Blair Mcpherson's Comments
It's a hard lesson for chief executives to learn but the reality is they don't make a lot of difference to how services operate day to day. Which means they can't have much impact on quality in the short term. They can of course make things much worse by imposing reorganisations which disrupt services, demoralise staff and distract managers. They can reduce staffing levels, change the skill mix to have more unqualified staff and cut back on training in an effort to be more "efficient". So I am heartend to read that this group recognises that they should not believe their own propaganda and that the emphasis is shifting from the previous focus on the money.
There is nothing wrong with recycling ideas and "empowering staff" is certainly not knew but there is a big difference between going under cover to find out what its really like and implying that simply by listening to staff managers will be able to deliver on budgets, performance and care. Empowering is more than listening it is giving power, sharing decision making. "Empowerment" is overused, discredited and a bit of a con. It usually means we will inform and we will listen but we will still decide. I am all for informing and listening but I thing to talk of empowering is to imply a shift of real power which on past experience is if not dishonest then misleading.
Commissioning is part of a tighter budget control process with in the NHS, a process that is not driven by an assessment of need but is finance led, it's about what we can afford, economies of scale and encouraging the private sector where they say they can do it cheaper.
Comment on: Happy staff mean a healthy business
In the long term particularly in the carding business then happy staff may well lead to a healthier business but in the short term in a climate of budget cuts, redundancies and proposed mergers fear seems to be effective. Of course that is assuming you regard health care as a business.
There are a lot of questions the NHS has yet to find answers to. Should Commissioners continue to use a Trust that is in special measures? If they withdraw their support the Trust is no longer financially viable. If they continue to commission services from the Trust despite a damming inspection report then what was the point of introducing a commissioning led NHS? How does a Trust get put of special measures? Is it inevitable that the chief executive, chair and most of the board have to go I order to restore confidence? This looks like another case of balancing the budget and making the efficiency savings at the expense of undermining the confidence of staff that the Trust is genuinely committed to providing even an acceptable level of care. But is this increasingly an impossible ask? What does the government really want the CQC to do , light touch resulted in unacceptable and dangerous care in depth tell it like it is reports seem be equally unwelcome and problematic! Are Trusts to be run as business or should the NHS be practise led rather than finance driven?
The NHS does have a number of equality and diversity issues to address. It is not just concern about the snowy white peaks but evidence from Trade Unions that black staff are more likely to be disciplined and less likely to be promoted. How the NHS treats staff has an influence on how staff treat patients and there are well documented cases of the neglect of older patients and the abuse of people with learning disabilities. Add to this the belated recognition of a criss in mental Heath services and what you have is an erosion of the Values that the NHS and public sector in general stood for. These values are dignity, respect and fairness. They are being replace by the values of the market place, competition,cost and profit . Blair McPherson author of An Elephant in the Room- about equality and diversity in the public sector organisations www.blairmcpherson.co.uk
Comment on: Fashion fades but the equality conundrum remains
Kosta This article in HSJ may go some way to answering your question. http://www.hsj.co.uk/comment/blogs/the-politics-of-language/5069946.blog
In adopting an equality and diversity approach to faith the first thing is to understand the difference between faith and culture. Single sex or women only is not a faith issue but a cultural issue which explains why some Muslim groups insist on it and others don't. A little sensitivity goes a long way so it's helpful if colleagues know a little about Ramadan and what's involved in fasting and when it comes to requests for time off for religious holidays not all dates are fixed like Christmas and New Year some are based on the new moon and declared by religious leaders at short notice. From an HR point of view faith doesn't provide a bigger challenge than other equality strands, race, gender, disability, sexuality and like the other strands the main issue is ensuring staff are not bullied, stereotyped or the subject of inappropriate comments or so called jokes. Blair McPherson author of An Elephant in the Room-about equality and diversity in the public sector published by Russell House www.blairmcpherson.co.uk
Some practitioners are celebrating the Supreme Court ruling in the cases of P v Cheshire West and Chester Council and P&Q v Surrey County Council as bringing many more people under the scope of the Deprivation of Liberty Safeguards (Dols), including older people who have dementia. Others argue that evidence from Care Quality Commission reports already identifies widespread under-compliance due to resource shortages. Broadening those covered will not improve this situation but make it worse. So now may be a good time to take a step back and remind ourselves what happened in the past and why the Dols were introduced. When I was a specialist social worker working with older people who had dementia I was very concerned about the willingness of relatives, housing officers, ward staff, GPs and fellow social workers to ignore the wishes of people with dementia bases on the fact that they were confused and forgetful. What this meant was they were admitted to a residential or nursing home without being involved in the decision. As a result, anyone visiting one of these homes would be accosted by a distressed resident asking to be let out as they wanted to go home. In response, staff would lock the doors, keep the individual under sedation or use the tray attached to the armchair to, in effect, pin the individual into their chair. Their home having been given up or sold staff would inform them ” you live here now”; and if this distressed them or they became aggressive in their attempts to leave then staff simply upped their medication. Being old and suffering from dementia all too often meant the risks they posed to themselves overruled their human rights. The difference in these cases to people with a mental health problem was the total lack of any protection for the individual who was to be deprived of their liberty to the end of their days. And, of course, a whole range of other decisions would be made about their home, their possessions, how they spent their personal finances, when they had a bath an even if they had sugar in their tea. It is over 30 years since I was a social worker, attitudes have changed, care staff have specialist training, the law has changed with the introduction of the Dols and rights are now independently balanced against risks. Well that’s the theory. But the Care Quality Commission’s annual report on the Dols concludes it is not the reality. All too often dementia in old age leads to relatives and professionals disregarding an individual’s rights in a way no one would get away with in younger people. The report states that hospitals and care homes often act to deprive an individual of their rights either through ignorance or convenience and that too many local authorites are under-resourced to carry out their duties of assessment and safeguarding. The law should not be interpreted to fit existing resources. Yet to expect local authorities to carry out new duties and responsibilities without providing the necessary resources is to set them up to fail. Blair Mcpherson
The issue is not the individuals professional background but their leadership skills and the type of leadership those who appoint think is required. Thinking on this changes. First we had leaders make the difference, success is based on strong leadership. Then it was no more heroes because the charismatic individuals insistence on uncritical loyalty can lead you astray. This was followed by the need for leaders at every level in the organisation and for all managers to have leadership skills. Unfortunately all managers didn't want to be leaders and all managers couldn't live up to the expectation, some though being an effective manager was enough. The latest slogan is " wining without leaders", essentially this is stressing the power of team work. Different times call for different types of leadership, the "strong leadership" is most effective for short term criss where radical action is needed quickly, a new management structure is imposed,budget cuts are forced through. Where as if an organisation needs to change its culture then a leader who prompts debate, challenge and openness will be more effective in changing the way people think. Team work is required whatever the type of leadership but winning without a leader implies that at different times different people can take responsibility and provide inspiration. This is particularly attractive in partnership working as it recognises that the biggest organisation is not always the best or most appropriate to lead. Having said all that successive governments have been obsessed with the quality of leadership in the public sector whether that be head teachers or chief executives of NHS trusts. Why? Could it be that they attribute the slow pace of change and the failure to convince teachers, social workers and doctors that their policies will result in better services, to poor leadership! Blair McPherson author and commentator on the public sector www.blairmcpherson.co.uk