and with a population that has grown by nearly 10% since the
establishment of the NHS Scotland, there is an apparent pressing need for reform – one which
has already gained a level of seriousness that has placed it on the agenda on the highest
echelon of the nation’s health leadership (Iacobucci, 2020). In a leaked document cited in the
case study, a few of these issues are elucidated along with various positions already taken by
leaders of government as well as the direct managers of the Scottish NHS. This report in a
considerably concise manner, presents some of this positions, the issues and points out
suggestions that have been made as a means of salvaging the situation before an speculated
collapse of the NHS Scotland (German, 2020).

An Internal and External Analysis of NHS Scotland Business Environment

Internal Analysis

For a balanced analysis of NHS Scotland’s internal business environment, McKinsey's 7-S
Model provides the appropriate framework for an objective assessment:

 Strategy: NHS Scotland is by its fundamental design and objective

meant to provide public health to the people of Scotland solely on tax
expense or public purse. The structure could therefore be well
described as one of a charity rather than a mere public good that is
jointly paid for from public purse and private pocket. Hence, the
internal structure obviously calls for some restructuring if the NHS
Scotland is to survive (Morris & Grey, 2018).
 Structure: NHS Scotland is a public healthcare services establishment
consisting of a board that oversees its management, executives and
healthcare workers across all levels of the organization. The leaked
document shows a growing resentment among the ranks of the board
over the need for reform of the NHS Scotland (“Scottish Healthcare
Support Workers Survey,” 2019).
 Systems: The NHS Scotland controls a cluster of health facilities
situated all across the nation with the sole aim of delivering public
health to the Scottish people on demand. The sustenance of the system
calls for a change in how it operates (Tahzib, 2022).
 Shared Values: The NHS Scotland was founded on the principle of an
institution established to serve the public quality healthcare “at the
point of need” at the full expense of the taxpayer in contrary to the idea
of shared profit of even a public-private shared responsibility.
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 Consequently there is a contradiction between what the NHS Scotland
is meant to do by its founding premise and what it can do in reality of
its resource capacity (Westgarth, 2022).
 Skills: The leaked document shows a growing skills gap as a result of
the growing population, new demands of users and the peculiarity of
each medical health case. Consequently, the need for more hands which
also higher cost of operations becomes imperative despite other
pressures (Supriyono, 2022).
 Style: A culmination of these issues therefore demands a complete shift
in the modus operandi of the institution in a way that allows it to meet
today and the emerging future’s demands on public healthcare across
Scotland (Supriyono, 2022).
 Staff: the document clearly indicates a broad support from across the
ranks and file base for a timely reform effort targeted at salvaging the
dire situation of the NHS Scotland as captured in cited minutes.

External Analysis

To assess the external environment, we apply the PESTLE model (Lutaaya, 2021):

Political: The NHS Scotland business environment is heavily influenced by politics. Its
nature as a public service institution for no less an important services as health implies that
decision over what changes or reforms to be made about it must be subjected to political
scrutiny. For instance, the health Secretary despite an clear leak that implicates the topmost
leaders of the Scottish health department; when asked by the media about whether or not there
was any reform in sight at the NHS Scotland, dismissed the idea and reasserted that the NHS
Scotland will continue to operate in-line with its fundamental principle of healthcare service
at the point of need.

Economic: Economically, there is also a huge burden of maintenance of the NHS Scotland
as an entirely taxpayers funded or solely public purse dependent service. The leaked
document even cites the NHS Scotland being referred to as a “billion pound hole in the
British budget”. The whole argument about the need for a reform and the near unified view
of key stakeholders except before the public for the public for political reasons earlier
highlighted is centred on sustainability of the NHS Scotland with its growing financial
burden informed by rising population and new demands of prescriptions and personnel to
meet established quality standards.

Social - The NHS Scotland service speculated collapse captured in the leaked document is
also driven by very powerful social forces of moral, care and the need to ensure that every
Scottish citizen regardless of the class has access to quality healthcare as a right and not a
privilege to the a few who can afford it in varying measures. Accordingly, managers of the
NHS Scotland are exposed to intense criticisms whenever there is any hint of constraining
that access as well as a concurrent pressure to maintain the status quo except through
application of appropriate change management measures.

Technology: From the technological standpoint, there is an acceleration of processes that

makes it possible for the development and maintenance of comprehensive databases of each
Scottish user of the NHS Scotland, history and balanced projections on their future
healthcare needs. Consequently, managers of NHS Scotland are able to determine cost
burdens and make reasonable predictions about where the institution may meet its breaking
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point in terms of capacity if there is no reform that allows it operate a mix public and
private pocket funding models for sustainability.

L – Legal – legally, the NHS Scotland legal environment calls for a constitutional from the
original acts which guided its establishment as of 1948 which indeed made the service fully
taxpayer money dependent rather than the suggested autonomy

Environmental – The NHS Scotland continuity is also now subjected to new demands of the
environment and ones which directly place additional budgetary burden on the Scottish
government especially on issues of climate change and climate action. The global aftermath
of one of the worst pandemics overly stretched the NHS which fundamentally had to add a
bogus COVID need to its coverage options to millions of Scottish citizens who depended and
still depend on the institution for healthcare (Mamirbaeva & Janabaeva, 2022).

Reflection on the Case Study Comments on the NHS Scotland

The fact is that conversations over the dire need for urgent reform in the NHS Scotland
operational or service model are currently ongoing at the highest stakeholder circles of the
service; government, health department, leading public servants as well as the technocrats
within the establishment. Hence, there is no question about the unity of the key stakeholders
or managers of the service that reform is the way forward for the survival and sustainability of
NHS Scotland. However, whether or not the Scottish public is ready for such a shift
apparently would affect what they can get from the current fully publicly funded health
service. As highlighted in the internal and external analysis – especially, the political external
analysis, it is crystal clear from a from a standard organizational perspective that there is a
compelling need for an overhaul of the NHS Scotland as established in 1948 to meet the post-
modern day’s demand for public health service delivery and which place huge burden on the
nation’s finances consequently fuelling other aspects as tax rates which constantly courts the
resentment of the mass public – the direct beneficiaries of the NHS Scotland.

To solve this problem of differences of interest between the managers of this essential public
service and the beneficiaries sustainably, there is a need to bring everyone on the same page.
Save the NHS Scotland while keeping the support of the people who can either hire or fire
their governments on the basis of what position they presume each takes on the who pays for
the NHS. To this end, the Lewin’s change appears a shortcut because of its emphasis on a
three-step process of unfreezing, transition and freezing in change management that often or
at least for the unique case of the NHS Scotland would exclude too many important details
Consequently, Kotter’s 8-Step Change Management model presents an opportunity to deal
with key concerns surrounding the whole process including the need for an all-inclusive
national conversation on the NHS as a need for the ‘creation of urgency’, an active
engagement of all stakeholders engaging to gain their support, need for clarity of vision for a
21st century NHS Scotland amongst other aspects of the process.

Strategies for Addressing the NHS Crisis

An assessment of the case study reveals some strategies which should be adopted addressing
the speculated collapse of the NHS Scotland as highlighted in the leaked document:

 Redesign the NHS Scotland Model as noted in the document, “designing in” –used in
in describing a proposed two-tier health service that would place responsibility on the

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 upper economic class of the Scottish people to pay for their treatment rather than
getting all free as the rest of the public.
 Organize a National Reorientation on the NHS Scotland to create a needed shift from
the mentality of taxpayers pay it all to one of shared responsibility for sustainability
and quality.
 Increase the risk appetite of hospitals to dismiss patients after 24 hours as a quick fix
to lessen the pressure on the limited facilities as well as medical health personnel.
 Introduce reductions to range of prescription drugs now offered totally free as a way
of generating additional revenue to the NHS from users who can actually pay for their
medical prescriptions.

The Role of the Leadership in the Recommended Change Management

Due to the rigorous nature of a reform process, the entire change management process
applicable here requires some tact with leadership. The application of Kotter 8-step model
makes it necessary to adopt a consultative approach of leadership which in essence would
mean active communication and engagement of all key or critical stakeholders, to ensure
acceptance each step of the way, a constant update on progress and sharing on short-term
gains as a way of inspiring even more support for the process, et al. Anything otherwise
would only stir unnecessary opposition to the change. The NHS is fundamentally a policy that
offers the Scottish public a variety of health services that are currently being solely paid for
by the public purse with limited taxpayers’ money. To create a shift would therefore mean
changing the rules and that can only be possible through extensive dialogue with those whom
the policy directly affects – the Scottish citizens.

Conclusion

In conclusion, the report presents an analysis of the case study using applicable tools for
internal and external analysis respectively – the McKinsey 7-Step Model and PESTLE both of
which encompasses various aspects to consider in effecting change. It also highlights the
strategies revealed by the documents for addressing the NHS Scotland crisis, an appropriate
change management model or theory as well as a leadership that aligns with the unique case.

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References

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Iacobucci, G. (2020, February 25). Marmot 10 years on: austerity has damaged nation’s
health, say experts. BMJ, m747. https://doi.org/10.1136/bmj.m747

Lutaaya, B. (2021). Dissecting the external operating environment of Uganda’s Sugar

Industry: A PESTLE analysis. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.4243404

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Supriyono. (2022, January 7). Case Report: Methotrexate and Etoposide as Adjuvant Therapy
on Patient with Hydatidiform Moles that Have Growing Rapidly Becomes Gestational
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https://doi.org/10.1093/pubmed/fdac110

Westgarth, D. (2022, April 4). NHS and private principal net profit: What do associates think?
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