Blair Mcpherson's Comments
Comment on: NHS leaders show courage under fire
How tough are NHS managers? " Courage under fire". Macho management is alive and well!
The clarity is encouraging. The recognition of the need to increase social care funding is refreshing. But the statement that health and social care don't work well together is not born out by experience and the assumption that the best solution is an intergeated commissioning budget ignores past experience. The system was made to work on the ground by social workers, home help organisers and district nurses. It wasn't perfect there was some duplication but you can't say it didn't work. It doesn't work so well now simply because Social service budgets have been cut by up to 40 percent at the same time hospitals have sort to reduce the length of stay of elderly patients in order to reduce waiting lists and demonstrate improved efficiency . The reason this is now a high profile issue is that hospital beds are blocked because SSD's can't fund a residential care placement or the necessary support to send them home. We don't need more structural solutions we need more money.
Comment on: Chief executives designed for the future
It is typical of NHS thinking that political skills should be thought of in Machiavellian terms. Political skills include political awareness and sensitivity.The realisation that it is not just about the strength of the business case. For example there may be a strong business case for closeing a hospital or transferring a service but it may not be politically do able because of the strength of public opposition.That the local MP may support the governments strategy in centralising specialisms but may led public opposition to its implementation locally on behalf of their constituents.
A consumer driven health system, well better than being finance driven but I think I would practise led even over patient led. May be doctor doesn't know what's best for me when it comes to independence, choice and risk but I am happy to defer on medical issues. As for personalisation it is well established in social care and has only a limited success. Excellent for people with a disability who are articulate and assertive provided the budget is sufficiently generous to meet their needs in the way they desire. Totally inappropriate for people with dementia and those offered a budget that is theirs to spend as they see fit but insufficient to meet basic needs.
Comment on: Tackling the cultural challenges of leadership
In order to change the organisational culture you need to change the management culture!
A disappointing response from those responsible. This isn't about complex staffing formulas or smart staffing rotors. This isn't about a response for all wards. A series of critical reports highlighted that elderly patients were being neglected, receiving poor care blade ring on abuse due to inadequate staffing levels and an over reliance on health care assistants. There were simply not enough staff on duty to ensure elderly people who might need help and encouragement to eat and drink revived it. That there were enough staff to respond promptly when an elderly patient needed the toilet and if the person soiled the bed there were sufficient staff to change the bedding promptly not leaving a patient lying in there own feces till a horrified relative arrives and complains. I think most board members would understand this.
Too much emphasis on leadership. Too much admiration for private sector management.
Intergreated health and social care is the goal because it is more efficient as it removes duplication of services and is more customer focused as services are better coordinated with information being freely exchanged between professionals so the customer does not have to repeat their story. In a prlonged period of austerity the focus is on efficecy as a way to save money. But there isn't much duplication now because it is so hard to qualify for help from social services. As for information exchange there appears to be a lack of will to invest in getting a shared IT system at local levels whether because of the costs, past failed projects or continued professional " confidentiality" issues. In Facebook terminology the relationship between health and social care would be described as "complicated" . And we all know that is code for going no where.
It's always a bad sign if players in a partnership have to go to the lawyers to clarify responsibilities.
Comment on: Equal access to the NHS: the next step
For me it is obvious get equality and diversity right and all else follows. If equality and diversity in recruitment is right you will have a workforce that reflects the diverse population you serve. If you recruit people who do not all come from the same background, hold the same beliefs and think in the same way you are more likely to have the creativity and insight to respond to the challenges of providing services to a diverse population. You are more likely to be customer focused if your staff recognise different sections of the community want their needs met in different ways and you are more likely to have people who can think of different ways of meeting needs. Of course this will only be realised if you have managers skilled in managing a diverse workforce. This requires focusing on developing managers' people management skills. It also requires developing a safe working environment - one where staff feel able to challenge and be challenged. If you get equality and diversity right you will have developed your listening skills as an organisation and so you will have the right approach to engaging communities and working in partnership with the voluntary, community and faith sectors. How will you know if you have got equality and diversity right? By monitoring recruitment and service take up, by setting targets based on local population profiles and by service user and citizen satisfaction surveys. Such an approach to equality and diversity promotes a performance management culture. Meeting the really big challenges means radically changing the way people behave in the organisation. It means engaging staff at every level in doing things differently and it requires people to be inspired. Leagues tables have limited motivational appeal, so does saving money. Claiming the customer is king is hard to maintain in the face of hospital closures, cuts in services, removing children from their parents or admitting someone into a psychiatric ward against their wishes. And despite the traditional emphasis on charismatic leadership front line staff don't do it for the chief executive. In fact in the public sector staff tell us in staff surveys they don't trust senior managers, they don't do it for the money, they do it for the people they serve and they do it because they want to make a difference. The challenge is to maintain this public sector ethos when services are contracted out to the private sector or to the “third sector “a cross between the private and voluntary sectors. The challenge is to maintain this sense of commitment to the general good rather than the bottom line. The challenge is to do this at the same time as the public sector is adopting many of the methods and much of the language of business. What better/clearer way of doing this than focussing on fairness because that's what equality and diversity is all about. Fairness in how we recruit people, fairness in how we select people for promotion, fairness in how we treat people at work, fairness in how we allocate scarce resources and fairness in how we provide services. Fairness is relevant, fairness inspires. Of course fairness is a principle and the tricky bit is applying it in the real world but that is the challenge for the organisation; that's what everyone should be working on. For a case study in a large organisation see An Elephant in the room www.blairmcpherson.co.uk