Blair Mcpherson's Comments
Comment on: Great leaders live and breathe their values
A friend drew my attention to a series of personal comments put on face book about a former colleague. The hostile comments had been provoked by an article the individual had written but the criticism wasn't about content, it was personal. The individual was an ex senior manager in the organisation those commenting had all worked for. Despite all concerned having left the organisation many years ago these individuals, judging from the comments, could not forget or forgive. The crime,being regarded as responsible for the forcing out of a popular director. Such loyalty ,such resentment and such naivety! As my friend said the new manager was brought in to change things but was never accepted because of their commercial background, even thought it was generally agreed that big changes were necessary because of the changing financial climate. The new person was simply doing the Boards biding. The director who left was indeed popular and had excellent people skills but even those who admired the values they stood for would concede that they were unlikely to address the financial issues in the way the board wanted. Which of course was why the board over looked them and brought in someone from out side. The director having lost the battle for the future direction of the organisation was astute enough to take the very generous packed offered. Why so much personal animosity after so many years? Whilst some of the changes over seen by the new boss were unpopular and seen as more to do with financial consideration rather than quality of care non of these managers felt strongly enough to resign or move on ,many were still there when the new boss was in turn replaced a few years latter. Should we be surprised that a group of managers should still be in contact with each other many years after they had left the organisation and that they should hold such personal animosity to a former boss? A boss who appears to have been considered reasonable by those who worked directly for them and as no worse or better by the wider organisation. Is this a case of misplaced loyalty,the need to find a villain responsible for the loss of their hero, is it resentment at the loss of their influence or naivety about how organisations work? Perhaps the lesson to be learnt is that we should neither seek to make our leaders heroes nor villains.
The title reflects the venim in the article. Certainly the NHS has had a very poor reputation for the quality of its management and the lack of leadership at all levels.Whether this is justified is debatable because the NHS has become a political football in a game managers can't win. I don't expect the quality of management to dramatically change if the political and financial environment remains the same.
A political consensus on pooling all NHS and social care funding. At the same time there is a growing professional opinion in the opposite direction!
Technocratic vision? Does this mean leave it to the experts? Well better them that the politicians ,business people or the economists. What about patients are they to be concidered experts in their own care? Does this mean that the future designe of the NHS would by led by Doctors? That would be like an education system designed by teachers! Which is fin until you introduce a cash limited budget. Or have I misunderstood the use of the expression "technocratic vision" is this really just another way of saying big data and managerialism will rise to the challenge if allowed to do so?
More radical change,more structural reorganisations all very distracting. What would be really radical would be a statement to make the current structure work, no reorganisations, no restructuring, no re configurations, no more out sourcing. A five year plan to focus improving the quality of care and treatment.
Comment on: Quality trumps cost in post-Francis NHS
I think across the public sector management has adopted " better a poor quality service rather than no service"". A financially driven system requires this in a period of austerity. Politicians would of courses say the service meets minimum standards and improved efficiency saves money with out reducing standards but they would wouldn't they.
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.