What’s in a Meme?
Earlier in the summer NHSE CEO Amanda Pritchard revived the concept of “earned autonomy” in a discussion about devolving power to Integrated Care Systems (ICS). The term seems to have emerged around the turn of the century in the US education sector, gaining traction in the UK during the mid-Blairite years alongside related memes such as “tight-loose control” (good) and “provider capture” (bad). While promoting the principle of earned autonomy, Amanda is not overly-enamoured with the wording , saying that she couldn’t think of anything better at the time. For anyone else grappling with the concept I would suggest watching some episodes of the TV series the Sopranos. In the programme the eponymous mobster Tony, both acquires earned autonomy from his superiors, and allows it to his underlings who have flexibility in developing the Mafia business model subject to some strict conditions. These include not missing payment deadlines, avoiding heat from the feds and keeping the number of people sleeping with the fishes at manageable levels. When things go wrong there are, of course, consequences for anyone who has crossed the line, possibly including a summons to a sit-down (similar to a sit-rep but a bit more uncomfortable). Other parallels with today’s NHS are so obvious as to need no explanation but it’s worth noting that the Care Quality Commission (CQC) doesn’t use wire taps. As far as we know.