Monthly Archives: July 2014

All this talk about patients – just run the NHS

Keep ignoring patients and you miss something of the divine and I guarantee you will miss the opportunity to truly transform the NHS. My experience is real change happens when you engage the patients, the advocates, the families. The job of a leader is transformational not transactional – you have administrators for that process stuff. Unfortunately, as business management has over run the NHS, too many administrators get told they are leaders. Some can be, but many cannot. I’m not bashing NHS leadership per se, I was one. Given my way I would still be one but I am bashing how we apply leadership.

I have been feeling down the last few weeks and so a blog was something I just couldn’t get around to. Hubby kept saying write it down, post it, tell it, but it would not come in any coherent format. Knowing it would probably be morose or a rant and not really touch what I felt I needed to say.

But, I have been keeping up with twitter and a number of people have influenced me of late @Sarasiobhan and seeking redress for Connors death of course @eden_charles @thornton_dt and today I read @JonNHSNorwich latest blog. Amongst other things last week he spent a day with the integrated learning disability team in Norwich. The integrated team I set up 10 years ago. As I thought of the teams across the county I thought of our patient leaders who helped me make change happen. I moved mentally from wanting to rant at the CEO who restructured me out of the NHS and shoved me off the career escalator and realised instead I had done some great stuff. Helped in no small part by some great people.

So, I want to focus on why really involving and listening to patients and their families is core business and not just for your patient empowerment team. This isn’t a history tour as it’s as relevant now as it was then.

Back in 2002 I found myself leading the closure of a long stay institution when many before had tried and failed. I was reminded of this a few months ago when I was honoured to be asked to give the eulogy at a funeral. Having been made redundant I was in Norfolk and available of course.

Joan had a learning disability, she had a large number of children, some of whom had been of interest to social services. She was in wheelchair, obese, had a number of long term conditions and was in her 50/60s when we met in 2002. We had nothing in common except our energy. She was loud, proactive and angry about the delays and mess of this supposed hospital closure programme. I admired her fighting talk and I tried to connect humanity to humanity.

She was a customer and a spokesperson for so many of our patients and families and if I was to pull off this huge change in the NHS then I needed to understand, persuade and take with me many people.

Joan was with People First advocating for people who wanted to move out of Plumstead Hospital. Joan was on the interview panel when I applied in 2002 for the post of Director of Learning Disability. She told me years later that although I did a good interview I got the job because I wore a red jacket!!! And she described the other candidates as trapped in dreary suits saying dreary things.

When we set up the Partnership Board she co-chaired it and was there advocating for better lives and independence for people with disabilities, telling the CEO of the Health Authority to stop talking rubbish and what we should follow was “the law of the bleeding obvious!” She helped me close Plumstead by making sure it was well planned. Managers would tell me all was going well and we were listening to and planning good moves for the patients. Off she’d whizz around the hospital in her wheelchair to hear direct from patients and come back and tell me my managers needed to buck up their ideas!

We would not have closed Plumstead or have the Community Services we have without her. She also helped me be better at the jobs I did after I left Norfolk through the lessons I learnt from Joan. I learnt that:

The NHS is accountable to the public, communities and patients that it serves.

I learnt that this is best tested by engaging directly with those who use our services and their families. I have tried to apply this in all my roles since and it has led to some great transformational changes and some success. But, as once famously said:

“There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success than to take the lead in the introduction of a new order of things. ”

So, I have come up against many who think even at very senior levels the job is to not to engage directly with patients, not try and change things, not ruffle feathers just be a good administrator. I’ve had colleagues rage at me for putting meetings with patient leaders in their diary and letting patients come to the HQ. Those people struggle with me and boy despite my smiles I really struggle with them. And this time they and my engagement with them were my undoing. The CEO who head hunted me was gone and the new CEO was appointed to retract the organisation, to sort the money and to bring stability. And of course that future didn’t include me. I didn’t fit the mould any more and the board was going to model the new strategy going forward.

I was dumb enough (my own undoing) to speak up for a strategy of engagement with patients, the community and partner organisations. A blended strategy of health and social care working together. I asked where in business there was a successful example of retraction? I think retraction says hunker down, don’t innovate, don’t expand, we will just slow down and wait till the storm is over. My experience tells me it is completely without ambition or hope and arrogantly assumes that all we do now works.

I am angry, but my track record shows I’m not interested in change for change sake I am interested in being a good guardian of the public purse. The money needs to be spent on liberating the patient and getting good value for the tax payer in doing that. The moral of the story here is if you do what I did you will have a great ride for a number of years working for great leaders who value your contribution. But, eventually they might kick you out if the power shifts to a conservative and containment strategy. But, I would not have done it differently as I have been proud of many achievements including the integrated teams and the long stay institution I closed in Norfolk. The good stuff is lasting even if I am no longer a part of it.

So, to Boards my message is engage directly with the patients and the families and you have a chance of assuring yourselves that you run a good health service. In doing this you will have to wrestle with the noise, the disquiet, the anger, the energy though. You might also, like me find solutions to the problems of the NHS direct from the customers (the patients and their families). You will sure as damn sleep well at night knowing you were part of making it much better.

I am beginning to attract work and have some work with the NHS Confederation, TLAP and the NHS Leadership Academy. It’s not enough to keep the wolf from the door so I am also using my business development skills supporting a cricket bat maker –

@norfolkbats Yesterday we heard that we have an order for the German women’s cricket team so I am off to Berlin in August delivering handmade bats!!! I have not been to Germany since I took the Mayor of Bedford there setting up the unitary council in December 2008 – guess I won’t see snow this time!

It’s a life, a good life beyond the NHS. But I miss it, the NHS was part of my life of work for 28 years. I miss the direct contact with patients, their families and staff and being part of making a difference there.
The honest truth is I feel bereft as a big part of my life and work is missing now and blog readers know I never felt happy being asked to walk away.