The Structure of Health and Social Care Services UK

Health care team of five people wearing surgical masks and PPE talk together

A ‘Thought Piece’ – for discussion

by Gordon Stirrat1, David Blockley2, Kirsty Alexander3 & Sabrina Phillips4

1 Emeritus Professor of Obstetrics & Gynaecology, University of Bristol, UK.

2 Emeritus Professor of Civil Engineering, University of Bristol.

3 GP & Chair Bristol North and West Locality Leadership Group at Bristol, North Somerset and South Gloucestershire CCG, UK.

4 Alliance Director  (Interim)| Lambeth Living Well Network Alliance


The United Kingdom’s National Health Service (NHS) was launched on 5 July 1948 with three underlying principles – the services were for everyone; healthcare was free; and provision of care was based on need rather than the ability to pay. In the intervening 72 years it has developed into an extremely complex organisation and one of the world’s largest employers. Because of its cost to the national exchequer, its organisation and funding have inevitably become matters of great political significance and debate. The general population has developed a great emotional attachment to ‘the NHS’ vividly expressed in, for example, Danny Boyle’s 2012 Olympic ceremony when, at one point, the floor of the stadium was occupied by a host of angelic nurses and 300 NHS beds filled with bouncing children. On the 60th anniversary of the foundation of the NHS Michael Rosen wrote his poem, ‘These are the Hands’, in praise of the mundane but vital contributions of healthcare workers. It has come back to prominence during our current tragic Covid-19 pandemic made even more poignant by the fact that Michael himself has been very seriously ill due to the virus. He has, thankfully survived and is gradually feeling better. Also, during the pandemic many of us have, along with our neighbours, gone out to clap on Thursday evenings as a sign of our support for ‘the NHS’ and the frontline workers coping with pandemic.

To many people in the UK, those working in GP surgeries and hospitals that deliver health (but not social) care are ‘the NHS’.  The reality is far more complex, and we suggest that the structure of Health and Social Care Services UK, including the NHS and social care, and how the system reports and is accountable to Government and the public are all unnecessarily complex and opaque.

A complex structure

The Department of Health and Social Care (DHSC) is the Government body responsible for implementing policy in England. It delegates the work to NHS England. It is accountable to the Cabinet, Parliament, and ultimately to the general public. Health policy and implementation is devolved to the Scottish and Welsh governments and the Northern Ireland assembly. England is the only one of the 4 UK administrations to have a quasi-market but all use performance targets.

The NHS is complex set of organizations which, for the most part, work quite well despite a myriad of sub systems. A number of authors have referred to this complexity (1, 2, 3, 4) and, for example Powell (4) says ‘The leadership of the NHS seems fractured……a system under siege where success isn’t celebrated but failure is catastrophised’ We need ‘to build the confidence of the people who hold the problem.’  Attempts to explain the complex systems are necessarily partial (5, 6, 7). Good people can make a poor system work well but when pressures overwhelm them failure can be catastrophic (8). The NHS England long term plan (9) recognises the issues and states that the NHS will move to a new service model with ‘properly joined-up care…..creating genuinely integrated teams….with Integrated Care Systems (ICSs) everywhere by April 2021. ICSs will ‘deliver the ‘triple integration’ of primary and specialist care, physical and mental health services, and health with social care………Breaking down traditional barriers between care institutions, teams and funding streams.’ The intention of the plan is that providers, commissioners, local authorities and others will together locally plan and integrate care to meet the needs of their population. This initiative has grown out of sustainability and transformation partnerships and is the latest in a long line of NHS organisational changes. Currently there are 18 ICSs but demonstrations of progress are sparse (10).

How will integration be successful?

What are the incentives that will make integration work? Why should the many providers take responsibility for the total care of the whole population for probably less resource – when they have very little control over all the parts?

Everyone in the NHS shares a strong common purpose of ‘caring for our patients’. But does that translate into more detailed shared purposes at the various levels of the sub-systems?

We suggest that the key to driving change should be ‘influencing from the bottom up’ and not more ineffective ‘top-down’ centralisation (11). When policy decisions for change make sense to those ‘at the coal face’ they will respond. However, that response is conditional on the need for change to evolve up and down through the entire system. Policy makers and those allocating resources should alter, and integrate, some of the factors that will incentivise the ‘coal face’ individuals and organisations to work differently. A particularly important aspect of that incentivisation is that adequate resource follows activity without waste through unforeseen issues. For example, hospitals may initiate medication for a patient for which they have a particular financial deal, but the primary carers are not part of the deal and the medication may become very expensive for them.

The various parties to Integrated Care must also be aware that their potential partners may be fearful of extra work and responsibility being ‘dumped’ onto them. Sometimes, for example, individual GPs may be reluctant to hold challenging risks that hospital staff, with their more collective responsibility, may not be exposed to. If a patient dies during hospital treatment after a late diagnosis of bowel cancer caused at least partly through unintended delays (in the systems and perhaps also by the behaviour of the patient) the GP may find himself/herself in the spot light of blame by relatives, for not diagnosing quickly enough.

Making integrated care work has been variously described as ‘pushing a boulder uphill’ or ‘swimming against the tide. For example, differing financial incentives may produce perverse consequences. The commissioner/provider split and ‘payment by results’ (where income is proportional to activity) sometimes leads to a tick-box culture when used for some parts of the system. Block contracts for others do not incentivise improvements. Payment models have to encourage closer working around the needs of patients by sharing ‘pain and gain’ in an agreed manner. Co-operating organisations in the public and private sectors may have different bureaucratic constraints and work to different priorities and time scales as they attempt to adjust with agility to rapid changes. Organisational culture (in simple terms, the way that things are done – including the unwritten rules that influence behaviour and attitudes) can often dominate strategic aims. Some of the factors that influence culture include: leadership, deployment of resources, clarity of structure and processes, values and traditions. Success rests on leadership that overcomes professional silos and tribalism with good IT and access to targeted data – to harmonise strategy and culture.

There is little evidence of an equivalent attention to the ‘joining-up’ the proliferation of higher level non-local fragmented organisations reporting to or sponsored by the DHSC. The drive for integration ‘at the coal face’ does not appear to be reflected at the top of the NHS. There seems to be no unifying concept around which the integration can coalesce nationally. Without that there is a significant risk of regional ad hoc solutions that may not join-up across geographical/national boundaries. 

Understanding the complexity through ‘systemic processes’

We suggest that the entirety of the health and social care system may be better understood by identifying its existing ‘systemic processes’. In saying this we do not imply the need for yet another total re-organisation. Rather we are suggesting an approach that could help the NHS system evolve into a more ‘joined-up’, less fractured and more integrated ‘whole’ across regional boundaries.

First, we need to describe the concept of a ‘systemic process’. This is not a sequence of events as in a flow chart (11). Neither it is simply a series of actions towards an end. Rather it is a reconceptualization of process as a potential that drives a flow of change – just as the volts of a battery drive an electrical current or water pressure drives the flow of water. A systemic process captures what people actually do and how change happens. In human systems the potential is contained in answers to questions ‘why’ – purpose, aims and objectives. The change is contained in answers to questions ‘who, what, where, when’. The transformation of the flow from one ‘state of affairs’ to another is contained in answers to questions ‘how’. The aim is to capture a systemic process as delivering the right information ‘what’ (data as performance indicators, success criteria and shared care records), for the right reasons ‘why’ (purpose), to the right person or organisation ‘who’ (role, stakeholder), in the right way ‘where’ (context) and at the right time ‘when’. Systemic processes are wholes and parts at the same time. They are ‘being things’ that change through natural forces – living or inanimate. You and I are ‘being’ wholes as individuals and yet also parts of family and social groups. As individuals ‘wholes’ we are made of parts such as our muscular skeleton structure and digestive systems. We are as we are because the parts collaborate to form the whole – in other words we show ‘emergent’ characteristics (12).

Applying these ideas to the structure of organisations we see logically related layers of interacting and interdependent systemic processes. For the totality of health and social care services this should encompass all of the organisations in and related to the NHS, including local authority social care and private companies. The successful delivery of a systemic process emerges from the success of sets of processes in the next layer down. An important part of the identification of these lower processes is that their successes are jointly necessary and sufficient for the process above – there is an explicit logical relationship connecting defined success, in all of its manifestations, at every level. It is also important to note that the layers are not hierarchical power structures. Rather they are levels of abstraction from setting policy down to detailed implementation. The attributes of each and every systemic process can be grouped under the headings of why, how, who, what, where and when. At each level the attributes can be identified by multiple players in a common format and implemented on a secure intranet to be accessed by those given authority to do so. Each and every process should have one ‘process owner’ responsible for leading the players involved in that process in detecting and monitoring progress, identifying unintended consequences and agreeing the required actions to steer the process to success (i.e. meeting purpose/aims/objectives) and avoiding failure.

We see the NHS as an ecology of interdependent relations and interactions between systemic processes. Survival and continued success depend on being able to generate an internal ecology of adaptive decision-making at all levels. It may be helpful to imagine each systemic process as a jigsaw piece. The ‘process pieces’ are connected to other pieces not by their interlocking shape but by recording their ‘neighbouring’ connectivity as an attribute and by enacting that connectivity by sharing relevant authorised messages (composed by attributes why, how, who, what, where when).  Creating the ecology may then be achieved by identifying, at a particular level, neighbouring processes and building them into clusters – just as you might piece together areas of a jigsaw. Practically it is helpful to name each piece of the jigsaw, each systemic process, using the present participle or ‘ing’ form such as ‘Doing something’ – ‘Testing a blood sample’ or ‘Diagnosing a condition’. An advantage of the approach is that the essence of what people actually do and how change happens is being captured. Then by growing and connecting clusters of systemic processes eventually a ‘whole system’ of layered clusters emerges. What is more during this ‘piecing together’ or ‘cluster building process’ changes and improvements will suggest themselves. For example, points of strategic dissonance may become apparent. This happens when an organisation hangs on to the old ways of doing things for too long because of a disconnect between actions and intent or purpose at any given level. For more on the details of this approach see (13, 14) 

The organisations reporting to the DHSC seem to be contributing to seven high level systemic processes as shown in Table 1. There are, of course, many more organisations that cannot be included in the table.

Table 1: The 7 High Level Systemic Processes of Health and Social Care Services UK

Commissioning care  NHS England, Scotland, Wales and Northern IrelandCommissions NHS services and is accountable to Ministers of Health 
Clinical Commissioning Groups (CCGs)Groups of GPs who purchase acute care on behalf of patients Accountable to NHS England.
Public Health England, Scotland, Wales & N IrelandArms-length Non-Departmental Public Bodies commissioning services to improve health & address inequalities Accountable to Ministers
Providing careGeneral Practitioners

Provision of primary care to patients under contract to Dept of Health & Social Care (DHSC)
NHS TrustsAcute Hospitals in England & Wales
NHS Foundation Trustsserving either a geographical area or a specialised function. (Do not yet have Foundation Trust status)
Supplying (including Special Health Authorities)NHS Business Services AuthoritySupplies business services  
NHS Blood and TransplantSupplies Blood and transplant organs.
NHS Digital

Supplies informatics 
NHS Resolution

Deals with legal claims  
NHS Counter Fraud AuthoritySpecial health authority fighting against fraud, bribery and corruption in the NHS.

RegulatingCare Quality CommissionRegulator for health and social care
Human Fertilisation and Embryology AuthorityRegulator of fertility treatment  
Human Tissue AuthorityRegulator of use of human tissue
+ 3 othersMedicines and Healthcare Products Regulatory Agency, Administration of Radioactive Substances Advisory Committee & National Data Guardian
AdvisingNational Institute for Health and Care ExcellencePurpose is to advise NHS on what constitutes good quality care.
Chief Medical OfficersReports to and advises Secretary State for DHSC plus other Government Departments
Chief Scientific OfficersEmployed by NHS England and leads healthcare science, advises all Government Departments & Chairs SAGE
Cabinet Office Briefing RoomsAdvises Cabinet on crisis and emergencies Accountable to Cabinet
Commission on Human MedicinesAdvises on safety & use of medical products
+ 18 others not identified here 
EducatingHealth Education England, Scotland, Wales & N IrelandPurpose is to support education and training An Arms-Length NDPB (Non-Departmental Public Body) Accountable to DHSC
Social Care Institute for ExcellenceIndependent agency that provides knowledge, evidence and accredited training for social care Accountable to Sponsors?
ResearchingNational Institute for Health ResearchReceives funds for research. Accountable to DHSC.

The success of each of these seven systemic processes depends on (and logically related to) the successes of many lower layers of systemic processes. For example, NHS England allocates budgets to Care Commissioning Groups (CCGs), and so a necessary but not sufficient condition for successful financial outcomes for NHS England depends on successful outcomes for the CCGs. Social care is shared between DHSC and the Ministry of Housing, Communities & Local Government. Advising is delegated to many disparate sources with the consequent risk of inconsistency. Educating is delegated to Health Education England and the Social Care Institute for Excellence which in turn relies on the Royal Colleges and Universities. Research is delegated to the National Institute for Health Research and the Medical Research Council and onto the Universities and research centres.  Clearly identifying all systemic sub-processes in the system is a considerable task. But it is a task that can and must be spread across all the players/actors involved in each and every process and captured on a national intranet.

We suggest that by structuring our thinking around these systemic interacting and interdependent processes we could achieve six objectives:

  1. Provide a simple overview of the whole organisational structure that everyone can understand and appreciate which can be traced right down to the detailed ‘caring for patient’ processes.
  2. Allow people to identify overlaps and interdependencies. For example, the 23 advisory organisations could possibly be streamlined to co-ordinate advice and avoid incongruity and inconsistency. Could the 8 regulating organisations be consolidated to avoid conflicting data and performance requirements?
  3. Enable caring for the sick, caring for public health and the vulnerable be under one ‘umbrella’ to avoid inconsistencies of policy over the longer time scales than politicians are typically in post.  
  4. Enable a common data structure for the why, how, who, what, where and when attributes of each systemic process – important to avoid different groups using different data structures that cannot easily be shared and for data exchange via an intranet, with appropriate permissions to sensitive data, and the monitoring of progress and interventions to steer processes towards success.
  5. Enable all those involved in delivering success for the NHS to identify how the necessary and sufficient conditions for the success of systemic processes at the ‘coal face’ feedback into success and deficiencies at higher policy levels
  6. Permit us to clarify 
    • pathways of precise terms of delegation and accountability – in particular;
    • how decision makers at all layers of the system delegate responsibilities down through the layers of processes – for example from government to NHS England and others to workers at the ‘coal face’ and ultimately to the patients;
    • how decision makers at all layers of the system are accountable up through the layers – for example from hospital ward care to Trust Boards, CCGs, NHS England and to government, parliament and ultimately to the public;
    • remove, reduce or ameliorate inconsistencies between policy and practice;
  7. improve adaptability of response to unintended consequences and future unknowns such as pandemics and potential impacts from climate change.


  1. The structure of Health and Social Care Services UK reporting to Government seems unhelpfully complex and opaque. We suggest a rationalisation using a ‘systems thinking bottom-up’ approach would be more likely to succeed than yet another top down reorganisation.
  2. Rethinking the interactions between existing organisations around ‘systemic processes’ could arguably bring considerable benefits including cost savings, better co-ordination, less ‘admin’ stress on staff at the ‘coal face’ and provide more organisational adaptability in an uncertain future. 
  3. Ultimately ‘systemic processes’ could help everyone deliver better patient care because that is the impelling purpose of the NHS.


  1. Timmins, N (2018) The World’s Biggest Quango: The first Five Years of NHS England, The King’s Fund & The Institute for Government, UK
  2. Hudson, A (2016) Simpler, Clearer, more Stable: Integrated accountability for integrated care, The Health Foundation, UK
  3. Powell, M (2016) Leadership in the NHS: Thoughts of a newcomer, The King’s Fund. (accessed June 2020)
  4. Dayan, M., Gardner, T., Kelly, E. & Ward, D. (2018) How good is the NHS? The Nuffield Trust. Available from: (accessed June 2020)
  5. DHSC (2013) The Health and care systems explained. (accessed June 2020)
  6. NHS England (2019) Breaking down barriers to better health and care, March (accessed June 2020)
  7. Bristol City Council (2018) Working with Us for Better Lives, (accessed June 2020) 
  8. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (2013), The Stationery Office, London (accessed August 2020)
  9. NHS England (2019) The NHS Long Term Plan (accessed June 2020)
  10. Goodwin N, Smith J (201) The Evidence Base for Integrated Care, The King’s Fund, Nuffield Trust, UK  (accessed June 2020)
  11. NHS Institute for Innovation and Improvement (2005) Process mapping, analysis and redesign, Improvement Leaders Guide, UK (accessed June 2020)
  12. Wikipedia (2020), Emergence at
  13. Blockley D I, Godfrey P S (2018) Doing it Differently, ICE Publications, UK 
  14. Engineering Synergy at 

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Why politics needs some systems thinking

by David Blockley

I am no politician. I did not foresee the rise of so-called ‘populism’ (by that I mean support for the concerns of ordinary people), calls for independence in all of its forms, major shifts such as Brexit and the all too many public financial and sexual abuse scandals. We are all struggling to deal with the competing trends and demands for localisation, ‘false’ populism and globalisation in the ways that we do things together. The scope, scale and speed of change, especially in science, engineering and technology pose enormous challenges.

The public debates around these topics concern me and have done for some time. I have come to realise that some of my discomfort stems from a lack of recognition of two important ideas underpinning systems thinking.

Politics is about power – collective decision making and action. Power is the capacity to influence each other and to make changes. Technically speaking (what many call ‘hard’ physical systems), power is volts times amps and velocity times force – more generally it is potential times flow (of change). Potential is the capability of becoming. In human (what many call ‘soft’) systems I believe that potential derives from the ‘why’ questions we ask of ourselves and others. ‘Why’ do we think, decide and act in the way we do – it is human purpose. Individual and collective actions are driven by the ‘voltage’ of purpose to achieve change. In this way we can begin to connect people with things.

In brief the two important systems ideas that need to be more widely understood are firstly, the natural life cycle of the evolution of dependence to interdependence and secondly, the intimacy between wholes and parts. After describing these two in a little more detail I will reflect on the very practical consequences of this lack.

The natural life cycle consists of three slowly emerging stages. It begins with total dependence. As babies we depend totally on carers – usually our parents or foster parents. As we grow we begin to develop as individuals and seek to move to our second stage – independence. In this stage we attempt to find out who we are – to ‘find ourselves’ as some express it. Some people seem to get stuck here unhappily as they struggle to exercise their individuality with their need to belong. Maturity emerges as we move to the third stage – interdependence. ‘No man is an island’ is John Donne’s famous truism. In this stage we begin to understand how much we need others. We learn to reconcile our individualism with need for recognition from our peers. In my personal view the key is to realise that our own selfish needs are best served by serving others and treating them as you yourself want to be treated. All religions include some form of the Golden Rule ‘Don’t do to others that you wouldn’t have them do to you’. Understanding our interdependence is a key to civilised life.

The second systems thinking idea is that we can think of everything as both a part and a whole at one and the same time. Arthur Koestler coined the word holon to capture this concept. Of course holism has a long history beginning with Confucius, Buddha and Aristotle. South African Prime Minister, Field Marshall and philosopher Jan Smuts was the first to coin the term in 1926. Holism emphasises thinking about wholes. It is sometimes confused with mysticism and some kind of ‘new age’ thinking and is used sometimes to the detriment of thinking about parts – as though parts don’t matter. By contrast holons focus our thinking on both – on ‘looking outwards’ and ‘looking inwards’ at the same time – they are one. Looking outwards a whole is a contextual part. Looking inwards a whole consists of interdependent parts which themselves are wholes.

How are these ideas relevant to politics? Firstly what is true of an individual life cycle is also true for a group. Here I include organisations whether companies, societies and political parties in governments or opposition and whether regional, national and international (e.g. the EU and multilateral free trade areas with the UN including the whole world). I also include politics with a small or a big P where some people have more power than others. Every group is full of holons. So for example I am and you are a holon. Looking inwards I consist of interdependent holons of structure (muscles and bones), nervous, respiration, digestion, blood circulation etc. that make me the person who I am. Looking outwards I am just as much an individual as a Bristolian, a family man, a west countryman, a professional, an Englishman, a Briton, a European and indeed a member of the entire human race. So I ask myself why would a Barcelonan see himself as a Catalonian but not a Spaniard. Even more puzzling why would a Scot not want to be a Briton but would want to be European. I think that the explanation, in essence, is the perceived need for independence because of some kind of unfairness from the larger organisation – without recognising the importance of interdependence. It is something we need to understand much better.

I suggest that better understanding lies in seeking much more clarity about what should be decided at each level within and without a given group. Some things are fairly obvious – others are not. In my experience lack of clarity about the latter causes endless confusion. For example in the Brexit referendum many people voted on the basis they did not like remote unelected bureaucrats telling us what to do. They wanted national politicians to control immigration. But population growth crucially depends on our relationships with other countries. Should we decide locally in isolation how to dispose of waste when climate change requires international co-operation? We don’t decide at local level which side of the road we should drive on and the conditions for the employment of workers – it would be obviously foolish for each region to make different choices. But is it appropriate for Brussels to make laws about shopping hours? Can we decide on security and defence without recognising our reliance on other counties through NATO for example. Should not there be an international agreement about people using tax havens – surely tax should be paid at the appropriate level where the monies were gained? The EU defined a principle of subsidiarity in 2007 but seems not to have followed it in making decisions. Nevertheless the principle expresses sound systems thinking. It says that models should be created at the lowest practical level consistent with delivering their purpose.

We are living through a time when these things matter. There are major concerns about the governance of all organisations because of corruption, exploitation, abuse and the growing disparity between the highest and lowest income levels. We are conducting major trade negotiations within the context for the need for the whole world to face up to the impact of changes in our climate.

So let’s initiate a public debate on what kinds of things should be decided at each level. Systems thinkers can help but it requires our politicians, political academics, commentators and opinion formers to clarify what constitutes appropriate governance levels. We need to discuss the way in which decisions at each level should relate to each other.

If we succeed then maybe all of us can feel improved control of our own lives whilst at the same time understanding our interdependence with others and the power they have over us. The purpose should be to define what it means to belong to each level. How should I feel about myself as an individual, as a Bristolian, and Englishmen, a Briton, a European and a human being all at the same time?

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What does the Über ban in London tell us about systems?

by Mike Johnson

As Transport for London’s (TfL) ban on Über comes into effect, there appear to be quite polarised views for and against this somewhat disruptive taxi firm. When reading that Über will contest the ban in the courts, I was left pondering what’s actually unique from a systems perspective between Über and those taxi firms permitted to operate by TfL. If there is nothing unique, then of course Über will have a strong case.

Starting from the functional perspective, there are four main functions required to provide for a taxi system:

  • Transport
  • Payment
  • Communications
  • Marketing

Note: Marketing is required in some form, as otherwise the users will never detect the taxi system.

Interestingly, at this point both Über and their competitors look the same. All taxi systems provide these four key functions (note that clearly their physical architectures (i.e. how they actually implement the key functions) vary significantly). Also, it’s worth noting how innovative solutions to an already existing problem can result from simply returning to the functional domain, whereas trying to innovate within an already existing physical architecture is far more restrictive. Über have shown how innovate physical solutions can be generated by re-addressing the original functions that a physical solution is trying to address. Evidently the solution space is far less constrained in the functional domain and one can effectively return to understanding the actual problem that can be solved with numerous unique solutions.

Let’s now consider the external interfaces to the taxi system:

  • User
  • Transport infrastructure
  • Payment infrastructure
  • Communications infrastructure
  • Marketing infrastructure
  • Environment
  • Other transportation users
  • Regulations

Although the Über taxi system has the same external interfaces as other taxi systems, the physical implementation has enabled – in most cases – a lighter coupling to regulations. Regardless of whether one views this as ethical or not, it certainly is novel and ultimately shows how abstracting a system’s functions and interfaces offers many opportunities for innovation.

When observing the physical characteristics of other taxi systems worldwide, one notices that often cities (such as Barcelona, where I was visiting a few weeks ago whilst pondering this topic) have very highly regulated taxi systems. This can be observed from a user perspective by the standardisation of the vehicles, the low cost variance for similar distance journeys, etc. Talking to taxi drivers reveals even more regulations. For example, the local government even restricts drivers on which days they’re allowed to work.

Personally, I’m not a huge supporter of unbridled and unnecessary regulation. Generally speaking, regulations can restrict engineering development activities and work against innovation, which, in turn, may lead to higher prices and less competition in a market.  However, there are many cases where regulations are absolutely necessary and wholly beneficial, such as in the medical device industry, where an absence of regulation led to many unnecessary deaths.  In the taxi industry it appears that regulations also have critical role to play. In the event that, overnight, an additional ca. 100,000 taxis are added to a market – apart from costs coming down, parts of the market can be driven out of business (excuse the pun) from the sudden increase in competition.

Considering the technology used by Über, is it possible that the company as such is nothing more than an emergent property of today’s highly connected world? If so, will banning Über achieve anything?

In conclusion, the innovative Über taxi system is indeed disruptive, but only in the transient sense as presumably the regulations on the already existing taxi systems are necessary. The lack of uniformity of regulatory rules leads to loopholes that can be exploited.  Innovation – which is essentially change – will always find ways of exploiting loopholes, as quite simply, that’s what change does!

This means that, eventually, it can be expected that the locations where Über operates will update their regulations to include Über-esque taxi systems (or simply ban them, as may be the case in London, depending how Über’s appeal goes)). The optimal systematic solution would be for the regulated markets to compromise, by taking in the “best bits” of this quite innovative business model. In addition, innovation needs to be handled sensitively, it can lead to unnecessary and unjustifiable controversy because the existing ways of doing things are being challenged and undermined, yet without it we’d be permanently constrained within the Status-quo.

Then a second topic came to mind, as I was traveling around the Barcelona with their highly standardised taxi systems, it was clear that the then upcoming referendum was going to be somewhat disruptive. Of course this ended up being the case and unfortunately there could still be additional repercussions until a politically stable agreement is made.

When considering the lengths that people went to in order to vote in the referendum, and the extent to which some of the authorities tried to prevent them from doing so, is it not remarkable that in today’s world – where documents are electronically signed, emails are legitimately used for authorising procurements, significant sums of money are transferred via online banking platforms, etc, etc – that actually the whole voting in the referendum could have been enabled by an online platform?!  A level of IT security provisions could no doubt have been put in place, giving at least the same degree of security and legitimacy as the voting in person. This would have most likely have resulted in a significantly higher turn-out. And indeed, one might expect online voting would result in a higher turnout in almost all elections! One could then also go further and consider why the Catalan Parliament doesn’t meet electronically too, as this would avoid having to circumnavigate anyone trying to stand in their way.

Technology can certainly be disruptive at the best of times, often though for a good cause if properly utilised!

Many thanks to my friends who I discussed these topics with over the past few weeks, I hope we’ve successfully brought the discussion into the systems domain!

8th November 2017
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Infrastructure & Systems Thinking


Neil Carhart

The Civil Engineering profession is entering a period of increased focus on complexity, interdependency, the effective delivery of stakeholder outcomes, and for some, the fundamentally broadening of what it means to be a Civil Engineer. Much of this comes from increased urbanisation, demands for sustainability and resilience, digital innovations and a need among western nations to renew their infrastructure.

The current approach to infrastructure planning and delivery within the UK has been criticised for being “fragmented and reactive[1]The Armitt Review [2] of Infrastructure reported that “when long term decisions are made, they can be taken in silos with little acknowledgement of the interdependencies between sectors”.  This is in contradiction to the widely held view of infrastructure as an interdependent network of smaller networks[3]. The Royal Academy of Engineering [4]  submitted to this review that: “A systems approach to infrastructure planning will be essential, noting the interdependencies between infrastructure sectors, and the opportunities for creating dual use infrastructure and co-locating services where possible”.  Past President of the Institution of Civil Engineers (ICE) Prof Paul Jowitt [5] also explicitly advocated “a systems view” to strategic infrastructure planning.  He wrote that “the need for systems-level decision-making for large-scale infrastructure proposals has never been greater.  One way or the other, it comes down to our ability to take a systems view and make decisions accordingly”.

In October 2016 the ICE launched its National Needs Assessment vision for UK infrastructure[6]. In launching this David Gauke MP, Chief Secretary to the Treasury warned against “ignoring the interdependencies that exist across different sectors”.  Understanding interdependencies, and how desired outcomes emerge from them, is at the heart of Systems Engineering.  The National Needs Assessment itself is wide reaching but includes the following:

Economic infrastructure sectors are typically viewed in isolation. The result has been organisations operating in silos and frequently uncoordinated decision making. This means that the interdependencies between infrastructure sectors have not been properly accounted for […] Analysing the national infrastructure as a system-of-systems allows these important interdependencies to be captured and quantified and measures to maximise efficiency to be identified.

The increased advocacy for the adoption of a systems approach to the challenges of infrastructure also exists internationally. An ICE report on developing and shaping Hong Kong’s infrastructure[7] makes three recommendations.  The second of these is the adoption of Systems Thinking.  It says:

In some ways, systems thinking is common sense. We instinctively know that changes in one area of the city’s transport system will have impacts on the rest of the network.  We understand that transport will influence decisions around where to site housing or commercial development and that this will create demands for energy, water and other services. Turning this common sense insight into a decision making process that delivers high performing infrastructure networks is a challenge facing engineers and decision makers across the globe.

Engineering the built environment presents many ill-defined, messy, interacting challenges that cut across social, economic, environmental, political, legal and technical domains in space and time.  Pre-emptively placing artificial tight boundaries in order to treat these challenges in relative isolation from one another is appealing in the false sense of simplicity and comfort it can create, but it is ultimately short-sighted.

The alternative is to embrace the complexity of the problem and the context within which it sits as fully as possible.  Systems Thinking and Systems Engineering offer methods and tools with the potential to explore and manage these situations, leaving us better prepared to avoid the hazards and exploit the opportunities they present.

[1] HM Treasury & Infrastructure UK, 2011. National Infrastructure Plan 2011

[2] Armitt, J., 2013. The Armitt Review: An Independent Review of Long Term Infrastructure Planning Commissioned for Labour’s Policy Review

[3] Council for Science and Technology, 2009. A National Infrastructure for the 21st Century

[4] The Royal Academy of Engineering, 2013. Independent Armitt Review of Infrastructure – Submitted by the Royal Academy of Engineering to Sir John Armitt,

[5] Jowitt, P., 2015. Why the Adonis Infrastructure Commission needs a systems approach. Infrastructure Intelligence.

[6] Institution of Civil engineers, 2016, National Needs Assessment.

[7] Institution of Civil Engineers, 2015, Infrastructure: Shaping Hong Kong

Blogs by David Blockley

Engineering has an image problem that needs fixing

The ingenious problem-solving of the modern-day engineer

Practical wisdom and why we need to value it

The rigour of engineering

The ubiquity of structure

Bridges, and What They Can Teach Us

When are bridges public art?

Is the George Washington Bridge a work of art?

7 Things I’ve Learned So Far

Is an engineering mind-set linked to violent terrorism?

For list of books and previous blogs from David Blockley go to here

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