Just read the very timely HSJ magazine piece (‘Why NICE is in need of a re-fit’) scrutinising NICE and discussing the public criticism it’s come in for over Herceptin and new guidance. And yes, it includes scrutiny of its public health remit, following the merger with the Health Development Agency (HDA) in April 2005. Well, if that’s not enough meat to chew on here’s the text of the email I sent to NICE chief executive Andrew Dillon in response to the staff merger consultation document.

Being a positive systems-minded kind of a guy I also wanted to reproduce my notes to NICE’s Magnus Anderson at the time of the merger on the implications of the different cultures of the two organisations for the merger. The response from Magnus was welcoming, though one line now jumps out at me: “It seems to make sense to consider cultural issues in the light of the overall structure and strategy – rather than the other way round.” It’s that old ‘systems first, people second’ syndrome (aka ‘fat finger syndrome’) is it not, which can contribute to systematic failure if you’re not careful? Surely culture and structure/strategy should ideally be co-designed in tandem? Anyhow all this contributed to my own ideas on ‘social complexity’.