Lets start with some definitions, official and unofficial.

Silly Rules. “outdated or unhelpful rules, policies, and procedures within healthcare settings that hinder efficient and effective care”.

Official: The Institute of Healthcare Improvement (IHI).

Originally called, Breaking the Rules to Improve Care and Increase Joy in Work and Well-Being (link here). Basically an IHI initiative to tackle some of the everyday irritations of working life by asking staff and service users to identify ‘Silly Rules’ and fix them.

But it does leave me asking, “how did we get here in the first place?”

Which leads to the next definition…

Bonfire of the Regulators. “a periodic purge of arms length government bodies that had been set up to implement recommendations from a review. However they are no longer doing what was intended or have passed their ‘sell by’ date.”

Semi – Official. I partly made this up. It’s based on this BBC article ‘Hundreds of NHS agencies to be scrapped’.

A note of caution here. Have a look at Chesterton’s Fence, ‘never take down a fence until you understand why it was put there in the first place.’

The BBC article reports, ‘Ministers said there were more than 150 bodies responsible for regulating or assessing healthcare services in England, and they risked overwhelming staff with “uncoordinated” guidance.’

If 150 is accurate, that’s a huge bonfire, but Iets wait to see what happens.

If this sort of thing interests you, look at the Institute of Government article ‘Not another Bonfire of the Quangos…’.

Bonfires seem to come around like boomerangs. Ironically, here in Wales some people are calling for the re-instatement of quangos, like the Welsh Development Agency, ‘burnt’ on the last bonfire,

You know that quote from Sun Tzu in the Art of War…. “If you sit by the river long enough, you will see the bodies of your enemies float by”? Just putting it here for reference purposes…

But, but, this post is not just about top down stuff. We do create local challenges for ourselves.

Improvementitis. “a feeling of helplessness created by the overwhelming number of rules, guidance and procedures required to your job. These will have been landed on you, often by people who have never done your job”

Totally Unofficial. I made-up this one.

All I’m going to say is try some mystery shopping. Whenever I go to an NHS building or any public body facility I try to look at the notice board.

Paul Taylor who prompted this post talks about his own hospital mystery shopping in, What I Got Wrong About Innovation and Design.

Paul points out that during the Covid pandemic, “unfreezing” of bureaucracy allowed for more agile and experimental approaches to service delivery.

If you’ve read this far, I hope you’ve picked up the link to the role of regulators.

Lots of my own mystery shopping has been overwhelming. Notice boards with literal forests of fluttering initiatives, screaming for attention and the NEXT BIG IMPROVEMENT!

I have seen examples of the ‘latest thing’ pinned on top of what was the last ‘flavour of the month’.

Behind the forest of initiatives are the unfortunate overwhelmed staff who are just trying to do their jobs (which they generally know quite well).

And to bring things right back to the start, we wonder why the Silly Rules initiative started…

Silly Rules in Wales. Our Silly Rules initiative kicked off late 2024. I’m waiting for details of what happens next.

Meanwhile you can look at what is a well intentioned, sensible, evidence based, carefully planned initiative:

• The Bevan Commission (Healthcare Think Tank) Silly Rules web page.
• Pembrokeshire Herald article.
• Llais. The Body Health and Social Care Service Users Voice Silly Rules web page.

Finally, The Georgia Guidestones. Principle 7, Avoid petty laws and useless officials, which I wrote about in 2011.

Apologies, I’ve not gone Tin Foil Hat conspiracy theorist, but there is something relevant in the Georgia Guidestones statement.

I’m wondering is if there is a case for periodic review of all sorts of regulators, quangos and even ‘initiatives’.

Because, the reasons they were put in place do change, society moves onwards and things pass their ‘sell by date’.

Just ask the question, ‘are we still fit for purpose?’

Something like the ‘going concern’ assessment that happens as part of the annual accounts process.

Something more ‘purpose led’ and regular, rather than ‘bonfires’ based on government cycles (and cost reduction pressures).

So, What’s the PONT?

1. Rules, regulations are part of any system and help it to function. There are the boundaries we should not cross, and things we must we do.
2. The reasons and the purpose of the rules can change over time. It is helpful to ask the question, ‘are we still fit for purpose?’
3. Before you remove anything, ask the Chesterton’s Fence question.