Opposition to NHS reform – proceed with caution

‘It’s 100 times harder to create something good than critique something bad’

The tweet above, posted by a psychologist, (@bjfogg) should serve as a pertinent warning to all of us who are slating Andrew Lansley’s Health and Social Care bill.

It is very easy to criticise this piece of legislation. In my opinion, and many others within the healthcare profession, this is a poorly structured, flawed and frankly idiotic dismantling of many of the good elements of our National Health Service. I am genuinely concerned that the infrastructure of the Nation’s largest employer is creaking at the seams and may actually fall apart. But how do we rescue the situation?

Primary Care Trusts are already making huge rafts of employees redundant. Hospitals Trusts are suffering budget shortfalls as even though they have delivered the required level of service, the PCT’s have not been able to honour their financial agreements.

I have spent the last few months morphing from an apolitical observer to an impassioned opponent to the planned NHS reforms. I have posted blogs with questions for the government, used ‘acerbic wit’ about GPs’ superpowers and bemoaned the lack of appreciation for the amazing achievements in many Hospitals. But have I come up with any solutions? I have a few ideas but haven’t written about them yet. Me and a million others.

There is a massive ‘Save the NHS’ demonstration planned for March 26^th in London. Charities, medical and care associations and professional bodies have written open letters to the Times, criticising the government plans and voicing concern at the speed of the reorganisation. And now the London arm of the British Medical Association has voted in favour of a motion calling for the BMA to scrap its policy of ‘critical engagement’ and replace this with a ‘policy of total opposition’ to the Bill.

We must be realistic. There should be cuts, as in other areas within the public sector. Jobs will go and efficiencies must be made. But as I, and many wiser and more influential commentators have said, the ‘savings’ are not logical so far. Many of those receiving generous redundancy payments now will probably soon be re-employed to help the GP consortia administer the commissioning process. So where is the efficiency in that?

Enough of the negativity. Go ahead and protest on 26^th March. Write to the Times, post your blogs. But now is the time for the thought leaders, the BMA, the Royal College of Nursing and many others to tell Andrew Lansley how he can rescue the NHS, how he can keep the good bits of the Bill, tweak the not so good bits and lose the rubbish bits altogether.

It doesn’t have to be a complete U turn. Maybe just a bit of a change in direction, re-set the sat nav and find a better, and more considered route to achieve the Holy Grail of an effective, efficient and sustainable National Health Service.

Time to apply some tried and tested ‘project rescue’ principles, Mr Lansley – get yourself a great Project Director, set up some dedicated ‘workstreams’ and plan a sensible way forward.

Any volunteers?

NHS Reform – Dream on….

I had a lovely dream last night. Andrew Lansley, UK Secretary of State for health

stood up in the House of Commons and said that he took full responsibility for the ‘debacle’.

‘We got this one wrong’, he said, head held low. ‘In this case, we got it wrong, we listened and we are going to take a fresh approach’. David Cameron had stated just 24 hours earlier that he was not happy with the policy either.

And then I woke up…

Yes the script was right, the U turn genuine. But it was the UK Secretary of State for the environment, Caroline Pelham who had back-tracked on a piece of deeply unpopular legislation to sell off the Nation’s woodland. So in the UK, we can rest assured that our trees and public spaces are protected for the population. Not so our NHS.

Alas, away from dreamworld, Andrew Lansley has not listened, will not admit that he is getting it wrong. He seems to be suffering from selective deafness when it comes to learned opinion such as the British Medical Association, Royal College of Nursing, and an independent think tank, the Kings Fund.

Alas again,  no U turn is in sight as GPs consider retirement or brace themselves for a huge administrative burden. Lansley continues to forge forward, foot on the gas, slicing through the NHS infrastructure like a straight Roman road through the green hills and valleys of our landscape.

I think I might go back to sleep – it was such a lovely dream……

Can you teach someone how to care?

A shocking report has been issued in the UK today, outlining some serious failings in the quality of care given to elderly patients in the NHS. 10 cases of neglect and poor care were investigated by the Health Service Ombudsmen, Ann Abraham who stated ‘.... these accounts present a picture of NHS provision that is failing to respond to the needs of older people with care and compassion and to provide even the most basic standards of care’

The tragic cases include a relative forgotten in a waiting room, denying him the chance to be with his wife as she died, and an elderly lady being transferred from a hospital to a care home in a disheveled, urine-soaked state.

Before we leap to criticise the beleaguered, bloodied and bruised NHS, I think we should remember the personal responsibility of the ‘carers’ in each case.  Yes, an employer is responsible for the service it provides and the NHS is no exception. But lack of resources, staffing levels or the depressive state of the country’s largest employer is no excuse for laziness, lack of thought and lack of compassion.

My mother spent nearly ten years in a nursing home, suffering from severe dementia. She was a vulnerable, weak scrap of humanity who was wonderfully cared for until the day she died. Every time I visited her, she was beautifully dressed, immaculately clean and apparently content. When she became seriously ill, the staff continued to care for her with respect and gentleness. I suspect that these carers were paid no more than their counterparts in other homes or hospitals, but the culture of professionalism, dignity and caring was apparent in every aspect of the organisation. The birth and nurturing of this culture clearly originated from the management.

I was recently visiting a friend in the high dependency unit of an NHS hospital near London. She was very poorly as was everyone else in this ward – the clue is in the name ‘high dependency’. As I waited to see my friend, I was horrified at the noisy, unprofessional banter coming from the nursing station as two nurses loudly, and with some hilarity, discussed the intimate details of one of their patients. They were sitting at two separate desks and hadn’t even bothered to lower their voices as this inappropriate conversation continued.

In the end, it was too much for me. I marched up to the desk and suggested that the nurses should lower their voices as clearly their patients were unwell and needed rest. I also mentioned that patient confidentiality was being breached. My request was met with much disdain and as I visited my friend, the conversations continued, with increased volume, as I was now the target of the vitriol. As I left the ward, I asked the main perpetrator for the name of the ward sister as I intended to make a complaint. She sneered at me – ‘I’m the sister’

And thereby lies the problem. Management and leadership. Most NHS staff are caring and compassionate, but anything less should not be tolerated by their managers. I don’t believe you can teach someone to care. Yes, quality of service is compromised if funds and staffing levels are short. But considering a patient’s dignity, however old or seemingly unaware they may be is a basic human trait. If you don’t care about the wellbeing of people, or if you are not interested to note the distress of a concerned relative, don’t work in the NHS.

What the NHS needs most is strong leadership. Managers who lead by example, who are aware of the value of good emotional intelligence in a team, whether it’s an outpatient department, an intensive care unit or a GP surgery.

Forget your ‘big society’ Mr Cameron, it is these ‘micro-societies’ that count when it comes to good patient care.

This post is dedicated to the loving memory of the adored Bob Jackson, who died eight years ago today and received the very best of care with the help of nurses from  Iain Rennie Hospice at Home.(http://www.irhh.org/)

NHS Reforms – where are the supporters?

Andrew Lansley, UK Secretary of State for Health wrote in the Guardian newspaper this week ‘with every new day, more of the people who matter are embracing the opportunities presented by our plans’

http://www.guardian.co.uk/society/joepublic/2011/feb/08/growing-numbers-backing-nhs-reforms-lansley

I have referred to Lansley in the past using the affectionate term, Pollyanna, with his naïve beliefs that his health initiatives are on track, but even Pollyanna usually had some basis for her optimism.

Where are these ‘people who matter’? ‘No decision about me without me’ is the boast of the Health and Social Care bill. Who is ‘me’ in this case?

There are 1.3 million ‘me’s’ working in the NHS and apart from a smattering of business minded GPs I am yet to find any who support the sweeping reforms, especially due to the unseemly hast of execution (I choose the term advisedly).

Lansley also says  ‘beyond institutional accountability, genuine patient choice will bring a dramatic level of direct accountability to NHS providers’

I have spent the past few months documenting my concerns regarding the NHS reforms but am I being blinkered? Maybe I should give Mr Lansley the benefit of the doubt…

But before I do – I have two deal-breaking requests.

Please Mr Lansley can you:

a)     Tell me who these people are who support your reforms and the speed of delivery? Name names. List organisations. Let them stand up and be counted.

b)     What exactly do you mean by ‘no decision about me without me’?

p.s. Apologies to my regular readers – I promised to be more positive.  So I shall end on a cheerful note. On Saturday I was at Old Trafford to watch Manchester United beat our local rivals, Manchester City. Fantastic Rooney Goal!

Enthusiasm – the good manager’s secret weapon.

To protect my own personal wellbeing, I am sticking to the theme of positive thinking in the workplace while avoiding too many references to the UK Health and Social Care Bill.

At the CIPD Wellbeing and Resilience conference last week, several speakers touched on the effect of positive, supportive and realistic leadership and one, in particular, impressed me with her enthusiasm. Wendy Cartwright, Head of HR for the Olympic Delivery Authority, told us of the challenges in working with 200 employees and over 12000 contractors, all on limited term contracts, while trying to avoid the ‘project mentality’. Their employee engagement survey demonstrated outstanding results with 98% of respondents saying they would be happy to ‘go the extra mile at work when required’

Listening to Wendy speak and viewing her exciting slides of progress on the Olympic Park site, it was easy to see why the employees are so committed. Her enthusiasm and passion for the project was infectious, as she brought to life the British Olympic dream for 2012. Wendy spoke warmly of the previous Chief Executive, David Higgins and his dynamic leadership and energy which clearly had a direct impact on the organisation. This energy was still present in the HR team, which in any organisation can play a key role in shaping company culture and emotional intelligence.

So why is enthusiasm so important? A vision of my late but still much missed Labrador immediately springs to mind. Her pure joy at welcoming us as we returned home from work each day, bringing us her toy as a gift, tail frantically wagging, always injected a feeling of wellbeing – however rubbish the day had been!

Enthusiasm, like misery, spreads to those around it and if you have passion and drive at the top, some of it is bound to spill over.

As Ralph Waldo Emerson said, ‘Nothing great was ever achieved without enthusiasm’. and one definition that I particularly like is ‘great excitement for an interest in a subject or cause’

Perhaps this blog may be of interest to the HR team of a London Primary Care Trust who, just as redundancies were being announced a few months ago, put a sign up on the closed door leading to their department ‘The HR team cannot currently accept any personal visits, as we are too busy’

Oops – there I go again – back to NHS reality……

Resilience – a new favourite

Yesterday my daughter mentioned that my postings were becoming very negative, ‘bordering on the rant’ and just before a recent session in the gym, my personal trainer made a plea for me not to watch parliamentary broadcasts before I saw her as it ‘makes you a bit scary’.

I admit - I do feel that I’ve been losing my mojo recently and for a happy little bunny like me that is akin to disaster. The problem is, I’ve been spending far too much time focussing on the problems with the Health and Social Care Bill, the inadequacies of the planning process and the general crassness (yes that is a word) of the coalition government’s healthcare team. A picture of Andrew Lansley (UK Secretary of State for Health) incites a Pavlovian response in me and a dark cloud instantly appears above my head. There I go again…

So it was most fortuitous that I attended the Chartered Institute of Personnel and Development (CIPD) Wellbeing and Resilience Conference this week. Resilience is a buzz word that is gaining momentum among corporate wellbeing specialists and I felt it was time to learn more.

The event was well organised with a good selection of delegates, including HR directors from public and private sector and a few well established coaches and trainers. The speakers generally met their brief and the day was stimulating and informative. As usual, a few speakers really stood out and provided me with some food for thought.

Leatham Green, Assistant Director, Personnel Training from East Sussex County Council was captivating, and provided us all with some real nuggets which I would like to share with you. Even though he occupied one of the ‘graveyard slots’ (straight after lunch), attention was rapt throughout the room as he provided the first of the day, and best, definition of Resilience.

‘Resilience = Realistic Optimism’

Perfect!

Leatham also went on to share some very sensible advice about how managers should approach job and budget cuts as they see staff redundancies and fear spread, especially in the public sector. Resilience is important as it is how people respond to change that impacts the way forward. He warned us that ‘Child-parent’ conversations with your staff should be avoided, but informed discussions, coaching and counselling regarding their options is key.

Which brings me back to the NHS……

There are many managers literally scooting down corridors effectively wailing ‘We’re all doomed! Doomed!’ (ref: The Undertaker, Corporal Frazer in Dad’s Army).  Luckily, there are also some very careful managers and leaders who are taking the ‘resilient’ approach.

So let’s hope for more realistic optimism and less panic and maybe we can start to make sense of workplace wellbeing and resilience and really help staff to find the best way forward.

And I shall do my best to stop being so grumpy…

How low can you stoop Mr Cameron?

I was horrified to see in the news that during a Downing Street briefing today David Cameron referred to the fact that his children were suffering from ‘nits’ (head lice)

http://uk.news.yahoo.com/21/20110204/tuk-downing-st-on-alert-for-head-lice-6323e80.html

Although this is a very common problem in English schools and the agreed wisdom is that the little swines only like clean hair, this is still not a nice thing for a child to have to deal with.

To have that very personal information shared with the nation must be excruciatingly embarrassing for David Cameron’s children.

I know that, as a parent, one of my key roles is to embarrass my children (something that I am still pretty good at), but surely this is an itchy scalp too far?

David and Samantha Cameron are clearly loving and caring parents and I suspect this was a throw away line to lighten the atmosphere of a press conference.

We have already seen that Cameron and Clegg are prepared to bend their principles for the sake of a coalition and a stab at power, hopefully for the common good, but really Mr Cameron, please find other ways to prove you are a ‘man of the people’