Neil Goodwin's Comments
I agree with comments above about being positive. Is it necessary for anonymous commentators to be so gratuitously insulting. It does neither them - whoever they are hiding under, sneering cloak of anonymity - nor the HSJ any credit. Mark Britnell worked for me some years ago as an operational manager. Quite frankly, he was excellent, a joy to work with, and was one of the handful of really good managers I had the pleasure to work with during my 20+ years as a CEO. I can understand the decision he's made and I hope he continues to make thoughtful contributions to NHS policy from his KPMG role. L
Comment on: Berwick chief: review critics 'miss the point'
David Dalton is quite correct in his reaction to publication of this important report, as are the comments above about culture change. But an important part of that change is allowing local organisations, in the operating context of their local health systems, to work out how best to implement Berwick for themselves. There still remains a dependency culture of looking to the centre for how to do it; and seeking action or check lists is symptomatic of that. Each restructuring of the NHS endeavors to address this, and largely fails. There does however remain two points of optimism for the future: the development of CCGs led by people outwith the historical management culture; and the appointment of the new CEO to NHSE who, along with regulators and government, must make every attempt to turn the NHS from a national organisation to a national industry.
Comment on: Alastair McLellan named 'editor of the year'
Well done Alastair, great news.
Two points. First, many of the people on the clinical leaders' list gave up their clinical career a long ago. So to what extent their medical degree impacts on how they undertake their current role will be debatable. Second, we shouldn't assume that someone who qualified as a clinician may make a better CEO of NHSE (or any other healthcare organisation). Reflecting the management research, as people progress through their careers, it's their personal skills which determine their future success and not their professional knowledge or background. So, what this says to me is that choosing the new CEO of NHSE should be driven as much by an assessment of their style as well the substance of their career to date. Whilst applicants need to understand international healthcare trends (and ideally also the UK NHS) - coupled with an ability to understand and relate to clinicians and patients - their professional background will be largely irrelevant.
Comment on: Burnham backs central planning
Central planning undoubtedly has its place and it's the default approach of most governments. But... it fails to acknowledge the importance of local context. It would be naive to assume that national organisations implement national policy and change in the same way and within the same timescale. They don't - as we see clearly across the NHS. Each component (region, district, organisation, etc) will have differing contexts of politics, relationships, resources, approaches to decision-making, etc; all of which influence the way they pursue change and transformation. This is frequently insufficiently understood by governments and explains their frustration in implementing national policy, leading to comments along the lines of why can't the whole country perform to the level of the best Re the reference to China above. It's interesting that they have largely abandoned central planning and are now a successful market-based economy within a single party system. It seems that like communism, China's historical approach to leadership has also been judged to fail.
Comment on: Exclusive: Chief inspector of hospitals revealed
A superlative choice. Mike Richards has the track record of operating at the interface of government and the NHS, excellent knowledge and intellect, and equally importantly, the right style to make this role work for the benefit of patients and the NHS.
I know that Chris would not want this to be considered as an 'either, or' issue but we must be careful not to throw the baby out with the bath water. Pace setting and achieving targets have their place, and are just as essential as quality and safety for maintaining public confidence. Historical context is crucial here. It wasn't too long ago that long waiting times were the norm with the public calling for improvements. They probably contributed as much to increased morbidity and mortality as those issues highlighted at Mid Staffs. And those of us who are old enough can equally remember the mess that public services were in at the start of Mrs Thatcher's premiership, although Chris is right when he says that she - like the majority of leaders in power positions - eventually began to believe her own rhetoric that led to her downfall. The trick is to balance the achievement of performance with developing a good quality culture using appropriate leadership styles. But as I have said in one of my recent blogs, I do see a disconnect between the hierarchical practice of management and the multi-disciplinary, team-based practice of clinical care. I believe this disconnect will make it harder for management to change. Hence, I argue for the need to pause and consider the purpose, role and practice of NHS management; and for it to establish a closer relationship with the clinical professions.
Comment on: Break away from 'heroic' leadership
Good piece for stimulating discussion. I too have called for more evaluation of leadership along with a stronger emphasis on management, which with administration has been somewhat sidelined by an over-emphasis on leadership. But perhaps the most important variable to take into account is the relationship between developing a stronger NHS ethos of caring and compassion, and how these qualities are viewed in society as a whole. I would argue that whilst I share Clare's aims, unless we are seen to be a more caring and compassionate society - as is the case in many other countries - we may have limited success in changing NHS (and social care) culture. Finally, and this is another way of looking at Clare's points, there is an increasing gulf between the multi-disciplinary, team-based approach of clinical care and treatment with the hierarchical nature of leadership and management in the NHS. NHS management needs to be reinvented so that it mirrors clinical care - perhaps then we would stand a better chance of developing the improved behaviours that we talk about.
Comment on: Failed NHS managers could face blacklisting
This is tricky but not impossible. Successful implementation will rest on a number of variables including: a sound, universally understood and objectively applied performance framework; differentiation and understanding of the roles and responsibilites of the CEO, chair and board (not an issue for teachers, where I imagine performance in the class room is more clear-cut), etc. The proposal also begs at least three further issues for addressing. First, ensuring there's a sound recruitment and selection process for CEOs including, among other things, avoiding appointing first-time CEs into known difficult jobs or very big organisations. There's little point establishing the register unless the basics are in place. Second, ensuring there's an equally robust and sound process for appointing (and appraising) board chairs. If there is a stronger role for regulators in senior personnel issues then it has to be this because if there's one relationship that could precipitate failure it's that between the chair and CEO. Third, understand that just because someone fails at being a CEO it doesn't mean they will fail as a senior manager (unless what precipitated their failure was a potential criminal act). In my experience as a former SHA CEO who 'moved on' CEOs, some realised that they hadn't enjoyed being a CEO and welcomed the opportunity to pursue their career at director-level, thereby not wasting their skills. In short, for this to work successfully process will be important but perception will be crucial.
Comment on: More management, less leadership please
Thanks for the above comments, I'm most grateful. I have reflected on what you have all said and re-ordered my own thinking as follows: 1. At times of austerity life is about choices and this includes investing in leadership development. If it can't be demonstrated to have a positive result then it should be changed or dropped. A year is sufficient time in any leadership programme to draw interim conclusions. 2. From a patient perspective (and like many I have been a patient) what I believe is needed to provide efficient and effective services is good quality management and administration - we have neglected both over the years at the expense of leadership, which we also have inappropriately elevated in importance above the other two. They are all of equal importance. 3. Improving management and administration does not always require leadership. As John Kotter said, sometimes you need more management and less leadership, and sometimes vice versa. I believe that now is a time for more management. 3. The NHS is rightly judged by those who have control over its future on bottom-line performance (finance, quality, safety patient experience, etc). As a tax payer I judge it that way too and will be assured by seeing improving and sustainable bottom-line performance. If staff development investments cannot demonstrably contribute to that then - to be provocative - they will have largely been in vain. 4. Sadly but inevitably given the nature of yet another scandal, the Francis report will adversely impact on the reputation of NHS management; however, it is of course only a small proportion of managers who let the side down. I assume Francis will also comment on board capability where, based on my own inquiries into adverse board governance, much development is still required. Mid Staffs has clearly demonstrated that regulation is not the complete answer which, in my view, is having a greater focus on building good quality local boards and local management. 5. What all this says to me is twofold. First, we are in the early period of a very difficult time for NHS management and I'm not sure I have yet seen sufficient evidence from people and organisational development investments to date that a firm enough foundation exists to create universal success. Success, we can be certain, will be at best distinctly patchy. Second, changing the language - by introducing 'management' and 'administration' alongside 'leadership' will help dispel the perception that leadership is only for the few and is somehow superior to management and administration. This is, I strongly believe, an important signal for the clincial professionals who in contrast to the hierarchical approach of management, deliver care on an integrated, multi-disciplinary and often non-hierarchical team basis. Somehow we have to bridge this gap between these two styles, which for me means reinventing management so that its aproach and style mirrors that of the clincial professions. 6.Finally, it may seem strange for a leadership academic to question what is, in essence, my livelihood. But looking at the issues facing NHS managment and the clinical professions today, although leadership does have its place I'm no longer convinced it is the answer we often think it is.