The Darzi Review

The 2008 review of the NHS led by Lord Darzi, High Quality Care for All, made leadership its central theme. The book reads it for how its arguments are built, rather than for what it says about leadership.

The word leader and its variants appear throughout, attached to formal role, to trait, to competence, to continuing professional development and to participation in the review itself. Leadership is simultaneously about individuals, about teams, and about whole organisations.

It shows enthymeme operating at the scale of national policy. A document addressing chief executives, clinical directors, general practitioners, frontline staff, policymakers and the public could not state its premises without alienating whichever constituency it failed to endorse, so it deploys structures that invite each audience to complete the reasoning from its own assumptions. The book reads this as strategically necessary rather than careless.

From Chapter One: Rhetoric

If it is effective at offering multiple pathways to the same conclusion, then enthymeme can be a sophisticated governance mechanism. The problem Alistair and I identified with the Darzi review is that it used this device so broadly when talking about leadership that the word essentially lost any meaning. A source of cynicism with policy or strategy statements, I would argue, is they can create a kind of semantic exhaustion if they over-rely on enthymeme. If readers have to carry competing versions of the same basic idea, and if terminology is stretched too far, then the story will not work.

The book works from published research. This is the paper the case rests on, in its own words.

Morrell, K. and Hewison, A. (2013). ‘Rhetoric in policy texts: the role of enthymeme in Darzi’s review of the NHS’, Policy & Politics, 41(1).

Political administrations try to present their policies in the best light to justify the ownership of power, and in doing so rely on rhetoric. The documents through which they communicate policy (policy texts) use rhetorical devices to do so. Through these, administrations need to create the impression that they have chosen the best possible course of action, and they also need to create the impression that they are doing something innovative.

Rhetoric · Naming

1. Which constituencies in your organisation are completing your strategy differently?
2. What would be lost — and gained — by stating the premise explicitly?
3. Is a claim doing coalition work that will later have to be paid for?
4. Who has been described as a leader here, and what does that description authorise?

Chapter One: Rhetoric — the chapter carries the evidence and the close reading this page only points at.

Status: the passage from the book and the passage from the underlying paper above are quoted verbatim and checked against the source · surrounding context is site-written · author review required · no case facts introduced from outside the manuscript