Monthly Archives: May 2014

Living recovery where the boss is no leader

This latest blog will share some of my experience of supporting and facilitating the development of patient leadership in mental health through the South Essex Recovery College. It is an important story to be told about amazing people doing some great work. The patient leaders happen to have used secondary mental health services themselves but that’s not the story. It’s a more generic story about recovery, courage, hope and overcoming the dumb, stupid, uninterested and those who stand in the way of needed change. Yes I’m afraid my experience even at the top was that some of the senior people in the NHS and Local Government think they need to be in charge of recovery themselves and patients need professionals all the time.

I will provide a small part of the narrative here BUT it’s NOT MY STORY. It’s their story that I share with their permission as they develop their work. If I claim anything here it is that I saw a great group of people who wanted to change a bit of their world. I was keen to travel with them and open some doors hosting them for a while. I had a chance to do all of that and of course upset some power by supporting the idea that patients should lead this themselves without highly graded NHS project managers to supervise them. My reflections are tinged with a sense of sadness that I couldn’t stay to be part of the recovery college further development.

My bit of the story starts a few years ago when I joined my last Trust Board and I was approached by one of our Trust patient governors, a researcher at the University, one of our psychiatrists and a senior social worker. Quite a dynamic quartet of strong advocates for change! They plied me with tea and biscuits and pleaded for me to take an interest in their work on recovery. They expressed frustration that although they had been part of a national programme of work which had birthed many Recovery Colleges their work had not progressed very well. I listened, I offered to host one meeting of the steering group and discuss it with my CEO.

A Recovery College comes out of the concept of recovering your health but not necessarily completely to a previous state. Though many with mental health problems do recover completely others don’t so the focus is to recover your life and your control. No longer a victim but someone who is reflective, who has the ability to plan and build a life beyond illness. Someone who is not settling for the stigma or discrimination of accepting less.

So off we went and I began to facilitate as we held meetings which lots and lots of patients attended as did front line staff. We asked at each meeting for a PLEDGE. Asking people to think about what skills they can bring to the setting up of the college? Suggesting you can offer yourself even if it’s just making the tea and we will sign you up as a trust volunteer. We had tea makers, policy writers, web designers, graphic designers. People told their recovery stories and these were inspiring moving and challenging. This gave us a list of 40 or more volunteers and the trust volunteer office were fabulous getting people cleared to volunteer and trained. All we had spent at that stage was money on tea and biscuits and expense to attend meetings. The energy and agency in the room was amazing as I hosted these events.

Soon the leaders in the group emerged and they quickly co facilitated events with me. My role switched to mentoring in the background and opening doors by facilitating links with trust departments. So I got communications, volunteering, the CEO and his office, governance and operations on board very quickly. We spoke to those in power inside and outside the organisation and with a number of great local user led organisations to get support, minimise challenge and ensure we were not derailed, a few times we came close.

We set up a good old project structure as here I have a few technical skills. I chaired the project board and reported to Executive Team colleagues and Trust Board. Our recovery meets became the BIG recovery meets as so many people were now involved. We got the University to support us and we bid successfully for some service development/research funds. Because we deliver the ARUs post graduate priorities of research to improve health and well being, innovative education and user led.

So we developed our PID project initiation document, sent key patient leaders and staff off to St Georges to be trained at their Recovery College and got on with recruiting and thinking about course locations and design. And just before I left the trust in February we recruited the project lead on an NHS agenda for change contract (no small feat). Somebody with excellent project and technical skills for the job, welcomed and supported by people with lived experience because he is also a person with lived experience of mental illness himself. And in June they run their first course called BE YOU.

I’m so pleased and proud beyond words to have travelled with them for a while as I gained so much and learnt so much because here the boss is no leader the patient is and it’s as it should be.

So I will end with further thoughts on recovery, the Equality Act and mental health discrimination. This follows the media reporting around Megan Cox and Emirate Airlines decision to withdraw their job offer to her. I don’t know Megan’s medical history, I like most of you know her story as it is presented by her in the media. But, I do know if Emirates were based in our country and subject to the Equality Act then they would need as an employer to prove they have not discriminated against Megan. In the Act there are 4 ways she could have been discriminated against here with her mental health history. Is it direct discrimination stopping her employment? (Because she had a mental illness). Is it discrimination by association as she is well now but had an illness? Or is it perception discrimination worried about the risks someone with mental illness might pose on a flight? Or could it be indirect discrimination because someone else in Emirates air crew has had mental health problems and the organisation has not got the systems and support in place to deal effectively with staff with this condition.I know for a fact based on averages 1 in 4 of Emirates air crew will be today or have in the past suffered mental illness. Are they being supported and treated? Or are they hiding it for fear of a potentially discriminatory employer? Would I rather fly Emirates or fly with Megan if that’s the case? I’m with Megan here and I hope her career takes off with a much better employer.

Meanwhile perhaps the UK based airlines could think about up signing up as an organisation to
As finally said so brilliantly by Margaret Wheatley in 2010 and paraphrased here:
“Leadership rests on the illusion that someone can be in control. …. we need to abandon our reliance on the leader as hero and invite in the leader as host…….these leaders as hosts are candid…..they don’t know what to do…..its sheer foolishness to rely only on themselves for answers. But, they also know they can trust in other people’s creativity and commitment to get the work done. They know that other people, no matter where they are in the organisational hierarchy, can be motivated, diligent and creative as the leader, given the right invitation.”
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Challenging Ourselves to THINK, LISTEN, ACT & most of all let THEM OTHERS in

Some more ramblings from an Ex NHS Board lead on Equality and Diversity
It’s a few weeks since I last blogged on the theme of diversity and I thought it was timely given it is NHS Equality Diversity and Human Rights Week to discuss the issues again.
My initial blog was prompted by Rogers Kline’s report:
“The snowy white peaks of the NHS: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England.” Middlesex University.
The report left me troubled at the situation we find ourselves in, with data going the wrong way on numbers of Black and minority ethnic staff (BME) and women leaders in the NHS. It not just the NHS either. Statistics tell us in the top teams of the Whitehall civil servants, those who chair national committees and MPs in Parliament numbers of black and ethnic minority staff and women are reducing not increasing. This is all happening at the same time as our country becomes more diverse and dynamic.
I am really pleased that Rogers report has had air time at senior levels in the NHS, in national media and has been taken seriously by the NHS Leadership Academy. Meanwhile Clive Efford MP spoke to the BBC about the FA and Mr Scudamore’s attitude to women:
“They either mean it when they talk about discrimination or they do not.”
This is a really important challenge for all of us, as the things we talk about as leaders get focused on. The things leaders focus on in big organisations usually get delivered on by their staff or in terms of culture get modelled by them. So, we need to now move beyond the talking about it.
In this blog for the leaders of the NHS I think more about the challenges we face in the lack of diversity in top teams and suggest it needs us to THINK, LISTEN, ACT & most of all let THEM OTHERS in.
As, if you talk quietly and off the record to those who lead board development and undertake executive coaching in the NHS they will tell you the sad facts. Women who apply for CEO roles are taking 4 times longer than men to get their first post and for the rest of the board appointments look at the pictures on websites. 80% of the time you will guess the ethnicity and its mostly white, middle aged and male. We need action and its urgent now and Rogers work puts a loud hailer to the problem.
This issue is fundamentally about the sort of NHS we are growing and developing. Can this NHS that we have been so proud of for 66 years survive the future if it does not reflect the population it serves?
A number of you will know the story of the man walking on the beach. In the distance another man is throwing things into the sea, as he draws nearer he sees the man is surrounded by thousands of star fish gasping their last breath. He asks the man what he is doing as the man throws another back in.
“I’m saving one at a time,” says the man.
This reminds me that no challenge is ever too big for organisations and their leaders if we start with one starfish at a time. It’s about a mind-set, a culture, a willingness to act and to change.
THINK, leaders when you are in your Board meeting or Executive team could you take some time to review Roger Kline’s report and consider the challenges in your own organisation. Look at your own stats your HR team will have a mine of info on workforce demographics and you are likely to have info on patient data elsewhere. Look at who goes on leadership courses, who is and isn’t getting coaching, mentoring or getting promoted.
Reflect for a while on when you staff look up who do they see? Do they believe it could be them? Do they see people like them sitting around the table? People with the skills and talent they possess being valued and celebrated.
But, when you think about these issues don’t beat yourselves up, start to imagine what little things you might do to better understand the blocks, barriers and the organisational behaviours that limit diversity. Use an appreciative enquiry approach and think of your starfish.
I have been thinking on this issue a bit since my last blog. And, over the weekend I finally got around to watching Mandela – Long Walk to Freedom. As I watched it I was struck by the very tangibly different way that Mandela acted from prison to his earlier life. When from prison he responded to the apartheid government newer thinking and that tentative reaching out to him. I thought for the first time about the governing leaders and how they needed to initiate the change, letting him in. They had begun to THINK and in small ways admit they needed to change.
What did Mandela do? Well he went and met them and spent lots of time listening to them and their concerns. So, trusts boards I bet your stats will not be very reassuring on diversity in your top teams. Don’t kid yourselves its better than it is, and it’s ok to say we need to do much more. You might be starting from a weak place but it’s a place. All you now need to do is begin to LISTEN to your staff.
If you don’t have one already then I suggest you get yourself a coach as you will be challenged. You will need to take time to work through what you hear. Some of it will be uncomfortable and difficult to resolve easily.
Then go listen some more find your body of staff, talk individually and in forums about equality and diversity. As in the crowd will be women who have been identified as potential leaders, the black and minority ethnic staff, the gay, the straight, the disabled, those with faith, those without, the carers of children and elderly relatives and the older and younger workforce themselves. Go find them and seek to listen to the issues from your workforce perspective.
I can guarantee that if you are genuine and authentic in your inquiry you will find out what this place is like to work in? The good, the bad and the ugly. You will discover what the organisation does that helps staff from diverse backgrounds get on and what hinders. You will also get suggestions from the front line of how you might make it better. That’s gold dust as we know unhappy staff equate to poorer care outcomes. So this is never just about the Equality Act .It is the core of what we need to do and its mainstream.
Then it’s time to ACT. That might mean more thinking, more listening, going back with more questions. That is all ACTION and all is valid. It probably will involve feedback to your board on what you found. You will not fix this quickly and it requires a leadership investment. Like with starfish the most powerful action can be a small thing that really tells your organisation you have listened, heard and are trying to be a better leader. Be honest about what you do not know, what makes you uncomfortable and do ask for help. Your staff want dialogue and to be listened to and they will value that.
My experience is you will need support so looking to NHS Employers is a good place to start. They provide regular briefings on equality and diversity, run events and they are very high profile on twitter. I found their support invaluable when I was leading this agenda.
Some suggestions for further on going work. You might commit to meet regularly with one of your BME staff to check progress on the issues. What about shadowing a senior working mum or older member of your workforce who has to organise their fathers care and support for his dementia before they come to work in the mornings? All of this will begin the slow and difficult journey of LETTING THEM OTHERS IN.
What struck me about Mandela was the way he sought to let the others in, he changed his mind-set on the challenges. They were not an easy group to trust or for him to meet with. I suspect without being let in and letting them in he could not have built the trust to then put his perspective and his people’s perspective over. And we would have probably never have seen the end of apartheid.
I urge us as leaders to do what we can to change this situation. Challenge ourselves, challenge our teams, and challenge our organisations to let others in.
As “It always seems impossible until it is done.” Nelson Mandela.
I hope you all have a productive week and give some time to creating a fairer more inclusive place for your staff, your patients and their families.