Motherhood,business and politics

Motherhood, business, politics.

I can identify closely with each of the above, yes, I’m a mother, a businesswoman and I am fascinated by politics. But there are other, possibly equally important aspects of my being –sports fan, widow, comic (I think I’m very funny sometimes), writer, friend….

Tory leadership candidate Andrea Leadsom’s faux pas in trying to attack her opponent Theresa May on her childless status in her recent Times newspaper interview is at best tactless and insensitive and at worst (hopefully) political suicide.

Or will it be political suicide? How many ‘yummy mummies’ will see this as a good enough reason to favour an apparently inexperienced chancer with a flexible attitude to truth over a heavyweight cabinet minister with nearly two decades in top tier politics.

I have had the privilege during my career to have met and worked with some phenomenal women, and their motherhood status has never been a consideration. Please judge us by what we do, how we behave and not our fertility or desire to reproduce.

I am becoming increasingly weary with the martyr approach to motherhood. Firstly being a mother is a gift – a precious gift – but not a badge of honour. There are hordes of women who ache to be mothers but for a variety of reasons this has just not happened. Most of these women live fruitful, fulfilling and happy lives. There are equally as many women who have chosen not have children yet find themselves unreasonably having to explain their decision – often to strangers who have no right to ask the question in the first place.

Leadsom’s premise that having children makes her care more than her opponent about the future of the country is, in my opinion, offensive and erroneous.

The motherhood mafia is epitomised by the website Mumsnet. While I concede that this site offers support and help for many mothers, the core of this concept is that motherhood is especially challenging. Yes, it can be tough, but no tougher than climbing the greasy pole in the workplace, managing a difficult relationship with your partner, caring for an elderly relative, coping with a needy friend, juggling finances and every other rose petal or thorn in the pot pouri that is life.

A quick glance at Mumsnet today offers the following headline,  ‘Does anyone else not enjoy the newborn stage?’ Duh? Does anyone enjoy interrupted nights, your precious little bundle regurgitating his or her food over your shoulder just as you’ve changed into your best top, stinking nappies etc etc? But does anyone enjoy that first smile, gurgle, giggle, look of wonder at the world around them? Of course you do – it all goes with the territory – it is nature and it’s nothing new. So please get over it.

Another section of this site for mothers advises the readers how to ‘survive’ a car journey with toddlers. Survive? Are we being just a touch dramatic ladies?

Possibly the most annoying section of the motherhood community is those mums in cafés and restaurants who feel that it is necessary for some reason to speak to their little darlings just a few decibels higher than is really necessary, while parking their designer buggies right in front of the exit or route to the loos. Loosely translated their high pitched meanderings come across as ‘look at me – I’ve pro-created’

I don’t care if the next prime minister is male or female, married or single, gay or straight. What I do care is that they are the best person for the job, that they will have integrity and demonstrate the ability to negotiate and lead. Most of all, the successful candidate should not try to take personal credit for some good fortune that nature has bestowed upon them.

And a final word for Ms Leadsom – if you are successful in leading the Tory party – you’ll need to build a good relationship with one of the most powerful and respected women of this millennium so far – Angela Merkel, Chancellor of Germany. Oh – and you might want to take note – Ms Merkel has no children.

 

 



Employee engagement is all about Love.

‘Employee engagement’ has graduated well past jargon to an acceptable and valuable measure linked to productivity in the workplace. But what does ‘engagement’ mean – and how can it be quantified?

If you are seeking awards or hope to tick the engagement box then there is a plethora of questionnaires and benchmarks to use. But employers should really go deeper to assess not only engagement but the emotional intelligence and culture of the company. In short – employee engagement should not be measured in isolation and employers should be clear not only what they are measuring but how they intend to use the information gathered to achieve ideal relationships.

The CIPD (Chartered Institute of Personnel Development) has produced a variety of papers on the subject and quote a definition from Utrecht University stating that work engagement has three elements:

• vigour (energy, resilience and effort)
• dedication (for example, enthusiasm, inspiration and pride)
•  absorption (concentration and being engrossed in one’s work)

mmm – not sure how helpful that is..

The CIPD also states that ‘positive relationships are evidenced with profit, revenue growth, customer satisfaction, productivity, innovation, staff retention, efficiency and health and safety performance’. Perhaps this is a little more helpful definition– but it doesn’t really reach the heart of the matter. A company can measure highly on all of the above but may not necessarily have a team of ‘engaged employees’. You can have accompany car park full of high performance cars owned by a successful sales team – but could they be even more successful or maybe the performance is unsustainable? How much do they actually care about their customers and colleagues?

At the risk of sounding fluffy – I believe that true employee engagement is about love. Passion for your job, care for your colleagues, love for the company and an emotional investment in your customers. And this is where the measure of engagement should start – with your customers – do they feel the love?

Kevin Kruse, a contributor to Forbes magazine refers to employee engagement as ‘a feeling’ and he compares corporate relationships with ‘the quantity of love you may have for your spouse’ He goes on to say that although you cannot truly quantify love, maybe you could use the five point Likert scale (1- strongly disagree to 5- strongly agree) to rate the key relationships. For example: A person deeply in love is …

Ø  More likely to brag about their partner (employer) than someone who isn’t in love

Ø  More likely to tell their friends (colleagues and customers) how good their relationship is
Ø  Less likely to fantasise about ‘hooking up intimately’ with another person or think about divorce (talking to a head hunter or seeking employment with a competitor)
I would add another measure to this list – they are more likely to act in ‘loving ways’ (helpful, positive) with their customers and colleagues.

I have been reminded of the damaging the lack, or loss, of love can have on relationships with customers twice over the past couple of days. A friend of mine was referred to the Accident and Emergency department of an NHS hospital the other day. Heavily pregnant, she was in a potentiallybut not imminently urgent situation and accepted that a certain amount of delay and hanging around would be involved. But what she wasn’t prepared for was the ill humour of the doctors. She was seen by several of them during her 7 hour stay during which time they were professional and undertook the medical investigations required but, in the words of my friend, ‘all had faces liked slapped a*ses’. Yes – they are royally p*ssed off with the current contract debacle and the lack of love they are feeling from their employer is translating directly into the emotional intelligence of the group and therefore the customer (patient) experience.

How sad that so much goodwill has been lost and I wonder how long it will take for that group of employees to become re-engaged. In the meantime, patients may not suffer clinically but they certainly won’t have such a good customer experience because of this lost love.

A more trivial example of poor employee engagement was clear at the restaurant I visited with my family for a birthday celebration on Friday night. One of the top veggie restaurants in London and only Michelin-listed one around, we were expecting exemplary service and great food. Alas we had neither. Luckily we were in good enough spirits (both metaphorically and literally) not to let the unhelpful and grumpy waiting staff spoil our evening. But on refection the lack of warmth we encountered was shocking. One of our group does not like dairy but every one of the main courses involved whey, curd, yoghurt or even ‘sheep’s milk’. When we asked if she could perhaps order two starters, and maybe have a larger portion of one as a main course she was told ‘No’. And no alternative was offered. There were plenty of staff around so we can assume that this waitress was not over-worked but she just didn’t care enough about her job, her employer and certainly not about the customer, to make any effort to enhance our experience. Maybe the employer doesn’t even care enough about the customer either to ensure that the staff offer good service. So there was very little love around (apart from our table of course).

I was sufficiently disappointed to be galvanised into placing a negative review on trip adviser in an effort to avoid other customers being disappointed. A clear example of how lack of caring for the business or the customer could have a detrimental effect on the bottom line.

An employee’s relationship with their employer is one of the most important relationships they ever encounter and companies should make every effort to ensure that this is healthy and positive and two-way.

The best way to ensure great customer satisfaction and employee engagement is to make sure that in the words of the song, each team member should… ‘Love the one you’re with’.

 

 

 

The living wage – it's not just about salary.

Increasing the minimum wage payable in the UK for those of 25 years and above must be a good thing. I’m not convinced by the age criteria though – how can it be right for a 20 year old and a 26 year old to be doing the same job but not earning the same income? I do wonder if age discrimination could apply here – a test case just waiting to happen methinks.

But minutiae aside – how is the legislation making a 'living wage' mandatory going to affect the employment landscape in the UK? Employee benefits consultants and healthcare advisers will have some larger clients operating in a variety of sectors, some of whom may feel a significant financial impact of this uplift in their wage bill. Who will ultimately pay for this?

This new legislation reminds me of the introduction of the Patient Protection and Affordable Care Act (PPACA or ‘Obamacare’) in the US in 2010. I attended several conferences across the pond where employers and benefits providers discussed this in great detail. The difference between PPACA in the US and ‘Living wage’ in the UK are that the first introduced a mandatory level of health care benefit to be funded by employers and the second is a mandatory level of pay. Both initiatives have the effect of compromising funds available to be spent on a section of the workforce.

As ‘Obamacare’ was introduced there was much bluster for the food and beverage industry – with one spokesman stating ‘This could bankrupt America’ – of course it hasn’t.

In the US, employers found ways of getting round this increased benefits bill which was estimated at being between a 6% and 10% uplift in costs. After Supreme Court challenges against the Bill failed, industry bosses changed employment practices – swapping full time employees for more part time staff (to avoid the minimum number of full timers required for the Act to apply). Salaries were subjected to downward pressure to offset the healthcare benefit costs. One study undertaken 6 months after the introduction of the PPACA showed that rather than charge the cost of the uplifted benefits bill on to customers, 46% employees found a way to pass the increased expense to the employees and only 9% companies absorbed the costs via their profit margin.

Interestingly, in another survey, a large number (44%) of enlightened employers actually planned to increase their health management and wellbeing programme spend in an effort to reduce the claims on the mandatory health insurance, and therefore reduce premium cost.

This brings me back to the UK and my main area of concern regarding the living wage which is the impact on employee benefits. While of course supporting a living wage for all, I fear that something else will be sacrificed to balance employment costs.

Corporate healthcare benefits such as cash plans (offering reimbursement of a range of health related services) has enjoyed a period of dramatic growth over the past decade – 12% in 2014 - as companies provide this low cost, but much appreciated benefit to entire workforces including ‘lower paid’ staff. It is estimated that there are currently well over three quarters of a million employer paid plans currently in place. Company paid private medical insurance schemes account for over 75% of the UK PMI market and corporate dental plans continue to be highly popular. Those covered by a company paid life insurance, critical illness and income protection schemes has also grown by 1.25 million over the past five years.

Put simply – good health is good business. A well-designed healthcare benefits plan protects the health, wellbeing, and engagement of employees –and therefore productivity of the workforce.

So employers please take note. Cutting employee benefits to offset the increased wage bill due to the living wage could be false economy. Investment in health is money well spent.

 

Jeremy Hunt may win the battle but he will lose the war with the Junior Doctors

 Come on Jeremy – take a leaf out of George’s book.

One good thing has come out of the recent welfare budget debacle. George Osborne   demonstrated how a government minister can quickly change their mind in the face of irrefutable arguments against a bad decision.

 

Oh if only Jeremy Hunt would do the same thing. The junior doctor’s opposition to the Health Secretary’s new contract has now reached a previously unthinkable stage as they plan a ‘full withdrawal of labour’ between 8am and 5pm on April 26 and then 8am to 5pm on April 27. This conflict must stop – and it is down to Hunt to make the pain go away.

I use the word conflict advisedly – this is much more than a dispute  now – it is more akin to a bloody civil war – where the blameless victims are anyone who may need the state health service now or on the future. And maybe the doctors are victims too. When the arguments started in earnest around this new contract in 2014 I felt sure that clinicians wouldn’t jeopardise the wellbeing of their patients, and as a healthcare professional myself, felt that I could never condone strike action. But two years on – no-one can doubt the strength of feeling among these doctors and their desperation that has lead us to this sorry state.

 

Hunt insists that the doctors ‘don’t understand’ the contract. Come on Jeremy – it may have escaped you, but you actually have to be pretty intelligent to become a doctor. The British Medical Association doesn’t just employ doctors, they will have had lawyers look at the contract too – and I am confident that they do understand it. And they don’t like it. Never will.

I have been privileged to have worked alongside many junior doctors and have been treated as a patient by several too and I have never come across a lazy doctor. They work their butts off. They care about their job, they care about their patients and they always do more than their contracted hours. Yes, there may be some need for cost cutting and reshaping in the NHS but if you are going to bash anyone- do not bash the doctors.

 

 

Savings must be found elsewhere and the planned changes to the NHS working week must be reformulated. If the doctors do finally give in - which is clearly what Jeremy Hunt believes they will do – he won’t have won. The battle will be momentarily over but the war will still wage. In a great little memoir on power – Robert Greene states ‘Any  triumph you think you have gained through argument is really a Pyrrhic victory: the resentment and ill will you stir up are stronger and last longer than any momentary change of opinion. It is much more powerful to get others to agree with you through your actions, without saying a word. Demonstrate, do not explicate’

 

 

So Mr Hunt, take heed. Please do not beat these hard working, dedicated decent human beings into a grudging submission. Less of the explanations, more of the demonstration. Withdraw the contract – redraft another one in close association with the BMA – and then everyone can get on with what they do best – looking after patients.

 

The NHS Direct/111 confusion epitomises the problems with government health policy.

If ever a snapshot was needed to illustrate that a plan isn’t working, the recent news that NHS Direct are withdrawing from 111 contracts provides just such an unwelcome image. Originally running around a third of 46 regional contracts to run the 111 telephone helpline service, NHS Direct has now pulled out of the ‘financially unsustainable’ arrangements. That leaves eleven regions with no provider to run this fledgling service. The reasons that NHS Direct (itself an NHS Trust) cited for the withdrawal was that projections reported earlier this month showed they had lost £2.8m since April and were "heading for a deficit of £26m if we continue to run the same volume of 111 services until the end of this financial year".

This is a new embarrassment for the embattled coalition health team as another plan fails to quite come together as predicted.  Interestingly, but not surprisingly when this story broke – news items included Andy Burnham, shadow Health Secretary as he said it was a "mess of the government's making" which had led to nurses being replaced by computers

During a debate in the House of Lords, the Lib Dem peer, Lord Willis of Knaresborough gamely tried to defend the service: ‘My Lords, may I try to redress the balance? There is a real sense that very significant numbers of people calling the 111 service get a good service. On 9 June, I had reason to call 111 because I was having a heart attack. The response from 111 was excellent, in York. At the same time not only did the service call the paramedics but it had me in hospital within 25 minutes to an absolutely superb accident and emergency service. If York can do that in such an efficient and superb way, why cannot we guarantee that service throughout the country?

With a spectacular own goal the venerable Lord demonstrated that 111 is a confusing and potentially dangerous option facing the man in the street with a health issue. No Lord Willis – you should not have called 111 – you should have dialed 999! 111 is billed as the service to call ‘when it’s less urgent than 999’ and NHS Choices website advises the public to call 111 ‘if you urgently need medical help or advice but it's not a life-threatening situation’. What was, in theory, a good idea has now sadly deteriorated to farce as a money saving, efficiency enhancing idea is spoiled though poor procurement, poor communications and poor implementation.

Which brings me to my checklist for Jeremy Hunt to use when trying to move the NHS forward.

When you have an idea for an NHS service redesign or enhancement:

1.     Think about the logistics. How will it work? Where are the pitfalls, or weak link in the chain? What will a successful outcome look like? Does the expertise and resource exist and if not – how is this generated?

2.     Assess the benefits. Will a successful outcome mean either a better or more efficient service, better clinical outcomes and/or more cost effective care? Basically – undertake an independent and transparent cost benefit analysis.

3.     Create a robust procurement process. ‘Screwing’ a provider down to an unacceptably cheap price means that you either have an unsustainable model or you will receive substandard delivery. Either can ultimately lead to disaster and expensive damage limitation further down the line. Use the considerable procurement expertise available within the NHS. Good, sustainable contracts are born out of the premise that every party is satisfied with the deal.

4.     Ensure that robust monitoring is in place. Just because something starts well, you can’t guarantee it will continue that way.

5.     Create and implement an effective communications strategy. I have no doubt that one of the biggest failings in the 111 service is lack of clarity for the public.

6.     Keep politics out of it. I know this is a fantasy rather than a realistic possibility, but our politicians and key NHS leaders should focus on the job in hand, not play a politically expedient game.

This really is very basic stuff, but I suspect that if these simple rules had been applied, we would not be facing the confusing and worrying situation regarding our emergency and non-emergency NHS services right now.

Ah well – a girl can dream…

Good public health policy takes courage

I was sitting in the Friday afternoon rush hour traffic yesterday and glanced to my right to see the epitome of a public health nightmare sitting in the car next to mine.

A hugely overweight man was driving his executive car with the cabriolet roof down. He looked hot and sweaty and his balding head was bare to the 33 degree heat. He was (I kid you not) smoking a cigarette, occasionally drinking from the large MacDonald’s branded container. The hand that was on the steering wheel was tapping furiously as he was clearly stressed at the crawling traffic. The one safe thing he was doing was wearing a seat belt.

This poor man is a real life caricature of the ‘ticking healthcare time bomb’ so often referred to by healthcare leaders and politicians. I suspect that when my hapless subject got home he poured himself a large gin and tonic or similar to ease the hassle of is day. Diabetes, respiratory problems and heart disease, let alone joint and musculoskeletal issues are knocking firmly at his door as the grim reaper will held at bay by medical professionals who will try to fix him as the inevitable happens.

Is this man a lost cause? Possibly. Does he know that his habits are life limiting? Probably. Will he do anything about it? Who knows.  I am in no position to judge as I am far from saintly when it comes to healthy eating and drinking habits so I do have great sympathy for Mr Cabriolet Man. But how interesting that he has at least vastly increased his chances of surviving a road traffic accident by wearing his seat belt. And why does he wear a seat belt? Because it’s the law.

Of course we can’t make unprotected sunbathing, alcohol, or even getting stressed against the law. But surely those charged with protecting the health of the public should take every reasonable action they can to not only educate us, but strongly guide us towards healthy behaviour. Especially the impressionable young.

We know that educational programmes help enormously as at least the general public now know that smoking kills, excess alcohol ruins lives and healthy eating and exercise are the route to longevity. We also know that despite these programmes, there are generations in the UK making very unhealthy choices.

A study reported yesterday regarding early death rates due to liver disease in young women is truly shocking. For women born in the 50s , the death rate due to alcohol related disease is 8 per 100,000, for those born a decade later the rate rises to 14 per 100,000 and those born in the 70s, women only in their 30s right now, are dying at a rate of 20 per 100,000. Various causes have been cited, but cheap booze must play a part in this yet the government shies away from minimum pricing for alcohol.

Smoking is an equally depressing story as although statistics show that smoking rates are decreasing, we still see young children and teenagers smoking even though they know it’s bad for them.

Controlling the smoking habits of a population is potentially one of the biggest public healthcare challenges a nation can face. We know that, apart from the human loss and suffering, smoking costs the NHS and estimated £2bn a year.

How disappointing, then that the government have decided to postpone a decision regarding plain packaging for cigarettes – a move that had been expected to reduce young smokers. In a strongly worded letter to the Guardian Newspaper, a group of chest physicians, paediatricians and public health specialists make a powerful case for plain packs saying.

The tobacco industry targets young people because it needs to replace the 100,000 people in this country who are killed each year by smoking related diseases. Every day roughly 570 children aged 11-15, nearly 30 classrooms full, start smoking. Tobacco packaging is designed to manipulate perception of risk. For example, even though terms that dishonestly imply relative safety in cigarettes like "light" and "mild" have been banned, research shows that smokers continue to believe that cigarettes in lighter colour packs are less hazardous.The government must now either bring forward legislation or allow parliament a free vote on what is an urgent child protection issue.’

It is equally disappointing that the coalition will also delay a move to introduce a minimum unit price for alcohol.Protecting the health of the public while maintaining their right to personal choice is a tough job. Introducing unpopular measures can a poison chalice for health ministers and legislators. Like the brave move to make the wearing of seat belts in cars compulsory for drivers in 1983. This was a contentious issue for several decades before it finally became law and has saved thousands of lives, while creating a behaviour that is now automatic and part of everyday life.Good public health strategy needs to be backed up by legislation where possible. Legislation that is designed to limit choice and change behaviour takes courage.

We need to see that courage from the government now.

 

 

How do we stop the bad news coming from the NHS?

Regular followers of this blog may have noticed that it has been a few weeks since I last posted any commentary. I could use the excuse that a heavenly week in Devon and Cornwall, followed by some speaking engagements intervened, but the truth is that I have been at a loss for words.

Bad news and the NHS are now synonymous. Horrific stories of poor care, failing hospitals, commissioning teams in panic mode, financial meltdown of Trusts and most frightening of all, unexplained high death rates make for very upsetting reading. I don’t want to be another purveyor of doom adding to the cacophony of despair but it is hard to find some positive insight into the disarray of our state funded healthcare system.

Most distasteful of all is the political interference, name-calling and finger pointing, not forgetting a hefty dose of arse-covering into the bargain.

In my opinion, the recent review of the Liverpool Care Pathway epitomises the current crisis. Medicine, and many related functions, is an inexact science. Clinical decisions have to be made on the best advice available at the time, backed up by robust evidence and those decisions monitored through clinical governance which is best delivered by clinical peers. Sadly the human element can override good science and even worse, a culture of poor care totally undermines good medicine.

It is absolutely right that a review was instigated into the use of the pathway, originally created to ease suffering of those near death, but absolutely wrong that this review was needed in the first place. How dreadful to learn that this carefully designed set of guidelines was in many cases distorted and recreated by badly trained or badly managed staff with little or no consideration for patients or their loved ones. Yet again, we have been shocked to hear of staff displaying ignorance, callousness and in some cases, downright cruelty all in the name of ‘care’.

The review, led by Rabbi Baroness Neuberger, was originally set up to research the use of this pathway but en route uncovered significant shortcomings in the treatment of the dying, notably at weekends when senior clinicians were absent.

How on earth did we get to a state where a nurse felt it was acceptable to shout at a relative for trying to give a patient a drink? Is the stress of the job turning good people bad or are they just the wrong people for the job in the first place? And how do good managers, senior clinicians and medical leaders turn this mess around?

I have just been watching some news footage from the House of Commons with the current Secretary of State for Health Jeremy Hunt lobbing salvos a cross the House aimed at the previous Labour Health Minister, Andy Burnham who with equal vigour retaliated. The headline for an article by Sean Worth in the Telegraph today shouts ‘Labour must bear the blame for the shameful decline of the NHS’ and the BBC has reported that Professor Sir Brian Jarman,  ‘an independent expert on mortality rates has suggested that ministers have suppressed details of NHS failings to avoid losing votes’.

Maybe Professor Jarman has the key and maybe he’s right when he advises us that we should take heart that following Sir Bruce Keogh's report, 14 Hospital Trusts have been identified as failing and 11 will now be subject to closer scrutiny and urgent service improvement activity.

I also agree with his premise that ‘a "basic problem" with the NHS was that the government both provided health services and monitored them’

Maybe that’s the answer. Let independent and wise individuals such as Baroness Neuberger review specific areas of concern and let us find an independent, non-political means of monitoring quality of care. Let there be zero tolerance for cruelty or poor clinical practice. A cruel or incompetent nurse, doctor (and that should include GPs) or healthcare assistant should be suspended pending investigation and poor clinical practice should be offensive not just to patients but to staff with no exception. Let clinicians have the final say on clinical issues and most important of all, keep politics out of it.

Improve from within and then maybe the bad news will stop.