The People Manager
Is it harder to be an honest senior manager in today’s NHS?
In over 30 years working in the public sector, many as a senior manager, no one ever offered me money to look the other way, bought me an expensive lunch or even a bottle of whisky at Christmas.
I have no experience of corruption, but fiddling the performance figures, withholding information and ignoring inappropriate behaviour was all too common, usually because a manager wanted an easy life.
‘Is the gap between how we expect managers to behave and the reality getting wider?’
Staff often say they don’t trust senior managers, claiming they are not open and honest about plans to withdraw services and make staff redundant. Some senior managers believe telling the politicians what they want to hear is all part the game. These managers are enthusiastic supporters of the governing party’s policies and equally enthusiastic supporters of the opposition’s policies when it gets into power.
Is the gap between how we expect managers to behave and the reality getting wider? Is it becoming harder to be an honest and decent manager?
Political environment
Honesty, openness and integrity are expected of managers in the public sector. We like to think that in this country our public officers don’t take bribes and are not corrupt. In general that is probably true.
But league tables and naming and shaming have put a lot of pressure on managers to hit performance targets, which may be too much in some cases. Whistleblowers have revealed abuse and neglect in the NHS that managers failed to pick up on and challenge. Is this incompetent management or a focus on cost at the expense of care?
In a period of drastic budget cuts, all saving options are on the table − redundancies, closures, outsourcing −but mangers are not lying when they say no decisions have yet been made but they’re not able to be open and honest as the cabinet or board decides what is politically deliverable before the media campaigns kick in.
‘Cuts and their impact will create many situations where a senior manager’s commitment to honesty and integrity will be tested’
Managers in local government work in a political environment where decisions are not simply based on the business case but take account of party political priorities. The policies a council follows are those of the party in power. Senior managers are not required to agree with them, just deliver them, and that requires some convincing enthusiasm on their part. It would be unprofessional to do otherwise.
Old dilemmas
But what about when claims are made that staffing cuts won’t affect the quality of service when your experience tells you it’s inevitable? Is it ethical to keep quiet? Can you honestly say the proposed changes will bring about better services when you know the driving force is budget savings? Can you claim to value staff and the work they do while cutting pay and plotting to outsource services?
These are not new dilemmas for people working in the public sector but in the past health and social care services have had some protection from budget cuts due to the vulnerability of their patients and service users.
The size of planned cuts and their impact will create many more situations where a senior manager’s commitment to openness, honesty and integrity will be tested.
Leadership lessons from the Thin White Duke
The music industry and the wider world has been getting excited about a new David Bowie single. The main reason seems to be no one saw it coming − after all, he hasn’t released any music in the last 10 years.
Now the NHS seeks to revive one of his greatest hits with a return to “heroic leadership”. The conference, like the song, claims we can all be heroes.
The promotional material speaks of the battles that have taken place and the battles to come, battles that have left many managers feeling bruised, demoralised and overstretched.
‘Managers do not need to seek fame by giving interviews to the local media, they just need to inspire their staff’
The rallying cry is heroic leadership is not an optional extra. Which like the new Bowie single is a bit of a surprise, because that idea has long been out of fashion among management consultants and leadership gurus. In fact, once the golden years of budget growth were replaced by dramatic budget cuts then there were bound to be changes in leadership style.
While some shouted “rebel, rebel” against the cuts others said we should look to the US follow the example of success in the private sector delivered by young Americans with names like Ziggy or Jean Genie.
Of course, to most mangers brought up under a public sector ethos this was totally alien. What works in Suffragette City isn’t going to work in Swindon town.
The era of the charismatic leader who by sheer force of personality made things happen is dead, so ashes to ashes, what we require now is all managers to be leaders. This does not mean managers need to seek fame by giving interviews to the local media, they just need to inspire their staff and make them feel good about the job again. If this requires all managers to play a bit of mood music, then I say let’s dance.
Military-style leadership doesn't suit the public sector
You wouldn’t be surprised to hear the military described as having strong leaders − you might be surprised to hear their style of leadership recommended for the public sector.
“Strong leaders”, is code for leaders that don’t negotiate, attempt to persuade people or feel the need to explain their decisions. These are the type of leaders who use expressions like “turkeys don’t vote for Christmas” and “this is not up for discussion or debate”. They are the type of leader who interprets dissent as disloyalty.
A report by management consultants Orion Partners last year recommends military-style leadership if the public sector is to get through these most turbulent of times.
‘In the NHS and local government we have long gone past any pretence that the changes are practice led rather than finance driven’
Only Orion doesn’t recognise the type of strong leadership we traditionally associate with the military, it refers to “brain-friendly” leadership where leaders get their staff to understand why change is good for them and the organisation.
The report claims there is more evidence of this type of leadership in the armed forces than in the civil service, despite Ministry of Defence cuts of over £4 billion and 54,000 redundancies.
Brain-friendly leadership does, however, appear to assume it is possible to demonstrate to staff and the wider community that despite the upheaval of major changes, redundancies and service reductions, the end result will be worth it. Presumably this was the thinking behind the government’s change of leadership of the NHS for someone who was a better communicator!
A different style
‘We are now seeing reports about the impact of budget cuts on the quality of care in the NHS’
I don’t know about the armed forces, but in the NHS and local government we have long gone past any pretence that the changes are practice led rather than finance driven.
Local government is not providing a better service to local people as a result of cutting up to 50% of its budget and the staff working in local government are not more secure in their jobs or financially better of as a result of increased pension contributions and pay freezes. Local people are not more satisfied with their services now that libraries, swimming pools and day centres have been closed.
We are now seeing reports about the impact of budget cuts on the quality of care in the NHS. So neither staff nor patients are likely to be persuaded that major changes are for the better.
A separate report from the Chartered Institute of Personnel Development and the Public Sector People Managers Association called Leading Cultural Change also talks about the need to take staff with you in implementing major changes. However, rather than trying to persuade staff that changes are in their best interests or will result in better services, they argue that it is about explaining why change is unavoidable, that the task is to make the best of it and that this will involve new ways of working.
The leadership task is one of negotiation and retaining the trust of the workforce. This style of leadership also requires excellent communication skills − not to sell an unpopular idea but to foster openness and a faith in the leadership
A new look for NHS leaders in 2013
One of the more unusual Christmas presents for the successful businessman last year was the gift of a hair transplant. A full head of hair on men has long been associated with virility and we apparently want our leaders to be strong and virile.
But in some parts of the world a full head of hair alone is not masculine enough. To be taken seriously men must also have abundant facial hair. Ali Mezdegi is a cosmetic surgeon, part of a booming health tourism industry in Turkey, where over the last couple of years beard and moustache implants have become very popular.
‘Could a lack of facial hair be a disadvantage for the NHS leaders of tomorrow?’
Irfan Atik is general manager of a Turkish tourism agency that specialises in hair transplants for men. He estimates that 50 foreign tourists a day visit Istanbul for the facial hair transplant procedure, which costs around £1,400, including medical and hotel fees for the four-day trip.
To date, most of the customers have been from the Middle East. As the West seeks to revive its faltering economy by doing more business with wealthy Middle Eastern countries, will 2013 see the growth of facial hair among the business community here in the UK?
As the public sector is encouraged to copy the private sector, will we see thick moustaches appearing on the upper lips of ambitious male chief executives? Could a lack of facial hair become a social disadvantage for the would be NHS leaders of tomorrow? In Turkish there is a word for it “kose” − baldness of the face.
Why the public sector shouldn't use head hunters
Recruitment consultants are routinely engaged to fill senior posts in the public sector. They are expensive but so is appointing the wrong person.
The best pride themselves on being able to put together a strong short list. When it comes to the unpredictable nature of interview panels it is important that everyone who appears before the panel is appointable. Top recruitment consultants know who is out there looking even if their current employers don’t.
‘Have an interview panel that is balanced in terms of gender and ethnicity, which might involve people from outside the organisation’
A successful head hunter’s reputation is based on being able to make a good match between candidate and organisation. They will identify the right person for the post but the right person is not necessarily the best person, which is why any organisation genuinely committed to equal opportunities should not use them.
A highly successful recruitment consultant recently put their impressive track record down to their ability to identify the “real client”, ie: the one who would really be making the decision. In some organisations this is the chief executive, in others it is the leader of the council or the chair of the board.
He went on to say, “I don’t aim to recruit the best candidate but the one the client will like the best. My reputation and that of the firm is based on being able to come up with someone I know the client will like.”
Self-perpetuating cycle
The right person is the one that will fit in; the one the client feels most comfortable with; someone the client could work with, who shares the client’s values, comes from a similar background; shares their sense of humour, interests, dresses like them and talks like them. It’s not hard to see how this would work against recruiting a diverse senior management team despite the rhetoric that might surround the recruitment process.
Of course the short list might contain a female candidate or a black candidate to show that the organisation was trying to address the existing imbalance, but no one is really surprised when these outsiders are beaten by the favourite.
So how do we reduce the risk of this self-perpetuating situation and get the best person for the post? Don’t use head hunters. Do use HR and have an interview panel that is balanced in terms of gender and ethnicity, which might necessitate involving people from outside the organisation on the panel. This would certainly lead to a more explicit understanding of what the panel is looking for in ideal candidate.
When it comes to recommending the best person or the right person for the post, head hunters will always go for the right person, which is why the public sector shouldn’t use them.
The drama of being a whistleblower
He didn’t know who he could trust. He was in a foreign country and didn’t speak the language. What was clear was that the chair of the board and the director of finance were involved. The evidence was undisputable.
First he made sure the incriminating documents were out of the country and in safe hands. Then he called an emergency board meeting. When he entered the board room everyone else had arrived early and was waiting for him. The chairman high-jacked the agenda and proposed his dismissal, which was agreed unanimously.
‘The classic public sector whistleblower is not a chief executive but a junior member of staff in a small nursing home’
They already knew and had chosen to protect the company and themselves. He was escorted out the building. He went straight to the airport and flew home. To protect himself while waiting for his flight he rang a journalist at the Financial Times and gave them the story.
It doesn’t get much more dramatic. This may sound like a Hollywood thriller involving a Japanese multinational company, a billion-dollar fraud, the Yakuza and what happens when a chief executive tries to blow the whistle – but it is a true story. Michael Woodford was a City high flyer who got the top job at Olympus only to discover a massive financial fraud.
In the public sector things tend to be less cinematic but no less traumatic for whistleblowers. The classic public sector whistleblower is not a chief executive but a junior member of staff and rather than a multinational company, the location is a small residential or nursing home for frail elderly people or people with a learning disability.
No guarantees
It’s not about exposing a multimillion-dollar fraud, though money and profit may play a part, but it is about power and abuse. While it may not be in a foreign country, the whistleblower may find themselves isolated and ostracised, not knowing who to trust. Because most staff live and work locally, there is every chance your children attend the same school, you shop at the same stores and drink in the same pub as those you have accused.
And their friends! There are no Japanese mafia connections but there can be poison pen letters, threatening late-night phone calls and nasty things through the letter box which are distressing and frightening.
‘Blowing the whistle is only the start. There is the struggle to be believed, then the fear of retribution’
It no surprise that the typical whistleblower is new to the workplace. In residential work, it is often a temporary member of staff such as someone brought in to provide short-term cover for sickness or holidays, someone who has worked elsewhere and knows the type of things that should not happen; someone who has no intention of staying, who knows a manager from outside the home who won’t ignore their concerns.
Blowing the whistle is only the start. There is the struggle to be believed, then the fear of retribution. An anonymous allegation may trigger an investigation but if no one is prepared to make a statement and appear as a witness it is difficult to mount a successful disciplinary case, so there will be pressure from management, as well as group pressure “not to get involved”.
Investigations and disciplinary action in these cases are notoriously drawn out. Staff are suspended, often for months, while an investigation is carried out and then, if there is evidence of abuse, while a disciplinary hearing is held.
At the end there is no guarantee those accused will be found guilty and dismissed, so they could be back at work alongside their accuser.
“Almost full”
Its an expression I first heard used by NHS colleagues. The question was, “What’s the bed situation?” The response was “Almost full.”
The manager tersely said either we are full and have no beds, or we are not full and have beds. But to the nursing/ward staff “almost full” meant they were rushed off their feet and did not want any more admissions.
A recent report informs us that the NHS is now permantly ”almost full“ and increasingly there are more days when it is full.
People can raise their game in an emergency but they can’t perform at that level indefinitely. Fatigue leads to mistakes, and being overworked and understaffed leads to a culture of doing things for the convenience of staff rather than the needs of patients. This in turn leads to indifference and poor care.
Concern that black staff are more likely to be disciplined
Not for the first time the NHS stands accused. This time it’s the Royal College of Midwives who have identified that black staff are disproportionately subjected to disciplinary action.
Earlier in the year, the Central Manchester University Hospitals Foundation was found guilty of racial discrimination, with the award of £1m to former manager Elliot Browne.
‘It is clear some organisations do not understand what institutional racism is or refuse to accept it exists’
Unite, the trade union that represented Browne, discovered that while 2 per cent of the workforce were black, they accounted for 25 per cent of people subject to disciplinary action. Why is the NHS disproportionately disciplining black staff?
This is not a situation unique to the NHS. Unions representing staff across the public sector have expressed concern about the disproportionate number of disciplinary cases involving black staff.
Is this to do with the nature of the jobs black staff do in the public sector? Are mangers and HR staff quicker to resort to formal process when a black employee is involved? Or do managers find black staff harder to manage? Whatever the reason, NHS trusts and organisations across the public sector will insist it is not racism.
Understanding institutional racism
This comes 18 years after the Macpherson inquiry into discrimination in the police first introduced the term “institutional racism”. It is clear that some organisations do not understand what institutional racism is or simply refuse to accept it exists.
“This organisation is not racist,” they say. “I am not racist, nor are any of my colleagues,” they say. “Just because black staff are more likely to be disciplined doesn’t mean it is because of racism. We don’t care what colour someone is we treat everyone the same.”
These are often the same organisations that resist collecting information on the ethnicity of their workforce. Not only who they employ, but who they promote and who they discipline.
Institutional racism is not the deliberate discrimination based on a belief that black people are less intelligent, less reliable, less ambitious or more aggressive. But it is based on a view they are different from white people.
‘There have been changes over the last 18 years but black people are still underrepresented in senior posts’
While such organisations claim it’s about appointing the best person for the job, what happens all too often is they seek to appoint the one they think will fit in, the one they feel most comfortable with; someone they could work with who shares their values, comes from a similar back ground, shares their sense of humour, interest in football, dresses like them, talks like them and is like them.
Long way to go
Likewise, when it comes to disciplinary processes there is a tendency to think people like them respond to a quiet word, people like them deserve a second chance, people like them learn from their mistakes. Whereas people who are different tend only to respond to clear boundaries and a formal response.
So what should an organisation do to guard against any tendency to discipline some staff more than others? First, recognise that institutional racism exists. Understand how it works, undertake ethnic monitoring because it is hard to argue against the numbers, introduce a challenge into the process to ensure the informal process has been exhausted.
Establish a consistent approach because it is just as damaging for some people to be seen as getting away with inapproproate behaviour as it is for others to be seen as being treated unduly harshly.
There have been changes over the last 18 years but black people are still underrepresented in senior posts. A male black manager is still likely to be described as “aggressive” when the same behaviour from a white colleague is called “assertive”. Black staff are more likely to describe their manager as unsupportive and in many organisations black staff are disproportionately subject to disciplinary action.
What's so hard about saying sorry?
What’s so hard about saying sorry and meaning it? The Health Service Ombudsman, Dame Julie Mellor, has reported that the NHS adds to the distress of patients by the way it responds to complaints.
Far too often, unclear explanations and insincere apologies result in dissatisfied patients and relatives taking complaints to the Ombudsman.
‘People would have more confidence in the public sector complaints system if they thought they were treated seriously’
Most people who complain simply want an apology or an explanation. They are not looking for compensation or for staff to be disciplined.
Complaints tend to fall into two categories: those about indifferent, unhelpful, uncaring staff; and those about the system that often seems to make no sense and designed to frustrate.
Blaming the system
Front line staff, be they doctors, nurses or social workers, are often equally frustrated by the system.They are sympathetic to patients and families but convey the message that changing the system is beyond their control, it’s not their fault and complain if you want but I doubt it’ll make a difference.
Managers have a tendency to focus on staff. If only people were better trained, if only we were better at recruiting the right people, if only it was easier to get rid of unsuitable staff − then things would be as they should be.
When I lost my bags at Gatwick airport it was clear this was not an isolated incident but a regular feature for those changing planes there. There is often simply not enough time to get bags off one flight and on to a connecting one. A delayed flight incurs a large financial penalty for the airline, so flights frequently take off without passengers’ baggage.
Clearly this is the fault of the system. You can always fly with a difference airline and use a different airport. The government would like it to work like this in the public sector.
Quick fixes
Sometimes complaining to the right person gets a quick fix. Before my father-in-law could leave hospital he had to wait for his drugs to come from the pharmacy. He waited and waited but the ward couldn’t say when the drugs would come. After a couple of hours sitting on a hard seat in a drafty corridor, my wife who had gone to collect him put him in a taxi and waited alone for the drugs.
‘Complaints are an early warning to management that things are going wrong’
She waited most of the afternoon, checking at regular intervals with the ward staff if there was any indication when the drugs would arrive. There wasn’t. She offered to go down to the pharmacy herself but she was told there was no point.
Eventually even her patience was worn out. Being a senior manager herself she understood there was no point blasting off at the ward staff, so she rang the hospital switchboard and insisted on speaking to the chief nursing officer. She explained the situation in a calm and reasonable way, resulting in a commitment to send the drugs by taxi later that evening.
In both cases there were clearly problems with the system rather than the staff.
Complaints present opportunities
People would have more confidence in the public sector complaints system if they thought complaints were treated seriously and resulted in changes to the system.
All too often, the impression given is if you make a fuss you’ll be viewed as a nuisance and if you make a formal complaint you’ll just get a standard response − an empty apology and a vague commitment to raise the issue with the staff concerned.
It doesn’t have to be like this. Complaints can be used as an opportunity to improve services. They can be analysed with a view to learning from them and making changes to the system.
Complaints are also an early warning to management that things are going wrong and that cost savings are having an unintended and unacceptable impact on patient care.
Protecting the NHS brand or devaluing it?
The NHS chief executive, Sir David Nicholson, has defended the appointment of a highly paid “head of brand”, saying that in the new era of increased private healthcare it was necessary to protect the service’s distinctive blue and white logo from unwarranted use.
Absolutely right. People trust and value the NHS; we don’t want some US private health company masquerading as our beloved NHS.
So why does he go on to say that with the growing number of private healthcare providers it’s important that they “understand what it means to be part of the NHS, the culture and the values, and treat their patients accordingly”?
‘Why we don’t we just adopt the successful McDonald’s business model? We could have an NHS university for healthcare managers’
When the chief executive of the NHS talks of protecting the blue and white logo, he seems to mean that we need to ensure any private company using it has signed up to the culture and values of the NHS.
Just like McDonald’s then. If you want to use their distinctive golden arches you have to sign up to their company values and treat customers accordingly.
Well why we don’t we just adopt the successful McDonald’s business model? We could have an NHS university for healthcare managers and the NHS distance learning programme for customer facing staff. Services are franchised but with strict compliance to size, colour and location of logo − and of course the NHS’s company values.
Have a nice day now.
Stairlifts on cell block H: who cares for older prisoners?
The photograph was of a frail man in a wheelchair handcuffed to a prison officer. The article and accompanying photograph appeared in The Guardian highlighting the problem of caring for the increasing numbers of elderly and disabled prisoners.
The story focused on the comments by the hospital consultant who criticised the care provide by the prison service claiming it has severely damaged the patient’s health.
Concerns over the care of elderly and disable prisoners however is not new. A number of reports over the last two years such as the survey by Prison Governors Association have highlighted growing concerns over social care in prisons.
‘In the US, where life means life, the problem of elderly prisoners has been around for a long time but it is a relatively new feature of British prisons’
Prisons are experiencing a growth in pensioner prisoners and in the absence of support from local authorities and primary care trusts they are using other prisoners to provide personal care.
In the US, where life means life, the problem of elderly prisoners has been around for a long time but it is a relatively new feature of British prisons. The over-60s are the fastest growing section of the prison population.
Kingston prison in Portsmouth is the first in the country to provide a specialist “elderly wing” equipped with stairlifts and other adaptations. Others will undoubtedly follow as the numbers grow and the inappropriateness of mixing frail elderly and disabled people in with the general prison population is recognised.
The numbers and percentages of prisoners with a disability varies. Prison data records record a figure of 5 per cent – around 4,500 prisoners – but a Ministry of Justice survey earlier supports inspection finding of 19 per cent. Clearly not all these prisoners are profoundly disabled and not every prisoner over the age of 60 is physically frail and in need of care, but clearly it is a growing problem.
Who should care?
Who should care for frail and disabled elderly prisoners? Prison officers say it is not part of their job to wash, dress, feed and toilet prisoners. Prison governors think the NHS should provide nursing auxiliaries as the health of prisoners is the responsibility of the NHS.
Health service managers think local authority social services should provide care arguing that if they were in their own home or sheltered housing they would. But they are not so they won’t.
‘Prison officers say it is not part of their job to wash, dress, feed and toilet prisoners’
So who does? Well other prisoners do which is neither satisfactory nor appropriate.
Budget cuts across the public sector are likely to entrench views about whose responsibility it is to fund the care costs of elderly and disabled prisoners.
In the meantime more elderly and disabled people are appearing before the courts. It is not clear whether this is because older people are committing more offences or whether the police and courts have adopted a harsher attitude towards older people breaking the law.
Whatever the reasons for more elderly people finding themselves before the courts the growth in the number of elderly and disabled people in prison presents a challenge to the NHS, the Prison Service and social services. A challenge which despite all the talk of collaboration and cooperation remains just that - talk.
Better to seek forgiveness than ask permission
Have you a management philosophy? Mine is if its not explicitly against the rules then I can probably get away with it.
As a senior manager I told a large gathering of managers that they should not be asking HR or finance for permission to do what they wanted to do they should ask for advice and then accept or reject it. This caused a bit of a stir around the room especially as the HR and finance directors were sitting next to me on the conference platform!
Just to ram home the point I said it’s your decision not theirs, you are responsible for your staff and your services.
‘You decide because you are responsible, but be prepared to justify your decision’
Some weeks later I asked a manager why they had made a rather controversial decision against the advice of HR. They replied that at the conference I had said they didn’t need HR permission to do what they wanted, it was their decision so they decided. Very good I replied but what was the reasoning behind your decision? Well this member of staff has always been difficult so I told them either do it or you won’t have a job.
The next time I gave my speech to managers I emphasised you decide because you are responsible but be prepared to justify your decision and it won’t be acceptable to say well HR/Finance told me to.
The head of HR liked this version much better.
Winterbourne View was shocking but hardly surprising
Shocked that you can get sent to jail for shouting at someone, calling them names and slapping them. Shocked because they have done the same, witnessed others do it, and worse, shocked because they don’t consider themselves bad people.
Are we really shocked that such totally unsuitable people are appointed to care for adults with learning disabilities? Are we shocked that unqualified, partially trained, inadequately supervised staff develop their own ways of controlling people? Are we shocked that staff work long shifts with minimum staffing levels? Are we shocked that a small group of individuals can come to dominate and control the staff room? Are we shocked that people choose to stay quiet rather than report what’s going on?
Are we surprised that people with a learning disability are unable to say what’s happening to them? Are we surprised that when they do they are not believed or are considered unreliable witnesses? Are we surprised that those who are bullied, ill treated and abuse may in fear and anger lash out or be uncooperative? Are we surprised that people placed a long way from home have fewer visitors and therefore fewer people to speak up for them? Are we surprised that inspection visits don’t catch staff abusing residents/patients?
Are we upset to see people treated so cruelly? Has this type of abuse happened before? So we are shocked but not surprised.
Blair McPherson author of UnLearning management published by Russell House. Follow Blair on Twitter @blairmcpherson1
Harassment has not gone away
The whole Jimmy Savile scandal has made people think about sexual harassment at work.
The workplace has changed since the 70s and 80s and many people assumed that even if there is still a pay gap between men and women sexual harassment was a thing of the past, but it is still a problem.
Sexual harassment continues to be a subject difficult to speak out about. This is despite the fact that public sector organisations have explicit procedures for tackling complaints and – in theory at least – a no-tolerance policy.
‘If you are a victim of sexual harassment, homophobic bullying or racism who do you turn to? Not your line manager’
So if you are a victim of sexual harassment, homophobic bullying or racism who do you turn to? Not your line manager because they are either the perpetrator or they have ignored the behaviour or dismissed your concerns as an overreaction or a personality conflict. Not HR because the first thing they will do is tell your manger, and in any case HR just want to protect the good name of the organisation. You will probably try and ignore it while looking to leave the organisation and you will feel very stressed. You may go off sick with the stress of it all, at which point your manager will instigate disciplinary action for poor performance.
It’s often at this point that people approach their trade union.
Shifting the balance
A trade union evens up the power imbalance between the employee and their manager. A trade union rep will get a positive response from HR. And if the situation can’t be resolved informally with a four way meeting then the trade union will guide and support you through the formal process.
From this point on it is no longer just about you and your manager. The circumstances will be put before a more senior manager, you may still not get the outcome you want but as senior manager who has heard dozens of grievances the support of your trade union will guarantee exposure to a wider audience.
As a senior manager I thought and continue to think the involvement of a trade union is a good thing. Some managers are weak and guilty of failing to challenge unacceptable behaviour, inexperienced mangers can fail to spot the underlying sexism/racism/homophobia and dismiss the complaints as a personality conflict. And a small number of mangers behave in a totally unacceptable way. It is difficult to see how even the strongest commitment by senior management and the clearest policies and procedures could be effective if it is left to the individual to challenge their manger unsupported.
In a pickle
I am therefore very concerned to learn that local government secretary Eric Pickles is encouraging local authorities to reduce the time they allow employees who are trade union reps to spend on union business. Pickles rallying cry is to let the unions pay for their own staff. This is in response to the established practice of giving union reps time during their working hours to help their members.
I don’t believe any organisation can be serious about tackling sexual harassment, racism or homophobic bullying if it does not give its employees access to the type of support they need to use the procedures that are intended to stop this type of abuse. That support cannot come from the line manager if they are the perpetrator or if they have already failed to act. It cannot come from HR as they are also advising management, but it can come from an experience and appropriately trained trade union rep.
There is a saying than an organisation gets the trade union it deserves. Well what sort of an organisation has grand sounding policies, clear and robust procedures yet makes it difficult for staff to use them?
The shocking truth about anonymous comments
You will often find on HSJ, and other professional publications, people responding to articles anonymously. Those who don’t put their names to their comments are invariably being rude, offensive or cynical.
I am often shocked that professionals, or those who read professional journals, would express themselves in this way. I can’t imagine they talk like this to colleagues in the office - people just wouldn’t put up with it. Maybe they have a moan over a drink in the pub but you really would have had a very bad day to be so vitriolic.
Of course the articles in question are often intended to be provocative, defending unpopular changes or advocating a more commercial approach in the public sector. There are strong feelings around in the public sector at the moment and there is nothing wrong with being opinionated but the anonymous responses are not just anti-management or anti-public sector, they abuse all managers as overpaid, arrogant, bullies and liars and dismiss all public sector employees as lazy, incompetent and over protected.
What must the state of industrial relations be in some NHS trusts for employees to be so hostile towards their managers? Why do people read HSJ or The Guardian if they think public sector employees should ”try working in the private sector as they wouldn’t last five minutes”.
These threads often squeeze out passionately argued commentary and discourage the reader. Online comments from Inside Housing are in response to issues raised by tenants and the anonymous replies are, judging from their content and tone, from disgruntled tenants or disaffected staff and often degenerate into trading insults.
I believe all online users should identify themselves before posting because if you’re not prepared to put your name to it you shouldn’t be saying it. No doubt some people will say that they can’t put their name to anything critical of their organisation for fear of reprisals. Of course if you publicly call your manager a liar and a bully then you can expect to have to explain why you are saying this in a national publication rather than through recognised internal grievance procedures.
Nor is this the medium for whistleblowing. Just like old-fashioned letters to the editor comments can be posted with the name withheld from publication but that of course gives the power of what appears to the editor.
I believe you can make a passionate argument challenging changes, calling into question management culture, drawing from your own experience to contradict statements but using the same language and tone that would be expected in a face to face discussion.
My concern is that what I am reading is how some people speak to other people.
Culture is as intangible as the air we breathe
Senior managers are fond of saying we need to change the culture of the organisation.
They are saying it now in response to the introduction of commissioning and greater use of the private sector in the NHS. It has been repeatedly stated in local authorities as part of efficiency initiatives and outsourcing services. Now I hear it said in relation to the culling of posts and the focus on competence in the civil service.
Commentators have expressed concern about the macho management culture in the NHS. Trade unions have complained that public sector employers have adopted a more confrontational culture in response to a harsher financial climate. Yet ask a manager about the culture within their organisation and they will struggle to define it other than a rather cynical reference to a “blame culture” or a “performance culture”. Most employee seem to be unaware of their organisation’s culture.
The simplest explanation of culture is the way we do things round here. Certainly there is a lot of time and energy going into changing the way the NHS does things, what local authorities do, don’t do and get others to do and how the civil service will do things in the future.
However culture isn’t so much about who does what, it’s about a set of values and beliefs, how we behave towards other organisations, are we about competition or cooperation are we about quality or cost, effectiveness or efficiency, niche markets or wider population.
As an old fish said to a young fish: “What do you think about the water you’re swimming in?” And the young fish replied: “What’s water?”
Equal opportunities under the new CCGs
The first week in October is a landmark for the NHS.
This is the week when the new NHS commissioning board takes on its new responsibilities.
The board has a massive budget of £60bn, most of which will be given to clinical commissioning groups for them to plan and pay for their population’s health needs.
There are 212 CCGs across England made up of GPs, nurses and hospital doctors. Will they be any more successful than the primary care trusts they replace at meeting the needs of people with a learning disability, people with mental health problems and older people? Will they be able to gain the confidence of the gay community?
‘The NHS has been slow to recognise the equality opportunity agenda in relation to service delivery and community confidence’
Will they find better ways to improve access to healthcare for gypsies and travellers? Will they get the equality agenda or adopt a “we treat everyone the same” approach? And can this be achieved at the same time as delivering £20bn of efficiency savings?
The NHS has been slow to recognise the equality opportunity agenda in relation to service delivery and community confidence. This responsibility will now presumably be taken over by the CCGs.
These will need to more explicitly recognise that health equality and shorter live expectance amongst gypsies and travellers or other minority groups is an equal opportunities issue. The poor healthcare provided to people with a learning disability is a disability equality issue.
Accessibility of services
The reduced spend on mental health services when other service budgets have not been reduced is a disability equality issue. The fact that older patients have been receiving a poorer quality of hospital care is an equality issue.
The equality agenda includes gaining the confidence of all sections of the community that their needs can be met. The closure of hospitals to save money and centralise specialist services may have some professional support but is strongly opposed by communities and is hardly designed to gain their confidence.
Certain groups will feel that having to travel further to receive a service makes it less accessible to them. Accessibility of services is indeed an equal opportunity issue.
The new equal opportunity agenda for the NHS is about considering the impact of budget cuts, service reductions and new commissioning arrangements and ensuring that these do not disproportionately affect people already subject to discrimination and disadvantaged through race, faith, disability, gender, age or sexuality.
This starting point is willingness to acknowledge that if we are making staff redundant rather than recruiting new staff, reducing services rather than increasing them, narrowing who can receive help rather than broadening it out or privatising services, then there may be a negative impact on equality of opportunity.
Blair McPherson author of An Elephant in the Room, about delivering equality and diversity in the public sector published by Russell House
Stampede for the exit
I am one of those people who says “I told you so”. The NHS Commissioning board has identified that it is struggling to find suitable people to fill its senior vacancies and there is a risk of posts remaining vacant.
The NHS reforms have so far cut 18,000 senior posts. The determination to reduce the management headcount, the uncertainty about future posts and structure, the macho management way in which existing posts and structure are being discarded, and a belief not discouraged by high-ups that future redundancy and early retirement packages will not be so generous has led to a stampede for the exit.
It has been the older senior managers who have gone, these are also the ones with most experience and while not always in tune with the agenda they have knowledge and skills that cannot easily be replaced.
This was entirely predictable. HR Directors across the NHS will and have identified this risk, mangers will have warned against it and unions foretold it.
Unfortunately this is typical of how a politically driven change is forced through. It is the big bang approach, because that’s the best way to deal with resistance. This is a familiar and costly pattern in the NHS. The previous big restructurings in the NHS – the introduction of PCTs and the restructuring to fewer bigger PCTs – saw huge amounts spent on redundancy and early retirement packages for directors and chief executives.
These costs were hidden in what was claimed to be efficiency savings. Well they would have made savings eventually if they didn’t keep being overtaken by another restructuring!
Did she jump or was she pushed?
The suspicion is that, if not pushed, they were encouraged to jump. Those less familiar with how things work at the top may be surprised to learn that whether they jumped or were pushed the issue was almost certainly not one of competence. In such cases the words whispered are confidence, trust and loyalty - as in the board no longer had confidence in them, they had lost the minister’s trust or their loyalty to the department/organisation was questioned.
Confidence, trust and loyalty are words used to describe a relationship with your boss or the board. The individual’s skills or abilities are not being called into question - neither is their professional judgment.
Is what makes women jump different to what makes men jump? In my experience a man jumps because he no longer has the support and trust of his boss or the board; a woman jumps because she believes she can no longer do the job. The two may be related but they are different. A man would never resign because he didn’t think he was up to the job. Men in senior posts have a tendency to overestimate their abilities, which means they are often over-confident and will likely see this set-back more as a reflection on their boss or the board rather than them. In my experience of mentoring women they tend to need some encouragement to apply for senior posts as they are more likely to focus on the gaps in their experience and skills and question whether they are truly equipped to do the job. Men tend to take the view that if they give me an interview they must think I can do the job. So a woman doesn’t jump because others think she should but because she thinks the circumstances make it impossible for her to do the job. One is resigning because the boss is a “fool”; the other because the boss won’t let them do the job the way they believe it should be done.
I am probably over-stating the differences. I acknowledge that to get the top jobs women may have to behave more like men do, but never the less I believe there are differences in how men and women approach their careers, why they apply and why they jump.
Blair McPherson author of An Elephant in the Room about delivering equality and diversity in large complex organisations published by Russell House, www.blairmcpherson.co.uk
How to be successful at interview
This very experienced former director who was advising the interview panel was giving us a little pep talk. She said, “you are the type of people who are used to success. You have no doubt got every job you have ever gone for”. She went on to say that at this level most people take two or three attempts before they are successful and not to be discouraged by the fact that three of us were going to be disappointed. She meant well but I was still dwelling on the revelation that my competitors for the post had always got the jobs they had applied for. This wasn’t my experience.
It took me three goes to get my first management post. My big break came after the disappointment of not getting the area manager job I desperately wanted - and felt I was well qualified for. On the rebound I applied for and got a project manager post which I was not well qualified for but was more qualified than the only other candidate.
I only lasted 18 months in my next post having told the head of HR that the tail should not wag the dog, the chief executive decided to back her and get rid of me. The next move was therefore a sideways one. After several attempts I got an assistant director post, which I hated - not the job itself but the person I was working for. I applied for a number of director posts, travelling up and down the country, including one disastrous venture into Wales. Banging in an application form was no problem but the selection process was gruelling - in tray exercises, group discussions, role play, a buffet with representatives from the voluntary sector, the NHS and councillors, plus “tests” - just to get through to the all important interview. I went for a deputy post as a stepping stone and got it. I loved it. I had the most productive period of my career marred only by my persistence in seeking a directorial post.
My point is this: at every stage, I had a lot of painful rejections, unsuccessful interviews and mostly unhelpful feedback. I was not one of those people who went for the top job in the knowledge I had always got the jobs I applied for. I always went into an interview thinking “well, if I have got this far I am in with a chance”. I always believed I was appointable because I was good at what I did.
So what has my experience taught me? Persistence pays off. Don’t fall out with the head of HR or chief executive. Your track record gets you an interview but not the job. You do get better at interviews because they tend to ask the same questions. And the best approach at interview is to be yourself. I could have played the game and told them what they wanted to hear but when I did this I got jobs where people didn’t want me to be myself and I couldn’t keep up the act. Of course being yourself makes the rejections all the more personal.
Blair McPherson, former Director in a large local authority and author of Equipping managers for the an uncertain future and People management in a harsh financial climate, both published by www.russellhouse.co.uk
Un-learning leadership in the NHS
Alternatively a despot who sees debate as decent and questioning as disloyalty - sometimes described as a strong leader often criticised for encouraging a macho management style. An organisation can only have one such leader. Yet increasingly it is recognised that transforming the NHS requires managers at every level in the organisation to show leadership skills to take responsibility, rather than to say ‘I’m only the message’. To be able to describe how things will look different in the future and explain the part their staff have in shaping that future, managers who understand the impact their behaviour has on others and who have good people skills are vital.
The NHS chief executive Sir David Nicholson recently spoke of the need for a new management style in his address to the Kings Fund Summit on Leadership. This came only days after the Institute of Leadership and Management (ILM) called for a more inclusive approach to management. In both cases the concern was that unless managers raised their game, the NHS would not deliver the biggest changes in its history.
Chief executives all too often don’t encourage and don’t get direct feedback on their own performance. We are all familiar with the unedifying sight of senior mangers “dancing around” their chief executive, meaning that they tell them only what they want to hear, filter out the bad news and wouldn’t dream of telling the boss that their focus on the big picture means they are missing some important detail or that their determination and enthusiasm is inhibiting people from asking legitimate questions for fear of appearing disloyal or not on-board.
The chief executive and their senior management team can model a more inclusive management style but they will need to do more than this to convince the wider staff group that imposed change and autocratic leadership is a thing of the past.
Changing the management culture throughout an organisation is a big task; it is not a one off exercise, it is a journey that will take years which of course is not what the board, the senior management team or those at the DH want to hear. However if you want to learn how one large, complex public sector organisation went about it then there is a detailed case example in Equipping managers for an uncertain Future published by Russell House.
Blair McPherson is author of numerous articles and several books on leadership and management www.blairmcpherson.co.uk
No U in team
I am sure I am not the only senior manager to discover that a member of their team is telling colleagues in partner agencies that they don’t agree with the approach the team is taking and don’t think you are effective in dealing with poor performance. Such behaviour is disloyal, disrespectful and a betrayal of trust.
The talented individual can be a mixed blessing. When they are the focus of admiration and everything is going well then they are forgiven a lot because of their ability to deliver, but when things are going wrong their constant criticism of those less gifted and less committed can be very destructive. It is even worse when they take their disparaging comments and snide remarks outside of the team.
In the work situation your most talented member of the team can start playing up if they think their skills and abilities aren’t getting the recognition they deserve. Not only did they think they should have been on the high profile working group they were rather hoping/expecting to be chairing it but being overlooked displeases them and they are only too willing to tell anyone who will listen why they would have done a better job than those selected.
When someone has to drop out you decide to replace them with the over confident, opinionated and occasionally abrasive but very talented colleague. This upsets group members who by now are aware of their colleague’s assessment of their skills and abilities. Having been invited to join the group this individual “respectfully “ declines on the grounds that he doesn’t think that he can rescue the situation at this late stage and doesn’t want to be associated with the failure.
As a manager you have to decide whether the individual’s talents and value to the team are such that you are prepared to put up with their ego and disloyalty. We all know where Sir Alex Ferguson stands on this but not all of us are in as strong a position. In the end, it’s ego or you go.
Blair McPherson author of Equipping managers for an uncertain future and UnLearning management both published by Russell House www.blairmcpherson.co.uk
Do extroverts perform better at interview or do they just think they do?
It has long been recognised that in western society there is a cultural bias towards extroverts, especially in the workplace. A new bestselling book by the US author Susan Cain has given the debate a new twist in light of the banking crisis. She claims that extroverts are more prone to risk-taking in business and that businesses have become increasingly dominated by extraverts, and that society, the economy and individual businesses would benefit from a better balance between extraverts and introverts.
In many ways this is stating the obvious in that so far as you can divide the population into extroverts and introverts business does need leaders who can sell the vision, who are decisive and prepared to take risks but they also need managers who are thoughtful, strategic and cautious. In my experience successful leaders have both these sets of qualities and the skill to know which to use when. However from my experience of both interviewing for senior posts and being interviewed for senior posts the interview process seems designed to favour the extrovert.
The interview process for senior posts is typically a protracted affair. First there is the longlisting interview which is an informal chat with the headhunter. There will be questions about your experience but they already know this from your detailed application form, this part is as much about how you present yourself as it is your skills and experience. So how firm is your handshake, do you appear relaxed and confident, do you come across as too serious and intense?
If you are shortlisted you can expect the trial by sherry, the presentation and the formal interview. The trial by sherry can be a buffet where all the candidates are present and expected to circulate around a roomful of interested parties making polite conversation and a good impression whilst balancing a plate of food in one hand and a glass of wine in the other. Alternatively it can be a formal sit-down meal in which candidates changes places between courses so that each member of the board can have some time to talk to you.
The presentation is on a topic given in advance, it is not, as many candidates assume, a test of knowledge. It is about the ability to communicate complex issues to a diverse audience. After all you would not expect to be able to do justice to a question on ensuring the business remains financially sound during the current financial climate in the 10 minutes you‘re allocated.
Finally there is the formal interview in front of the whole board/cabinet in which each person gets to ask their two questions. The interview is only allocated 45 minutes because there are six candidates and the interview panel’s diary commitments mean the interviews have to be completed and appointment made by the end of the day. Despite the varied and often slightly off the wall questions the only real question they are seeking to answer is can they see themselves working with you. Hence the advice given to me by my boss prior to the big interview, “Smile, Blair. You need to smile more”.
I think if is fairly obvious from that description of the process that it favours extroverts. My experience as an interviewer giving feedback to unsuccessful candidates casts further light on the differences: extroverts always thought they had performed better than they had, often being overconfident and confusing having a lot to say with having something to say.
50 Shades of management
Grey suits, grey hair, grey is the colour of management. Grey comes in many shades from the gravitas of silver grey to deceit of dark gray. Like shades of gray subtle differences in management behaviour distinguish pain from pleasure. How else would you describe the rollercoaster ride that is senior management recruitment: the frustration, the anticipation, the pain of rejection the joy of success? How would you describe the annual appraisal but a game of tease – maybe I will, maybe I won’t give you that bonus. I know you want it now, convince me you deserve it. What is a management restructuring but a way of gently but firmly forcing you to adopt a new position, moving you out of your comfort zone, testing your flexibility and willingness to please? And through it all you must convince that your passion is undiminished.
These one-offs can be satisfying but have their limitations, for prolonging the agony it is hard to beat the cuts. Even the most experience manager can be taken by surprise at just how far these can go.
Blair McPherson is the author of UnLearning management and other books on whipping people into shape www.blairmcpherson.co.uk
Is trust really the be all and end all of leading?
You can’t be an effective leader if you don’t have the trust of your peers and the public. That is according to chair of the Royal College of General Practitioners writing in the Health Service Journal.
I suppose that depends on what you mean by effective. But if you mean get things done well many chief executives are not trusted by their staff or sections of the public but have deliver service reorganisations and dramatic budget cuts. This is a classic case of those who believe that major change is achieved through winning hearts and minds and those who say grab them by the balls and the rest usually follows.
It seems to me that the management culture in the NHS has always tended towards the authoritarian style of leadership and that in times of budget cuts and weaker trade unions persuading people that this is the right thing to do is less important than getting on and doing it. In any case winning hearts and minds assumes that the changes being proposed can be shown to be for the better, they will result in more flexible services or services that better meet the needs of patients/service users.
Even if these changes are less convenient for staff, involve unattractive or longer hours of working, relocating or learning new skills they are harder to resist if they can be show to be better for the patient. But if they can’t be shown to be an improvement, if those doing the work say this will lead to poorer services, if professional and patient opinion is united in opposing the changes, if the reason for change are simply to save money then the leadership task is not to win hearts and minds but just get on with it.
The hearts and minds brigade will claim the leadership task then is to engage people in establishing how to live within reduced means, to make cuts that are fair not arbitrary. The pragmatists will say reductions of this magnitude can’t be achieved by salami slicing a little bit more off everywhere but requires closures, redundancies and out sourcing. These actions are not about fairness but about affordability so there is little scope for debate.
If trust is about believing those in charge will do what’s best for the service or the patient/ service user then it is hardly surprising it is in short supply but that doesn’t mean leaders aren’t delivering. Effective leaders deliver - it’s just that in the public sector what they deliver isn’t always what the customer wants.
A death in a hostel
There was a time when Social Services inspected their own homes, a time before whistleblowing procedures, a time when complaints from relatives were trivialised. The absence of damming inspection reports, scandals and dismissals did not mean abuse was not going on, just that it was too often undetected.
Every senior manager has their skeleton in the cupboard, the mistake they made early on in their career which they hope will never catch up with them. And every so often something happens that reminds them that it could have all gone badly. For me it was reading about a murder investigation in a hostel for old men. One I had management responsibility for - even if it was only for a few months.
Where do elderly gentlemen of the road go when they are too old for sleeping rough? Your average old people’s home doesn’t want an elderly alcoholic who can be abusive and threatening to staff and residents, someone whose chaotic life style means they don’t respond well to communal living, bath rotas and bingo nights. The first time they push past a frail resident knocking them over, take a swing at a member of staff for suggesting a change of clothes or are abusive to a visitor who declines to give them a “couple of bob for a pint” then the manager wants rid of them.
At one time most large local authorities had somewhere that would take these difficult old men. The authority I worked for had a place that was run more like a hostel than an old people’s home. It was a men-only establishment for those too frail and vulnerable to survive on the road or in a homeless hostel, but too socially unacceptable for an old people’s home.
The manager of the hostel was very popular within the department. He boasted no one was too difficult for him and his staff to manage and he had a reputation for never having refused to take anyone.
The hostel was near the city centre and on my patch. I was responsible for a number of large older persons’ homes in the area but not this specialist unit. I was asked to take over management responsibility on a temporary basis following the departure of the line manger and a recruitment freeze pending a management restructuring.
The hostel did not look like any of my other homes and was definitely not homely. The manager explained that the spartan feel was both a practical necessity and how the men preferred it. There were no carpets, no pictures and plastic mugs and plates. In the communal area there were plastic chairs arranged against the wall waiting room style and a battered, old, second hand settee with armchairs full of cigarette burns.
“We throw the stuff out every six months because of the smell”, the manager informed me. He had a reputation as a hard man but his staff were loyal and most had worked there for years. His confrontational style with the men was considered appropriate in view of their behaviour. Not everyone agreed and one new member of staff lasted only a couple of weeks saying he did not like the way staff spoke to residents but wasn’t any more specific. It was rumoured that the manager would intervene if there was an altercation between residents or a resident and a member of staff by grabbing the offender by the lapels and threatening to throw them down the stairs.
I did raise this with my manager and his advice was to make some unannounced visits rather than listen to rumours. So over the next few months I called in on a regular basis and always walked around the building speaking to whoever was about. I never witnessed anything untoward but the place had an unpleasant atmosphere. The manager always seemed to be there no matter what day or time I visited.
I didn’t rock the boat, despite my misgivings, after all I was only covering for a temporary period and the place had been operating like this with this guy in charge for years. Never the less four or five years later and by now I am an assistant director in another authority and I read in the local press of a murder investigation due to the death of a resident following a “fall” down stairs. I fully expected to get a visit from the police.
At first it was assumed that another resident may have pushed the victim but then the manager was arrested and the police statement referred to a series of suspicious deaths over a number of years.
I was never contacted by the police or my former employer. Maybe the period under investigation did not cover my time in charge. There were no more reports in the press so I assume nothing came of it - but I did hear the manager had left and the hostel was now run by a housing association.
Who cares what they think?
“Who cares what they think, they will only use the opportunity to moan.”
You can’t imagine a group of senior managers saying this about customers but they say it about their own staff. And if they say it about staff, do they think it about customers?
Is this why customer care and employee engagement, whilst given plenty of lip service, never seem to deliver the promised transformation?
Customer care and employee engagement are both promoted as the way to turn a failing organisation into a successful organisation, an ordinary organisation into a world class organisation the thing that the best organisation have in common. Both good customer care and effective employee engagement seem to be common sense and both are backed up by extensive research. Yet they are the exception not the norm. Why? Could it be that the energy, commitment and skill to make it a reality just isn’t there?
When it comes down to it do the senior managers who set the tone and the priorities really think it’s worth the effort and the hassle? Do they want to expose themselves to negative feedback? Who can blame them if they don’t? In the current financial climate with service reductions and redundancies there is no good news and no friendly audiences. Who wants to stand at the front of a packed hall defending library closures, who wants the thankless task of telling angry relatives that “we can’t afford to keep this day centre open”, who wants to be the focus of public hostility? And it is no less uncomfortable addressing staff who face redundancy, redeployment and a pay freeze.
User satisfaction surveys and staff satisfaction surveys were intended to provide evidence that for the majority of people we were getting it right and that where we weren’t we had a good story to tell.
The difference between organisations now is how they give the bad news to customers and staff. Are the consultation meetings with service users fronted by councillors or officers? A local authority committed to customer care can’t leave it to frontline managers to defend the council’s decisions.
If leaders within the organisation talk about standing on a burning platform to convey the need for urgent dramatic action, they imply that there’s no time to waste on debate. If they claim their decision is a no brainer, they mean we have no choice however unpopular or unpalatable, and if they talk of ”turkeys not voting for Christmas” they mean people will never agree - so no point in asking them.
If the chief executive is of the view there is no point in discussing this with staff because we already know what there response will be then the message is clear: we don’t care what you think.
Lessons for the care industry from the car industry
The car industry and the health care industry have much in common. Both deal in body parts, and what are surgeons but mechanics, hospitals mere repair shops and people “soft” machines? Both seek to remove demarcation from the factory floor/ward, both claim staff must change if the business is to survive and both must compete for business. Both are striving to be more efficient. Soon both will seek to make a profit and staff will only be motivated by bonuses.
This was the thrust of a recent article in the Health Service Journal which claimed the car industry had much to teach the health and care industry.
The piece, written by Unipart chief executive John Neill, compared the NHS to the car industry before it became a leaner more efficient and more competitive industry. Like the car industry then, the NHS now is in denial about its efficiency. The author claims that if Unipart was run like the NHS it would go out of business tomorrow. The car industry and Unipart were forced to acknowledge that they were nowhere near as efficient as their competitors nor were they as good at assuring quality. The industry need to remove demarcations, change working practices and adopt a “leaner” approach. We are told it was hard but with strong leadership and a lean approach the NHS could also become a successful (profitable) industry.
What struck me most about this was the online responses from readers. They agreed.
Admittedly those responding did not appear to be surgeons, nurses or other medical professionals but they were clearly people who worked for or with the NHS. Where I would have expected people to mock such an inappropriate comparison, to ridicule the idea that the factory floor was like a hospital ward and to say the only place for a “lean” approach in the NHS was in treating obesity, instead the ideas were described as having merit.
It seems that in some parts of the NHS people have accepted without question the proposition that health is an industry and that if hospitals were run like private sector companies they would be more efficient. It is apparently irrelevant to this argument that hospitals are about treating the sick not making a profit. It follows therefore that management techniques used in the private sector can and should be applied in the NHS. Neither does the motivation of staff seem to be an obstacle to this approach even though the car industry is known for a pay system based on “piece work” and bonuses and where as doctors and nurses don’t receive payment by results. Not yet anyway.
Remember this article didn’t appear in the Daily Mail. Worryingly, the HSJ thinks that the ideas expressed are worthy of publishing and of even greater concern has been the readers’ response. Maybe the doctors, nurses and other medical professionals just think these ideas are too daft to warrant a response.
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I can’t get no satisfaction
When is customer satisfaction not an indicator of quality? When they are NHS patients. Well that seems to be the thinking of the government in response to a dramatic drop in satisfaction with the NHS. The Kings Fund has just published its analysis of the annual British Social Attitudes survey and it shows that satisfaction with the NHS has fallen from 70 per cent last year to 58 per cent. The government claims this drop in satisfaction is not evidence of a drop in the quality of service.
They may have a point: patients may still be positive about their experience of the NHS whilst the cross section of the public surveyed may be reflecting the general anxiety about the big changes planned for the NHS despite opposition from all sections of the medical profession. This might be the explanation but why would there be such high levels of concern if, as the government claims, the changes have the support of the majority of the public?
We shouldn’t be too surprised at the reaction of government ministers, their advisors and senior managers in the DH. After all this is a typical response from senior management across the public sector to “disappointing” feedback from customer satisfaction surveys. Let’s face it most public sector organisations are not really that convinced of the value of customer satisfaction surveys. They are useful if they confirm services are improving but not very “helpful” when they don’t. After all if waiting lists are getting longer, staffing levels reduced, libraries and day centres closed and home helps with drawn then people are going to be unhappy.
You can see why the senior management team might suggest to the board that the expensive annual customer satisfaction survey become bi-annual in the future or even suspended during this exceptional period of austerity, service reforms and organisational transformation. After all the government stopped funding the annual Social Attitudes survey last year!
Hiring and firing at will
I would have sacked a lot more people if I could have got away with it. If this government has its way then in the future managers will be able to fire at will. Under a raft of proposals it is claimed will stimulate jobs and make our economy more flexible, employers will be free from the threat of being taken to an industrial tribunal for unfair dismissal.
Basically employers would like to employ who they liked and fire who they liked so a “no fault dismissal” would be very helpful. Of course you can fire someone for gross misconduct, fiddling their expenses, accessing pornography on their work laptop etc, but it is a far more lengthy process to get rid of someone who is simply incompetent… and then there are those people who are just “difficult”, who ask awkward questions and are cynical about management motives.
Life would be a lot easier if we managers could just say “sorry we don’t want you anymore“ and not have to make up some reason to justify it to HR.
I heard a colleague say it would be just like extending the probationary period say from six months to two years or indefinitely. Well I hope not because getting rid of someone at the end of their probationary period can be hard work unless you have been taking them to task at regular intervals and kept a detailed record of what they were doing wrong and what they had to do to improve.
You can’t just say at the end of the probationary period: “look you really haven’t impressed me, I don’t think you are going to fit in here so we will not be extending your contract.”
Whereas this no fault dismissal would allow you to do just that whenever it suited. It would make reorganisations and restructuring a lot easier and staff would be a lot more co-operative.
If no fault dismissals had been in place when I was a senior manager in local government I would have sacked a lot more people. Mind you if it had, I probably would never have made it far enough to do so!
Change management, and changing definitions
Knowing the meaning of the word manager
Management covers a range of activities: managing budgets, managing information, managing buildings and equipment. But you are not a proper manager unless you manage people. People are challenging, they can be difficult and uncooperative, some people behave badly at work and some are not competent at their job. People get sick at inconvenient times, have lives outside of work, children, elderly relatives, unhappy marriages - all of which you must take account of as a people manager.
Even so some managers are more administrators, others more leaders. The difference is whether you’re trying to run a smooth operation or shake things up. In the current harsh financial climate all managers are expected to manage change. The changes may be to reduce costs, increase efficiency or to run the service with fewer managers. All of which will involve getting people to do things differently.
Whilst you’re busy cutting management posts you are also acquiring a broader span of responsibilities. The result is that your professional background is less relevant and your managerial skills are more valued than your professional knowledge.
Now you’re a manager that manages change but in this climate of pay freezes, increased pension contributions and redundancies can you inspire staff or is it enough that you get them to do what needs to be done?
Didn’t I read that another difference between managers and leaders was that leaders ask questions? Yet in many organisations asking questions can be seen as dissent, even disloyalty. So you can call yourself a manager, but expect means something different these days.
Knowing the value of doing something for nothing
As a parent you will have had that discussion with your child where you ask them to do something that is not one of their routine chores - cut the grass, wash the car - and they respond by asking you: “how much will you give me?”
You will probably have been irritated by this attitude and pointed out how much you do for them. The idea that we should do our bit for the common good and not always expect a financial reward is a value that as parents we try and teach our children.
Doing something for nothing seems to be going out of fashion. I read the other day that there was a shortage of people regularly donating blood and that we might have to adopt the American system of paying people to give blood to ensure adequate supplies. The debate on organ donor cards continues around whether people should have to opt in or out whilst the illegal sale of organs is now big business. In China and India poor people sell their kidneys and middle men make a health profit selling them to the wealthy.
Trying to persuade a materialistic youngster that they should not expect to be paid for doing something for other people is like trying to persuade the government that public sector services should not be subjected to the profit motive. I thought hospitals are about treating the sick, not making a profit?
Playing to the whistle?
Are whistleblowers good people trying to do the right thing or are they persuing their own agenda, just trying to get someone else into trouble because they don’t like them or want their job?
Things go on in old peoples’ homes, hospital wards and board rooms that shouldn’t. Those in charge may be the ones responsible or they may want to hush it all up, whether to protect themselves or the reputation of the organisation. It is clear from the scandals that have been exposed over the last 18 months that organisations need a system whereby an individual employee can sound the alarm, bypass line management and expose wrong doing. Anyone blowing the whistle on bad practise risks victimisation so it takes courage and they need protection.
Why then do so employees feel there is something distasteful about those who choose to report their colleagues? The motives of the whistleblower should make no difference to the response to their allegations which must be to taken seriously, rigorously investigated and following the outcome acted on appropriately.
As a senior manager I chaired many disciplinary hearings which originated with a member of staff bypassing their line manager to report serious concerns. In such cases the whistleblower was often subject to considerable peer pressure, often continuing to work alongside colleagues who did not support their actions. I admired the courage of these individuals but it is not always so straight forward.
In one particular case the Officer in Charge and three of her staff were dismissed as a result of allegations made by a whistleblower that were upheld. However a local councillor who had taken an interest in the case and was unhappy that disciplinary action was not more widespread and felt that senior management were closing ranks. This councillor had a long running feud with the director about the way she ran the department and responded to issues raised by councillors. The councillor went to the local press, presented themselves as a whistleblower and claimed that the organisation was covering up widespread management incompetence.
The result was a further independent review of the case which concluded that the line manager should have been more proactive and challenging but recognised that it would have been very difficult for any manager to establish what was really going on in the face of such a plausible officer and a loyal if misguided staff clique.
In the first example the whistleblower was seeking to protect vulnerable service users. In the subsequent actions the so called whistleblower was after a management scalp to prove a point. It’s clear just how unclear it can be to distinguish the whistleblowers who are doing it for the right reasons.
The fall of the Roman Empire
The opening scene of the film The Fall of the Roman Empire pans steeply up to the top of a high viaduct. Along the top, lined up shoulder to shoulder looking down at the rocks below, are Roman soldiers. Their commander riding a white horse stops at random and with the words “those not prepared to die for Rome have no right to live” pushes a soldier to certain death below.
The Legion has just suffered a humiliating defeat and those in charge blame the rank and file.
I don’t know if there is an historical evidence to support this scene but it must be the ultimate in macho management and the use of fear as a motivator.
Now I am not suggesting that those in charge at the DH or your average NHS chief executive takes staff to the tallest building on campus and pushes a few nurses or doctors off the top just because of a bad inspection report, delays in hospital discharges, an increase in the waiting list, a dramatic slide down the league table or a leak to the press about patients waiting on trolleys in corridors. Although the departure of a high profile individual is often accompanied by the question “were they pushed or did they jump?”…
The nurses at their annual conference made their anger and frustration clear to the health service minister. And yet I was reading on the Health Service Journal website an article that had provoked lots of comments when I realised that all the responses were anonymous.
It was the same for other articles: people were very unhappy about changes in the NHS and very cynical about their leadership but no one was prepared to put their name to their comments!
This is a clear indication of a general climate of fear and a condemnation of the management style in the NHS. But macho management is not restricted to the NHS.
The newish head of Ofsted has suggested dawn inspection raids on schools suspected of underperforming and stated that if staff morale is low in the teaching profession he must be doing something right. Little surprise then that in a recent NASUWT survey a third of teachers said they did not feel respected as professionals.
A similar story is told in local government with chief executives imposing restructurings, outsourcing services and overseeing redundancies whilst using phrases like “turkeys don’t vote for Christmas”.
As staff morale sinks leadership has become increasingly autocratic and alienating, management by fear is replacing leadership by inspiration. Many working in the NHS must feel like those Roman soldiers on the viaduct - and like Rome in its decline, the NHS is in danger of fallign as its services fragment.
Holding a mirror up to the managers
Managers need to take a hard look in the mirror to see themselves as others see them, according to a new report by the Chartered Institute of Personnel Development.
The report arises out of CIPD’s quarterly “Employee Outlook” survey which identifies a significant gap between managers’ image of themselves and the experience of those they manage. The report provides evidence of the size of the gap but does not offer much insight into the reason for its existence.
I regularly experienced this “reality gap” as a senior manager. The policy was clear: every manager should provide one to one meetings with their staff once a month. All managers claimed to do this yet staff surveys, feedback from training courses and disciplinary hearings all provided evidence to the contrary.
When pursued most managers genuinely thought they provided regular one to one sessions with a few disclaimers for annual leave, sickness and the occasional double booking. The reality as evidenced by the supervision records was some what different. The gap was in the difference between sessions booked and those that happened. Managers were surprised at how many sessions failed to take place because one or other was on holiday or something else came up at the last minute. Once cancelled, sessions weren’t rearranged often because there was another in what was already a crowed diary.
The same difference in perceptions was found when exploring what was covered in these meetings. Managers were clear that they provided feedback, encouragement and discussed personal development. Employees said sessions were routinely used to allocate work, chase missed deadlines and occasionally sign a training form which they didn’t consider constituted discussing professional development.
Some managers when challenged were even less conscientious saying that they didn’t think the policy on one to one supervision applied to all groups of staff giving admin as an example and saying experienced staff didn’t need that level of support. Or simply that they had too many staff to provide all of them with regular sessions.
Some managers have good intensions but are just too busy, some know what’s expected and just ignore it as unrealistic and some think it is a waste of time. The research makes the point that good managers make the time to support their staff. 360 degree feedback might help managers see how their staff view them but even then some mangers would find it difficult to square the feedback with their perception of themselves.
From my experience the most effective way to develop managers’ self awareness and people skills is through coaching where the coach observes the individual in a variety of management situations like a team meeting or a one to one session and provides detailed feedback.
Bounce-backability
This expression originated in football, I think, but has made it into the latest edition of the Oxford dictionary. It is something all ambitious managers need.
I don’t recommend getting the sack as a way to advance your career. But if you have never failed, never been out of step with colleagues and never refused to compromise then you probably don’t have what it takes to get to the top. Of course being seen as opinionated, abrasive and intolerant of those less able and less committed than yourself will not endear you to your colleagues. Whether you are sidelined as an awkward personality or earmarked as a rising star will depend on your ability to carry the staff with you and get the job done.
In the current climate where senior managers are treated like football managers and organisations are judged on their position in a league table you will inevitably be faced with an ambitious set of performance indicators, expected to deliver efficiencies and find new sources of income. Sometimes you will be able to deliver on these demanding expectations but inevitably you will fail at some point. How you deal with these setbacks will determine how far you go. Rising stars need bounce back ability.
Remember every management star who makes it to the top has been sacked at least once in their career.
Devaluing social work with adults will cause huge problems
If local authorities continue to cut the number of social workers working with older people, people with learning disabilities and people with physical disabilities or sensory impairment, then the impact will be felt by hospitals, GPs and community health services. So the recent interview with the new president of the Association of Adult Directors of Social Services should be of great interest to those concerned about inappropriate hospital admissions, delayed discharges or the care and support of vulnerable adults in their own homes.
Sarah Pickup, in her first interview on taking up her new post, is quoted as saying there is still a role for qualified social workers working with adults. By saying ”still” she concedes that it is no longer assumed that older people or people with a disability should be entitled to the same degree of professional support as children and young people. She confirms this interpretation by saying that in Hertfordshire she reduced the number of social workers working with older and people with a disability.
I am not saying there isn’t a role for social work assistants. I am not saying that everyone who works with older people or people with a learning disability should be qualified any more than I would say everyone working with children should be a qualified social worker. But as a profession we have been here before.
In the days of generic social work and generic social work teams the qualified social workers were allocated the childcare and mental health cases and most of the work with older people and people with a disability was carried out by social work assistants and students on placement. The result was that despite some very able, experienced and committed social work assistants the status of this work reflected the fact that it was carried out by unqualified staff. As a result there were fewer resources to help people stay in their own homes, vulnerable people ended up in hospital for non-medical reasons, patients sat in expensive beds awaiting decisions from senior managers whilst others end up in residential care when they neither needed it nor wanted it.
The reduction of qualified social workers working with adults is bad news for the profession, bad news for patients and bad news for the NHS.
Inspections can only hope to inspire managers into stopping abuse
An elderly woman with Alzheimers disease suffered physical abuse in a care home rated as excellent by the Care Quality Commission CQC. What were the inspectors doing? Did they have the wool pulled over their eyes by devious staff or were they incompetent? Is the CQC just not up to the job?
These are the questions asked in the Panorama documentary earlier this week, which exposed this shameful treatment, and these are the questions the papers and commentators have been asking since. But these are the wrong questions.
Inspections don’t stop abuse, managers do. Inspections ensure that policies and procedures reflect good practice and that homes have sufficient staff to deliver good practice - but inspectors aren’t there in the night when a resident calls for assistance to go to the toilet, inspectors aren’t in the bathroom when someone is being bathed or in the bedroom when they are being helped to dress.
So who does ensure that best practice is followed? The manager of the home and the manager on duty do. They are in the building, they are supervising staff, challenging bad practice and promoting good practice, or they should be. They should not be in the office but on the floor. They should be overseeing the delivery of care not drawing up staff rotas or ordering supplies. These tasks should be delegated. They should be recruiting staff because getting the right people is the most important guarantee of good care.
Managers of care homes cannot work 9 to 5 because care is delivered in the evening and weekends as well. Staff need to know that good care should be given whenever it is delivered - and whoever is watching.
Sent home in the early hours
It’s not just care homes where out of hours patient safety is under scrutiny. A recent report expressed concern about the number of hospital patients discharged in the middle of the night. How things have changed.
When I qualified as a social worker ward staff would conspire with hospital social workers to ensure elderly vulnerable patients were not discharged on a Friday. The ward staff would hold onto a patient over the weekend due to the difficulties of organising support services on a Friday afternoon.
In those days there was no Day Care on Saturdays and Sundays, the meals on wheels weekend service had a waiting list and home helps worked Monday to Friday; anything else was considered a special favour. The consultant who was so inconsiderate as to pronounce a patient ready for discharge on a Friday ward round would not be in at the weekend so what they didn’t know wouldn’t hurt. They probably did know but in those days they were less inclined to support hospital managers.
Services are now available at the weekend, well, a 15 minute home care “pop in” service - enough time to make a sandwich, a cup of tea and ensure the person takes their tablets. They will probably spend the weekend in bed and be padded up if they can’t make it to the bedside commode. Still, better than being discharged in the early hours to an empty flat or to the care of an equally frail partner with the promise that social services will be in contact.
How will doctors see fit to spend their budgets?
The biggest reorganisation in the history of the NHS will supposedly give GPs have control over 60 per cent of the NHS budget. How will they spend it?
I was involved in a previous re organisation that was supposed to give GP’s more say in how the NHS budget managed by their local primary care trust was spent. As the social services representative I joined a group of GPs who sat on the Primary care Executive Committee with the chief executive and directors of the PCT. It was a very frustrating experience for the GPs.
Each meeting was dominated by progress reports against government targets and budget updates. A GP wish list of new services or extra money for community services was drawn up every year only for it to be withdrawn in light of budget pressures. So I guess that now they control the budget the first thing they will do is revisit their wish lists.
You might be surprised at how modest their bids were but you won’t be surprised that they reflected the frustrations they experienced daily in their surgeries. One GP put it very bluntly, if rather crudely, as the “shitty life syndrome”. He explained that an increasing number of his patients took up a disproportionate amount of his time.
Typically it would be a woman whose husband had been unemployed for over a year, debts were starting to overwhelm the family, she was concerned about her husband’s drinking, her teenage daughter had just announced that she was pregnant and her son was truanting from school mixing with a bad crowd, getting in trouble with the police and, she suspected, taking drugs. Not surprisingly she wasn’t sleeping well!
What could a GP do except listen sympathetically? These were not medical problems: the poor women was suffering from a “shitty life”. What he wanted was a social worker based in the practice that he could refer the patient to then and there, someone who could start to provide practical solutions to her social problems.
Of course he and his colleagues had approached social services many times with this request only to be told it was not a good use of scarce social work time and that with the current pressures on the department such a case would not be considered a priority. If they had the money this GP practice would definitely employ their own social worker.
Another example from the wish list was for additional mental health support. There were numerous patients presenting with low level mental health problems who the GPs felt would benefit from counselling - something they did not feel qualified to do and they did not feel was best use of their time. Requests to the local community mental health team had unsuccessful as the team said their priority was patients at high risk such as those who presented as a suicide risk or who had recently been discharged to the community. If they controlled the budget every GP surgery would seek to have their own mental health worker.
It is not hard to predict the tensions that will arise when GPs start taking money from specialist services to fund the type of services they want for their patients
Yes, we do talk about you
My colleague on the senior management team seemed surprised, shocked even - “Do you mean to say you talk about me and members of my team during your meetings?” - as if this was slightly improper, unprofessional and indiscrete.
“Of course we talk about you and individuals in your team - don’t tell me you don’t talk about us”.
I don’t mean gossiping or moaning tactics, but if you’re responsible for support services like HR, Finance, IT, or Policy then you are a corporate messenger trying not to get shot. You are asking people to do things they don’t want to do - provide information (form filling), adopt fairer recruitment practises (further delays in post-filling), attend Health and Safety courses (waste of time), do their own data entry (what is admin for?), or respond to a press enquiry or complaint (justify their decision).
At which point, someone always asks: “well how many staff do they have in HR?”, “what do the policy group do anyway?” and, ultimately, “if we need to save money, then why not start with this lot?”
So yes, we talk tactics. Who is the most vocal and why? How do we convince them that this is worth the effort? How can we make them more aware of what we do? What should we do differently so that they appreciate us more?
Collaboration with the private sector: a necessary evil?
Collaboration has both negative and positive connotations. Collaboration between public sector organisations and the voluntary sector is generally seen as a positive, whereas collaboration with the private sector is viewed with suspicion.
According to a recent survey by the management consultancy Hay Group, whilst public sector leaders predict an increase in public/private collaboration, they oppose and even resent the trend. In their report, “Relationship Counselling”, they record the concerns of senior managers about the effect such increased collaboration will have on public services, stating that senior managers refute claims that the private sector can deliver public services more effectively.
However, there is a strong feeling in some parts of the public sector that collaboration with the private sector is a necessary evil. Those who have worked their way up through the public sector are very uncomfortable about doing deals with the private sector. In my past experience, many senior managers have been left feeling that slick private sector operators have taken advantage of public sector organisations, their members seduced by glossy presentations and the promise of painless budget savings, and their officers out-manoeuvred by clever sales techniques and smart lawyers.
It is not inevitable that the predatory private sector will rip-off the naive public sector but a long-term relationship will require both sectors to put aside their prejudices and find ways of collaborating which allow for both profit and social benefit.
In the past, social services have tried to frame contracts with the private sector to reflect public sector values whilst accepting that companies need to make reasonable profits. Local Authorities view themselves as model employers with favourable pay and conditions, opportunities for staff development and a commitment to equal opportunities. They have however, found that they cannot tell private sector companies what they should pay their staff or who they should employ.
They have had more success in offering financial incentives to employers who invest in staff development. The idea is that contracts allow for premium payments for organisations that, for example, have over 50% of their staff with an NVQ in care. The argument is that not only does this help “skill up” the local workforce but it also means that staff turnover is lower, thus allowing for more consistency in care from better trained staff.
The two biggest complaints from service users are the high turnover and the lack of experience of staff, resulting in personal care being provided by a succession of inexperienced strangers. Of course, this only worked whilst the premium was financially attractive, and once local authorities had decided they could only afford the basics, then they had no leverage.
And it is this experience which has convinced many that only financial incentives will make private sector organisations adopt public sector values.
How to be unforgettable
Every organisation has its “stars” - people who stand out; those who have a cause, a reputation for speaking up, and for making things happen and getting things done. Others talk about them, stories are told about them, and they make an impression. Sometimes their challenging attitude leads to the sack; sometimes their ability to deliver leads to promotion. They don’t stay too long, but when they go they leave a legacy.
Most of us think we could be a star. Sadly, some of us are as deluded as those who audition for Britain’s Got Talent. Others feel it is within them but are too lazy, too afraid or just too happy, as I am, thanks. Some would argue the secret to a happy life is to be satisfied with your lot. After all, being a star may not be all it is cracked up to be - a lot of effort, a lot of disappointment, the risk of failure and of course, being a constant target for criticism.
If you seek stardom, how exactly do you obtain it? And are you prepared to pay a price?
You must shine. Get yourself noticed and stand-out from “the crowd”. To do this, you must challenge - stick your head above the parapet and risk getting it shot-off.
You must offer your opinion even if it is not requested or wanted. You must be critical but have ideas about how things could be done better. This will not make you popular.
You must seek every opportunity to show off your talents; this means that take on extra work and responsibility.
You must have a cause - something you believe in strongly and wish to champion, something to focus on, because you cannot be effective if you spread your energies too thin.
And above all, you must have confidence in yourself even when others doubt your skill, wisdom and integrity.
Still want to be a star?
The appeal of diversity - in theory
Did you know that one of the reasons we were awarded the Olympic Games was our emphases on celebrating diversity? Adecco the recruitment sponsor for London 2112 has just completed a survey of employers’ views on diversity. Overwhelmingly companies reported that having a workforce that reflected the communities they served was an advantage and improved the culture within the organisation.
However when asked about the value of champagnes to promote diversity there was a high degree of cynicism with more than half saying they thought this was more about good PR than any real attempt to change the way things were done.
It seems that employers say that diversity is a good thing and may truly believe it, they just don’t know how to support it. This is a problem we are very familiar with in the public sector. Despite a decade or more of recruitment strategies to encourage more staff from minority groups and changes to recruitment processes to reduce the opportunities for intentional or unintentional discrimination changes have been slow.
The focus is often on race and faith because these are linked to culture and people from different cultures with different life experiences will add something new to the organisation. Of course this is equally true of people who have a disability. Include someone with a disability on the working group to redesign the reception area and you will get a different perspective. Include a working mother on a group to look at flexible working arrangement and you might end up challenging the whole culture around what constitutes commitment and whether we are too impressed by how many hours a manger puts in when what we really should care about is how effective are they.
This prompts the question: do we really want people questioning the way things are done round here? It can be very uncomfortable for those of us doing ok out of the status quo to have people come along with a very different way of looking at things and an expectation that their views will be listen to and acted upon. The idea of diversity as a good thing is much more comfortable than the reality.
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The public sector is not a business and should not be run like one
Discontent and rebellion all around as the Tory led coalition government continues to force through legislation to turn the NHS into a Healthcare business. The public sector is not a business, it was set up to serve the whole community, it was not required to make a profit, to break even or show a good return for investors. The NHS was established to ensure that people received the best medical care irrespective of their circumstances because good healthcare was considered a right not a privilege or something that had to be earned.
As medical science has advanced and life expectancy increased the cost of the NHS has risen. Successive governments have tried to control the costs of the NHS and persuade voters, tax payers and patients that the NHS does not have an open budget.
First, like other sections of the public sector, managerialism was to be introduced to the NHS with the aim of making it more businesslike. The new mangaer class were to introduce changes that would make services more efficient. Ways of doing things from the world of business were to be introduced like benchmarking, performance targets, customer care, staff engagement and annual appraisals but most important of all tight budget controls. Managers were to ensure the medical and care professionals stayed within their budgets.
The costs continued to rise. The assumption persisted, despite the lack of evidence, that the NHS was inefficient. What made business efficient? Competition. Therefore that’s what needed to be introduced to the NHS. The internal market was tried basically getting different bits of the NHS to compete with each other. It didn’t work because at the same time as sections of the NHS were being split into providers and commissioners they were being required to cooperate and better coordinate. So if an internal market doesn’t work then open up the market so that others can compete for providing healthcare.
And that’s where we are today. As the healthcare professionals can’t be persuaded that these changes will lead to a better service or won’t lead to a worse service, new organisational structures will be imposed to transform the NHS.
These reforms are no more likely to succeed than previous ones, especially as they don’t have the support of the majority of health professionals; they place an emphasis on competition when the increasingly fragmented health system requires co ordination and co operation and they break a political promise not to mess with the NHS.
In NHS board games, no one is safe
The resignation of the chief executive of the CQC may not surprise many people but it should make us stop and think what messages it sends out. Even the support of your chair can’t save you if the DH needs someone to blame.
The deaths at Mid Staffordshire Hospital and the failings of the Care Quality Commission to protect patients have raised issues about accountability and responsibility in the NHS. Members of the management board are responsible for how the organisation operates but unlike local authorities they are not democratically elected and not locally accountable.
NHS boards are made up a chief executive and directors plus a chair and non executive directors. The chair and the non executive directors are appointed and ultimately accountable to the secretary of state for health. Non executive directors have been sought with a business and commercial background to improve the financial management of NHS Trusts.
The recent public inquires into these two NHS organisations have revealed how tensions and disagreements are played out in NHS board rooms. It is generally assumed that a strong chair backed by the majority of non executive directors can hold the chief executive and their senior management team to account. It is also assumed that a good working relationship between the chair and the chief executive is good for the organisation.
But what happens if one or more of the non executive directors think the relationship is too cosy? What if some think that the chair seems more concerned with supporting the chief executive than challenging them and their team? What if some board members feel the chief executive has too much power?
I have seen this happen outside of the NHS where the long serving chief executive maintained their control over the organisation by influencing who was invited to join the board and by ensuring a turnover of non executive board members. This turnover was achieved by increasing responsibilities, requiring a greater time commitment and by replacing payment of expenses with salaries and thus justifying a new job description for non executives and looking for a new type of board member.
So how is the balance of power maintained in NHS boardrooms? The chair with the backing of the board can get rid of the chief executive. But of course the real answer is that each board finds it own way, which is fine until the budget over spent comes to light, the trust is named and shamed over its performance or there is a major scandal over the quality of nursing care.
Is there an I in success? Busting the team building myth
They saying goes: the job would be easy if it wasn’t for the staff!
Often it is just one member of staff, one person who disrupts the harmony in the team. Not everyone in the team dislikes them but nobody likes them. This individual is hard work, they always seem to want to do things differently to the rest of the team. If everyone else wants the window open because it’s hot they want it closed because it’s too draughty. They don’t see why they should give way just because they are in a minority.
Or maybe it’s just two individuals who seem to rub each other up the wrong way and end up not speaking to each other. This is all very immature but don’t assume that these two scenarios don’t happen in senior management teams.
What’s needed is some team building. You could try and get the team to go for a drink after work but that’s not likely to work after the Christmas meal fiasco. We couldn’t agree when to go, where to go or whether partners were invited. Truth is we didn’t want to socialise outside of work so team building would have to be in work time, not optional and with a skilled facilitator.
The away from the office day was expensive, hard going and only reinforced views.
Then I read about two top English Premier League footballers who couldn’t stand each other but when the transfer window closed they found themselves in the same team. Throughout their time together at the club they never spoke to each other. During this period the club was very successful and their striking partnership was considered the best in the league and the basis of the team’s success.
In his autobiography the team’s manager wrote that he was never able to get to the bottom of the animosity between the two but didn’t care as long as they got on with their job and did it well. He also revealed that although this team was often held up as an example of people working well together most of the players did not socialise together. He went so far as to say people don’t have to like each other to be good at their job or to work together well - they just need to know what is expected and deliver.
This seemed to go against everything we are told about successful teams, the importance of good team spirit and the role of the manager in achieving this. Except it didn’t. I worked for a very authoritarian chief executive who didn’t care whether his team got on together or not, in fact he encouraged people to compete as in: ”I asked each Directorate to identify 10 per cent cuts and Education have already come back with a plan to deliver 12 per cent.” Performance targets were achieved and exceeded budget cuts were delivered and the authority moved up the league table. Success was achieved without any socialising outside of work, debate was discouraged and criticism viewed as disloyalty.
Maybe the chief executive read the same autobiography; he was a massive football fan.
Size does matter - when it comes to money
While we’re talking about rich Premier League footballers, on a related theme it appears that size does matter - when it comes to bonuses. Apparently a £million bonus for a banker is offensive and not justifiable when ordinary folk are enduring a pay freeze. Does that mean that a bonus of, say, one hundred thousand pounds would be acceptable? What about 10 per cent of salary: surely that’s a modest reward for exceptional performance?
The bonus culture is a very private sector arrangement like so much modern business practise imported from the USA. The idea is that to succeed as a company you not only need to attract and retain the best you need to keep them interested by offering big rewards. So because you are already paid a shed load of money and don’t have to worry about paying the gas, electricity and mortgage this month you need the prospect of a massive bonus at the end of the year to keep you motivated!
The whole bonus culture thing is alien to the public sector. When the heavy snowfall disrupted public transport and made roads impassable the nurses at a local hospital stayed overnight to ensure there would be staff to care for the patients in the morning. The meals on wheels driver could not get down the side roads to deliver meals as they had not been treated. So he got out the van and trudged through the snow. It took a lot longer but it meant every elderly client got their hot meal on a bitterly cold day. No bonuses were involved.
When attempting to address the absenteeism problem some colleagues suggested we give a bonus to staff who had no time off during the preceding 12 months. The rest of us balked at the idea, not only because it assumed that people were taking time off when they were fit to work but because we had visions of very ill people dragging themselves into work as the year end approached in order to get their bonus.
As someone else pointed out - we already pay staff to come to work.
Is fiddling the figures all part of the game now?
“This is what I said - this is what I told people. I said that they weren’t interested in finding me a job, just hitting their targets and getting their money”.
Mark was reading about 4Ae. He had been unemployed for months. He eventually found part-time work through a friend of a friend. 4Ae had forced him to do a totally unsuitable work placement and tried to push him into work as a care assistant with threats of withdrawing his benefits. After he told them he had a job and wasn’t signing on anymore, they kept calling him, repeatedly.
Now, he realises that this wasn’t his case-worker expressing an interest in his welfare but submitting returns to claim 4Ae’s fees. He was outraged to learn that they were still getting money for him being in employment. In fact, they stood to receive more money from him than he was going to earn in 12 months of part-time work.
Jane worked in hospital administration. She blew the whistle on waiting list figures and exposed the ways her department “got round” the 18-week waiting list target.
The target was for 90% of patients to be seen within 18 weeks. Good practise would dictate that those who had waited longer would be a priority, but she was told to give priority to those who were coming up to 18 weeks. The patients who had exceeded the 18 weeks no longer counted. Of course this meant lying to them about why they were still waiting. The most telling part of this story is that when she raised her concerns with her manager, he said that all the other departments and in fact, every hospital used this and other manoeuvers to get round the system - the implication being that they would be at a disadvantage if they didn’t follow the rest.
The relevant government departments could introduce tighter contracts, smarter targets and more monitoring but it wouldn’t change the nature of the game; people would still have an incentive to find ways round the system.
Both of these examples should make us question the whole sale adoption of a performance management culture for public services. In the case of 4Ae is payment by results the best way to use of public money to help people into work? Are waiting list targets the best way of prioritising patients?
Is fiddling the figures the inevitable consequence of payment by results, over ambitious target setting and micro management? Is the performance management culture with its emphases on measuring success, management by targets and naming and shamming the best way to run hospitals, schools and social services?
Meetings make you stupid
It’s official: research in America has confirmed what you long-since suspected - meetings make you stupid. No one would suggest that meetings would make you more intelligent, but new findings from the Virginia Tech Research Institute appear to confirm that they make you dumber. The research found that subjects performed less well in IQ tests taken shortly after meetings.
So far, no explanations have been found for what it is about formal work meetings that makes people less intelligent. My experience would suggest it is a range of factors, from the way the meeting is chaired right through to the group dynamic.
I had a boss who liked to keep people guessing about where he stood on an issue, which made it really difficult for those who liked to earn bonus points by telling him what he wanted to hear. We have all experienced colleagues who disagree in meetings irrespective of the merits of the arguments in order to attempt to establish position in the group pecking-order. And we are all guilty of not really listening to what is being said but simply waiting for a break in the dialogue to say what we came to say. Most of us have experience of sitting through a meeting with the feeling that the decision has already been made or that the real debate took place outside the meeting when we weren’t present. So perhaps the real question is why our diary is filled with back-to-back meetings when we consider them so frustratingly pointless? Surely further evidence that meetings do, in fact, make you stupid.
Are managers too busy to manage?
NHS managers are too busy to address staff health at work, according to this headline in HSJ. The report on the launch of the Healthcare Management unit code of conduct provided the opportunity for Dame Carol Black to express her disappointment and frustration at the lack of buy by the NHS. Of the 370 organisations signed up to date only eight are from the NHS.
Dame Carol said: “Individual chief executives always tell me they understand the agenda but they’re too busy or they don’t believe the business case.”
Too busy to effectively deal with absenteeism? Too busy to deal with bullying and harassment at work? Too busy to deal with violence and verbal abuse in the work place? Too busy to look at the impact of increased workloads and staffing reductions? What else are senior manager too busy to do? Listen to staff; ensure fair recruitment and development, promote good patient care? So what have managers got time to do? The budget and reorganisation?
The online response from managers was swift and angry. No, not too busy for the health of staff but too busy for a bureaucratic form filling, tick box exercises designed to give the impression the DH is doing something. The initiative was dismissed as an exercise that focuses on support of staff with chronic health conditions, encouraging staff to stop smoking and offering healthy food in the staff canteen. In other words things Trusts already did,had already tried or had already discounted.
But it still left me feeling that chief executives don’t think the health and welfare of their staff is a good use of management time and this is reflected in how managers within the NHS behave. I am sure the NHS is not the only public sector organisation where managers are too busy to manage.
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Is it alright for a man to wear black eyeliner to work?
In timely reference to my recent blog, I was at a senior manager’s question and answer session at the end of a two-day staff equality and diversity awareness course. I didn’t see it coming but I know the sound of a bear trap snapping when I hear one. These apparently naive questions from frontline staff are never hypothetical.
Someone in the room had a colleague who wore black eyeliner to work. The issue had come up during the course and the trainer, wishing to move the discussion on, had suggested it would be a good question to ask the director at the Q&A session.
Of course what was really behind this question was a reaction to the organisation’s move to be more gay friendly. On the plus side some staff were clearly more comfortable about expressing their sexuality, however the more open some staff were, the more it exposed the fact that as an organisation we hadn’t had to think about some issues in the past. The unofficial office dress code was smart casual except for managers who wore suits. It was generally left to individual managers to determine what was appropriate to wear to work but the only time it had ever been an issue was in a short lived heatwave when some staff, not just the younger ones, took to exposing too much flesh.
Singlets, T-shirts and shorts were banned for men and women. When a new member of staff started showing sufficient cleavage to cause comment, a female manager “had a word”. I don’t recall there ever being an issue about someone wearing too much make up and I wasn’t aware of any guidance.
One thing I had learnt from experience though was not to make up policy on the go.
Running through my mind as I tried to think of an answer was a range of scenarios that I could be presented with as follow ups. You couldn’t stop people at work forming sexual relationships but it was an unwritten rule that such a relationship between a line manager and someone they managed was inappropriate. In all cases people were expected to be discreet: any open show of affection like holding hands or kissing would be extremely unprofessional. Flirting was discouraged because it got confused with sexual “banter”, or double entendre, which had in the recent past led allegations of sexual harassment. So did these “rules” also apply to gay relationships? There were certainly a small number of staff who seemed to want to push the boundaries.
I concluded that the same rules had to be applied but that maybe in the future we needed to be more explicit about what these rules were. I also decided that black eyeliner was ok.
Are leaders a product of their environment, or is it the other way round?
Miss Congeniality they are not - but then they weren’t fast tracked because of their people skills. No it was the ability to manage a budget, hit performance targets and rationalise unpopular decisions. It seems a bit unfair now to complain that they are strident, competitive and unimaginative.
I am talking about senior managers on the NHS Top Leaders Program but I could be referring to any group of up and coming mangers in the public sector.
These were the findings of a detailed assessment of 900 participants in the NHS Top Leaders Programme under taken by the Hay Group consultancy for the National Leadership Council.
Three quarters of senior managers on the program were assessed as over confident, lacking insight into their own limitations and despite their above average verbal reasoning skills were poor at providing colleagues/staff with clarity. I think this description is not limited to those who are being fast tracked but go so far as to highlight the management characteristics which get people promoted - and not just in the NHS.
The problem is that these skills may get you the job but if you are to succeed in the job they do need to be supplemented. To transform the service you need to be able to innovate, to develop partnerships and establish a harmonious working environment. To achieve this you will require insight into your own behavior and how it affects others.
Senior managers rarely get this sort of direct feedback. Who is going to tell the chief executive that they are unclear about what they are telling them to do, that the way they respond to requests for clarification is seen as abrasive or that any attempt to debate is seen as disloyal? Much easier to help managers gain these insight on their way up, when hopefully they will be more receptive.
So we should not be too critical of the senior managers on the Top Leaders programme for being over confident, lacking insight and thinking they are better communicators than they are. They are after all a product of their environment. We should however encourage the type of individual detailed assessment that confronts managers with their skills gaps and a leadership development programs that address these deficiencies.
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If staff morale is at an all-time low you know you are doing something right
Who would make such a provocative statement? The thick-skinned health service minister, the no nonsense chair of the board, the over confident and ruthlessly ambitious chief executive?
It is in fact a quote from Michael Wilshaw, the chief of Ofsted, in an interview he gave to the Guardian newspaper this week. A sign of the times that we could imagine any one of a number of public sector leaders saying publically what they must have often thought privately.
Does this indicate that in the current financial climate public sector leaders expect staff to be unhappy about the changes taking place because they view staff as an obstacle to change? I have heard this summed up in the expression “turkeys don’t vote for Christmas”. It reflects a leadership style based on imposing change by sheer force of personality. In the interview Mr Wilshaw is referred to as having a reputation as a “heroic head” and is quoted as saying “a poor leader runs a poor school; a good leader runs a good school”. So it is all down to the leader!
Some might argue that whilst the leader certainly sets the tone and has considerable influence success is determined by a range of factors such as team work, effective collaboration, political support, adequate resources and may be a little luck. And how far can you go by simply imposing change on a disempowered staff group?
Sometimes a leader must say “this is the right thing to do even if it is unpopular”. I have said it myself but this is very different to saying “I don’t care what staff think”. You would not think much to a colleague from another agency who announced during partnership negotiations that they “didn’t care what you thought”. So whilst low morale may be a consequence of pay freezes, redundancies and fear of unemployment it is not a measure of effective leadership. In fact, those that would boast that morale is at an all-time low would sound like a bully not a leader.
The issue of heterosexual discrimination
They thought gender was no longer an issue but the statistics on women in top jobs proved that wrong. They assumed race had been overtaken by faith in the “be careful what you say category” but were still wary. They regarded disability as an occasional recruitment issue despite the prevalence of mental health problems in the population.
It was sexuality that was making them feel uncomfortable.
They kept coming across references to gay, lesbian, bisexual and transsexuals. “They” were managers. They had heard the one about the man who wanted to be a woman and HR’s advice that he/she should use the unisex disabled toilets. Most viewed that as an interesting HR issue, not an everyday management issue. No, the hot issue was managing gay men.
Ever since the chief executive had come out as gay the organisation had become decidedly gay friendly. It was most noticeable at head office where there was a dramatic increase in the number of young gay men employed. The organisation had probably always had the usual cross section of people within its staff group; the difference was people now felt empowered and able to discuss, perhaps even flaunt their sexuality. Or at least the men did. But whereas people were clear on the rules for behaviour at work for heterosexuals, were they different for homosexuals?
The former chief executive had a bit of a reputation for surrounding himself with young women so was this chief executive’s behaviour any more unacceptable? However the former chief executive wasn’t in the habit of inviting his junior staff out to lunch or for after work drinks. It was the cliquey nature of this that drew the comments; these same young men seemed to be on a lot of working groups chaired by the chief exec.
Clearly some managers felt that some of their staff had more access to the chief exec than they did. And some staff made the most of this, dropping into the conversation at every opportunity what he had said at lunch yesterday or on Friday when a group of them went for a drink after work. The implication was clear: they had a powerful friend.
This was perceived as a potential problem should there be issues of time keeping, attendance or quality of work. Mangers also claimed to feel under pressure to approve applications, to attend conferences and workshops which they felt were more about sexuality than of direct relevance to the business.
It was the senior women managers who felt most excluded. They referred to the “gay mafia” and complained they were often out the loop since conversation had obviously taken place outside of the senior management team meetings.
It all came to an abrupt end with the chief executive’s sudden departure and the instillation by the board of an acting CEO - who was a woman.
Managers are not always comfortable with the diverse nature of the modern workforce. In the past people management issues tended to be about tackling homophobic bulling, inappropriate “jokes” and supporting staff who felt they were being excluded or talked about because of their sexuality. Now we have managers who don’t know whether they are feeling uncomfortable because of a person’s sexuality or because the behaviour is inappropriate.
Profit and loss in the 'new' public sector
It is very clear that the new public sector is going to look very different to the old public sector.
The state is to have an increasingly smaller role in providing public services, private hospitals are likely to have the same number of NHS patients as private patients and as many as 50 per cent of NHS hospital beds could be taken up by private cases.
Local authorities have already closed most of their homes for older people in favour of buying places in private sector homes and have replaced their in-house home help services with private sector care providers.
The driving force behind this transformation has been money.
Initially, it was imperative to be more efficient in the face of increasing demand due to an ageing population creating a need to buy more with the same amount of money. The private sector offered this by providing cheaper services, largely achieved by paying their staff less than the public sector did for the same work.
But we have now gone way beyond making the public sector more efficient. The aim now is to make the public sector a commissioner of public services which are then provided mainly, although not exclusively, by the private sector. There appears to be no service that could not be contracted out to this sector, in fact the only obstacle to increasing their provision of public services is the question of profit.
The government are keen for the private sector to increase its role in providing public services, however this sector is not driven by ideology but by profit. There is, no doubt, much profit to be made out of providing selective public services both in health and social care but we have already seen companies go bust when they get it wrong.
The profit margins in caring for older people are so small that homes will make a loss if occupancy rates fall even a fraction, fees are not up rated in line with inflation or running costs increase. And these costs are increasing - gas, water, electricity, food and staffing are all going up in price - however local authorities are refusing to increase fees and are unable to afford to fund increased placements.
If the market is left to find its natural level then in some areas there will be considerable turbulence; a lot of homes closing, a lot of distressed elderly people being shunted around and a lot of very bad publicity.
The experience of the private sector providing publicly funded care services for older people is a warning to both providers and commissioners. I can see private sector companies cherry picking the most profitable areas of public services, but what about the rest?
Don't presume that racism is no longer a problem
HSJ today carries a report that the Central Manchester University Foundation NHS Trust has been found guilty of institutional racism with the award of £1m to a former manager. The trade union that represented the manager calls for an independent enquiry into the trust’s disciplinary policies following the discovery that whilst 2 per cent of the workforce are black they form 25 per cent of those subject to disciplinary action.
The trust strongly disputes that institutional racism is a feature of the organisation. This comes a week after the convictions in the Stephen Lawrence trial and the subsequent Macpherson enquiry into the police investigation which first gave us the term “institutional racism”. It is clear that some organisations do not understand what institutional racism is or simply refuse to accept it exists.
Stephen Lawrence was attacked because he was black. Eighteen years after his murder two of his killers have been sentenced to life in prison. His death and the inquiry that followed not only highlighted the level of hatred some white people directed towards black people but that police, intentionally or not, treated black people differently.
They were treated with suspicion and assumed to be more likely the perpetrators of crime rather than the victims. Black youths were stereotyped as violent gang members, drug dealers and drug users. The Macpherson enquiry gave a name to this unthinking prejudice based on ignorance and negative stereotypes, and said it could be found throughout our society. The point was emphatically made that racism was not just about the extreme behaviour of a few wicked people nor was it limited to unprovoked assaults, abuse shouted in the streets or outright discrimination.
As a result public sector organisations reviewed their recruitment practises and set targets to employ more black people. They provided staff with training to make them more aware of the experience of black people, the need to address their under representation in the workforce and the opportunity to examine negative stereotypes. But most of all to make it clear to staff that they should not use language that was offensive to black people, they should not make so called jokes about skin colour or race, and they should not discriminate against black people as colleagues or service users.
It is worth reminding ourselves of this because it is clear that some people have never understood the concept of institutional racism or have steadfastly refused to accept that it exists. “This organisation is not racist” they say. “I am not racist nor are any of my colleagues” they say. “Just because there aren’t any black senior managers doesn’t mean it is because of racism. We don’t care what colour someone is, we treat everyone the same.”
There have been changes over the last eighteen years: the casual racism in which people would refer to the “Paki” shop on the corner or made offensive jokes linking race and intelligence have become socially unacceptable. However black employees are still under represented in senior posts, a male black manager is still likely to be described as aggressive when the same behaviour from a colleague is called assertive, black staff are more likely to describe their manager as unsupportive, in many organisations black staff are disproportionately subject to disciplinary action. Perhaps as a consequence black members of staff have less faith in the organisation’s disciplinary and grievance procedures.
After the energy, enthusiasm and commitment to change following the Macpherson report there is a general feeling that the reality for black staff does match the rhetoric. There is also a feeling that senior managers have moved on, that austerity has brought a new set of challenges and priorities and that whilst individual’s personal commitment remains, their time and energy is directed elsewhere.
Can you make a racist remark and not be racist?
Last October, an incident took place that rocked English football, in which Liverpool football player Luis Suarez was alleged to have racially abused Manchester United’s Patrice Evra. According to Evra’s statements, you can make a racist remark and not be a racist.
Was he just saying that the opponent who he accused of repeatedly racially abusing him was not racist to appease his fellow professionals? Did he mean: “look this guy is not a wicked person just ignorant and insensitive”? I can understand the reluctance to call someone a racist, it is after all one of the worst things you can say about someone in our society. Presumably that is why no one ever admits to being a racist even those who use racist language and hold racist views. Being a racist is without dispute a very bad thing.
If a racist is not someone who uses racially abusive language, however, what does a racist do that makes them so? To be a racist do you have not only to abuse someone because of the colour of their skin but hold views that some people are inferior due to that reason and therefore do not deserve to be treated the same as the rest of us? So if you only meet part of this criteria does that mean you are not racist? If you call someone “black so and so”, that is useing racist language, but if you claim at the same time to believe in treating everyone fairly and not discriminating on the grounds of colour does that mean you are not a racist?
I know it sounds like we are just playing with words but what people say and how they say it is important, as is what we assume when they use this type of language. I belive that most people I have come across through work or socially are not racist but I have heard racist language used at work and in social gatherings. I explain this by the fact that people are often ignorant of other people’s culture, circumstances and feelings. That people are constantly fed negative stereotypes about Muslims, Asians or black people and so they often speak without thinking or realising the impact their words will have. But if an individual repeatedly makes these remarks despite being told it is offensive, hurtful and racist then clearly this is not ignorance but a true reflection of the way they think.
But does this view that using racist language, especially due to ignorance or insensitivity, does not make the individual a racist then result in people claiming that there is no racism in football or in this office - and lead to the concerning implication that nothing needs to be done?
Abuse and negelect: what 2011 will be remembered for
2011 will be remembered as the year that the image of the caring nurse was shattered by widespread evidence of neglect on NHS wards. This was the year we realised the disturbing truth that inspecting services could not prevent abuse. It was also the year we were confronted with the knowledge that complaints, even serious complaints, were all too often not taken seriously.
It is comforting to think that those who neglect and abuse vulnerable people are bad people. Better that than acknowledge they are the same as you and me and that given a certain set of circumstances we are all capable of the indifference recently revealed to be widespread in the care of elderly hospital patients. A few bad apples can be removed and better recruitment and supervision could identify the wrong un’s at an early stage. So why is abuse and neglect of people with a learning disability and older people such a recurring and widespread problem?
Neglect and abuse persists despite recruitment practises aimed at selecting people who have a positive attitude to old age. Bad practise and indifference to the discomfort of individuals continues despite renewed emphases on supervision. We should acknowledge that the problem is not simple one or two bad people. We need to recognise that disciplining and dismissing the worst offenders and providing more training for the rest won’t stop abuse and neglect from happening if the causes lie outside of the individual.
Of course we should dismiss those who abuse older people but we know this is just the tip of the iceberg. Those who shout or swear at a patient for being incontinent or steal their money and valuables or bruise them through rough handling are easily identified and dealt with. But neglect and indifference is more subtle than this, it is ignoring requests for assistance so that the individual soils or wets themselves, it is putting off cleaning them up in the hope that it can be left to someone on the next shift.
It’s making the individual feel that they are being a nuisance with their requests for a drink or to be helped sit up when you are so busy. It is giving a patient a bath whilst carrying on a conversation with a colleague as if you were washing a car not a person as you share what you did last night and what you are having for tea later.
This is the real problem: the staff group as a whole stop seeing patients as individuals, they become just another incontinent, confused, feeble body that needs washing, feeding and toileting. The way things get done is organised to make life easier for the overworked under-resourced staff. The good patient is the one who places no demands on staff but is grateful for any help, the good patient is cooperative and cheerful.
We cannot rely on inspections to prevent abuse and neglect although we can reasonably expect that a properly resourced inspection service will make it harder for it to go undetected. We cannot assume that just because a complaints system is in place mangers will act decisively although we have a right to expect they will. We should not think that abuse and neglect is down to one or too bad people because the persistence of abuse and neglect despite dismissals disproves this.
We can, however, do our best to make 2012 a good year for patient care.
Pointing the finger
When things go wrong - and things do go wrong - do you look for someone to blame or do you analyse the complex inter-relationship of events, people and money? Politicians look for someone to blame and the tabloids call for their head. Very convenient .since politicians don’t want awkward questions asked about the contribution of their policies, the impact of budget cuts or the unintended consequences of a reliance on targets. And public executions in the press have always sold newspapers.
You would however expect some sections of the media to spot the potential for exposing a few government myths, like “cutting staff does not affect quality”, “more can be done with less” and “targets don’t distort practice”.
The public enquiry into the Mid Staffs Hospital deaths is just such an opportunity. Pity then that the Guardian seem content to call for the head of Cynthia Bower. It’s strange also, since she was not head of the regulator at the time of the scandal nor was she chief executive of the hospital.
So why has the Guardian used the public inquiry into the scandal at Mid Staffs Hospital to call for the head of Ms Bower? The answer appears to be Ms Bower can and should be personally held accountable for the failings at Mid Staff because as chief executive of the supervising Heath Authority she failed to spot and stop the neglect of patients. Further evidence of her supposed unsuitability and incompetence is the subsequent failure by her inspectors to stop the abuse of residents at a home for people with learning disabilities in her new job as chief executive of the CQC. Well, if that is to be the logic we would expect directors of social services to be losing their heads on a very regular basis.
If heads are to roll why not the one who appointed Cynthia Bower as the CQC’s chief executive at a time when the scandal at Mid Staffs had already broken? If this is about accountability the chief executive of an NHS trust is accountable to their board and the chair and most of the board appear to have supported the actions of the chief executive. Logically if the board, who are ultimately responsible to the minister, got it so badly wrong, either they should go or the minister should acknowledge that this was a failure of the system and not a failure of one individual.
Is community care, as we know it, dead?
Community care for older people is dead. Community care has been dead for sometime but its death has yet to be publicly acknowledged. The signs that all meaningful life had drained out of the concept have been there for all to see. There were the persistent complaints from the NHS about bed blocking in hospitals due to cut backs in social services, media campaigns against the closure of day centres and the removal of grants from voluntary organisation. Community care for older people no longer exists in any meaningful sense of the phrase: it has been replaced by cheap care.
Community care was about replacing institutional care which robbed people of their privacy, dignity and independence. Long stay geriatric wards were closed to be replaced by smaller homely nursing homes for those who required nursing care. Very sheltered housing was to replace residential care homes, the idea was that people would remain in their own home or in sheltered housing and the help would come to them.
If people had their own front door then the thinking was that they would retain their privacy. If the right levels of care and support were provided people would retain their independence and if people were seen as individuals they would be more likely to be treated with respect and more likely to retain their dignity. If people need help to wash, dress, go to the toilet, get into and out of bed it could be provided even if this involved three or four visits a day, seven days a week.
In the past institutional care was characterised by care routines that operated to suit the convenience of staff such as staff determining when people got up, went to bed, had a bath, what they wore and what they ate. Patients/residents deprived of choices and control over their own lives became passive, accepting and lethargic, and this behaviour came to be described as institutionalised.
People preferred to continue to live at home with help. The growth in the number of people over 80 put pressure on services and budgets. The budget pressure was relieved by buying care from the private sector rather than providing through staff employed by social services. The private sector was cheaper so the same amount of money could buy help for more people.
Despite the growing number of providers of home care it was logistically very difficult to get customers into and out of bed when they wanted. The problem was that a home care had a list of people to be visited, but someone had to be first and someone had to be last. So someone would be put to bed at six in the evening, someone would receive their lunch at 11am while someone else would gets theirs at 3pm.
Right from the beginning there were complaints from customers, about high turnover of staff meaning that frequently a stranger turned up to provide very personal care, of young and inexperienced staff and of staff whose English was poor. The private sector could not attract or retain experienced staff on the wages it paid. Employers were reluctant to invest in staff training when staff went as soon as a better paid job came up.
Costs were kept down by keeping overheads low which meant few managers and minimum supervision of staff. As social services budgets were squeezed they forced down or didn’t update contract prices. As the number of people being referred for support increased they “reviewed and reassessed” to reduce the number of visits and they reduced the length of a visit. Initially contacts were based on a visit being an hour; as demand grew the typical visit was reduced to 45 minutes and the “pop ins” of just 15 minutes were introduced!
Care in the community for older people had become care on the cheap. The report by the Equality and Human rights commission simply confirmed what cares and customers had been saying that this so called community care robbed them of their dignity, privacy and self respect that it often left them to lie in their own mess, cold, hungry and confused causing them to feel ashamed, lonely and frightened.
So clearly community care in any meaningful sense is dead.
The failure of community care is the failure of older people
You lie in your own mess. You are cold. You are hungry and confused. You can’t remember whether you have taken your pills. You feel ashamed, lonely and frightened. It will be hours before someone will let themselves in to wash and feed you before rushing off to their next client. No time to chat, probably no conversation at all, only the TV for company.
I speak of the failure of community care when I describe the collapse of care at home.
The savage cuts in social care funding will mean hospital beds are blocked as people cannot be discharged home due to lack of support services. Blocked hospital beds means longer waiting times for others to get into hospital for their operations. Some will be forced into residential care not because they need it but because community services are not there and families cannot fill such a gaping hole. Those who end up in a home may not be any more fortunate as local authorities try to force care home fees down to make their reduced budget stretch and financially struggling homes cut back on food and staff pay. Whatever happened to joined up thinking? Whatever happened to living longer being something for society to celebrate? Whatever happened to old age should be enjoyed not endured?
Community care has failed older people not because people didn’t want it, not because it wasn’t preferable to institutional care, not because it didn’t have the support of the professionals but because you and I decided (or others on our behalf) that we couldn’t afford to treat older people well.
When is whistleblowing not whistleblowing?
I was recently surprised to hear an NHS board member described as a whistleblower. After all a board member is in a powerful position, has access to the chief executive and directors and is presumably privy to if not directly involved in all the key decisions. All the more so when their testimony was not exposing corruption or abuse but criticising the leadership of the organisation and its strategic direction.
The alliance between a chair of the board and a chief executive can be very powerful and it must be frustrating if you are a lone dissenting voice -but that doesn’t make you a whistleblower.
What this case highlighted was how tensions and disagreements are played out in NHS boardrooms. It is generally assumed that a strong chair backed by the majority of non executive directors can hold the chief executive and their senior management team to account. It is also assumed that a good working relationship between the chair and the chief executive is good for the organisation. But what happens if one or more of the non executive directors think the relationship is too cozy? What if some think that the chair seems more concerned with supporting the chief executive than challenging them and their team? What if some board members feel the chief executive has too much power?
I have seen this happen outside of the NHS where the long serving chief executive maintained their control over the organisation by influencing who was invited to join the board and by ensuring a turnover of non executive board members. This turnover was achieved by increasing responsibilities, requiring a greater time commitment and by replacing payment of expenses with salaries and thus justifying a new job description for non executives and looking for a new type of board member.
So how is the balance of power maintained in NHS boardrooms? The chair with the backing of the board can get rid of the chief executive. But of course the real answer is that each board finds its own way, which works just fine… until the budget overspend comes to light, the trust is named and shamed over its performance or there is a major scandal over the quality of nursing care.
And this led me to ask: what is the difference between a whistleblower and a trouble maker?
When I think of a whistleblower I imagine a fairly anonymous member of staff who publicly exposes the wrongdoing of an organisation despite the fact that this might cost them their job. The member of staff is acting out of a moral conviction.
If we want people to expose bad practice or high level corruption whether its shady practices in the awarding of large contracts or covering up the abuse of patients/residents we need to give them the promise of protection and the confidence that their allegation will be treated seriously.
The initial reaction to a whistleblower, however, is frequently to question their motives. Is this a disgruntled member of staff, does the individual have a personal agenda? Some in the organisation will view any public criticism as disloyal but the only real issue is whether there is any truth to the allegations.
I was concerned but not surprised at the findings of a recent Royal College of Nursing survey which found 80 per cent of the 3,000 nurses surveyed had raised concerns about issues on an NHS ward. Perhaps it is also not surprising that at a time of severe budget pressure nurses would highlight the impact on the ward and patient care. As managers seek to save money with skeleton staffing levels - not just on bank holidays but weekends and evening - it’s not surprising that nurses would complain nor is it surprising that managers will ignore these complaints.
It is the same for covering for vacant posts or staff absences; management will impose a blanket ban on the use of agency staff and overtime because of pressure on the budget and nursing staff will identify the impact on patient care: no time to ensure elderly patients drink, no time to help an elderly patient eat their meals, being unable to take a patient to the toilet when they first ask and having to leave them in soiled or wet sheets until they are less busy. The result is the now well documented and alarmingly frequent reports of dehydrated, malnourished and neglected elderly patients.
There is another type of whistleblower, frequently a new member of staff or someone who has been brought in as temporary cover for staff holidays. They are experienced staff and are clear on good practice and what they see as passing for routine care is not good practice. They quickly realise that there is little point raising their concerns with the manager or officer in charge as these practices have either been sanctioned or are ignored for the smooth running of the home. I have in mind the “liquid cosh” where residents who “wander” are over medicated so that they stay put in their chair, using the bed sheets tucked in tight to stop someone getting out of bed in the night, putting those who need assistance to bed straight after tea so they are all in bed when the night staff come on duty who in return will ensure everyone is up and dressed when the day staff come on duty, even if this means some people will be got up at 5am!
This of course is fairly mild stuff but a culture where everything is run to the convenience of staff rather than the needs of residents is one where indifference can soon result in bullying and verbal, maybe even physical, abuse.
In such circumstances it is vital that staff resist peer pressure and have the courage to speak out without fear of reprisals. These aren’t “trouble makers” but people who aren’t satisfied when poor care becomes acceptable.
The strikes don't mean staff don't like doing their job
The public sector is to foot the bill for economic recovery. The price to be paid in reduced take home pay and job losses will be felt by all those working in the public sector. The newspaper headlines warn of six years of austerity. This year’s budget cuts were painful, next year’s budget cuts are already being drawn up and it is clear things are only going to get worse. As staff fight to protect their pensions and jobs, do managers face an impossible task in maintaining morale?
I have worked in organisations where the budget has allowed for growth and the service has been held in high regard but morale has been low. I have worked in places where services were being cut to the bone and where criticism in the local press and from local MPs was relentless, yet staff morale remained high.
Two factors seemed to influence morale: the quality of leadership within the organisation and the people management skills of line managers. Yet in both sets of circumstances there was no direct relationship I could find between the level of morale and the individual’s commitment to doing a good job for the service user.
This seems to be because people’s commitment in the public sector is to the client/service user rather than the organisation. They don’t pull out all the stops for the organisation’s reputation, to hit government targets or to make senior management look good, they do it to make a difference to an patient’s life. They can be fed up with the way the profession is treated and feel undervalued and unappreciated by the organisation, but they will still do their best to help the individual because this is why they joined the profession in the first place.
In general people who work in the public sector are proud of what they do. People can feel very positive about the work of their team or service but negative about the organisation they work for. This often comes to light when organisations prepare for Investors in People accreditation. The senior managers fret over what staff will say to the assessors in light of budget cuts and management reorganisations but staff are asked about what they do and they are invariably positive about their own work and that of their team.
People who work in parts of the public sector are highly motivated by the prospect of helping people and making a difference to an individual’s life. If they get on with their line manager, trust them, feel valued and that their efforts are recognised, then what’s happening outside of their team/establishment has limited impact on their morale. This works both ways, as if there is conflict within the team, if there is a lack of trust in the manager then any additional pressure caused by staffing vacancies, service cuts or changes in the way work is organised will result in people feeling unhappy at work, looking for other jobs and complaining about their lot.
However bad the big picture gets experience shows that managers can influence morale in their team but if you were a teacher, nurse or social worker would you encourage your children to join the profession?
When customer care alone is not enough
There are those who tried to convince us that improved efficiency would be enough to deliver the budget saving in the public sector. They were wrong and we now see rationing in the form of increased waiting times in the NHS, tighter eligibility criteria in social services and service reductions as libraries, day centres and swimming pools are closed.
Now some people are claiming improved customer care is the answer. All we need to do is get better at identifying and delivering what our customers want. If we simply listen more we would waste a lot less time and money on providing service that people don’t want and we would have fewer complaints.
Of course good customer care makes good business sense. Of course the public sector wants to shake off the “take it or leave” image of old. And of course doctors and social workers are keen to distance themselves from the professional knows best culture. So yes, we need to get better at listening to people and finding out how they want their services delivered.
Only it’s not quite as straightforward as that in the public sector. Just for a moment let’s pretend the private sector has sorted this problem, that the utilities, the banks and the train operators have developed sophisticated and effective ways of listening to their customers and adapting their services in response. That call centres are a fast and easy way to do business, that computers don’t automatically generate threatening standard letters and that the member of staff at the other end of the phone doesn’t keep repeating “but the screen is telling me such and such”.
How does this solve the problem of getting home help to help you into bed when you want as opposed to when they are available? How does this help you deal with opposition from neighbours to opening a home for people with learning difficulties? And how does this work when local people voice their opposition to plans to close their local hospital or library or day centre or want their bins emptied weekly?
Simply put, customer care is not the knight in shining armour for this situation. On its own, it is not enough, especially when times are tough.
Whose fingerprints are on the backstabbing knife?
Cynthia Bower must have really upset some one at the DH. She does have a reputation of speaking her mind. The head of a public service knows they are in trouble when the Guardian quotes their salary as if earning over a certain amount of money should ensure the organisation you head has no problems. I would have thought it was the other way round.
Then there is the attempt to rewrite history, success is turned into failure. “You know that scandal that happened, well they were involved”. As if the DH would appoint someone to a top job in the NHS if they were not absolutely convinced they were placing the safeguarding of all patients in the NHS into a safe pair of hands.
Finally there is the implied character flaw. In this case deception, we are informed that the CQC mislead Parliament by producing a report for the DH which claimed an inflated number of inspections and reviews. We are given no explanation as to why the CQC revised the figures, only that they have “admitted” doing so.
Am I the only one who suspects that it is not as straightforward as this? People rarely risk lying about the facts but the DH frequently asks for figures to be recalculated excluding this or including that or using a new definition to clarify the difference between a visits to homes as in a visit to register, a visit to inspect or a light touch inspection which doesn’t involve a visit.
I am suspicious of the motives of the Guardian article because there is no attempt at analysis of the political and organisational context. The merging of several inspection organisations resulting in a prolonged period of disruption and loss of experienced staff. The subsequent restructuring which demoralised staff by forcing them to apply for their own jobs. The efficiency drive which saw a significant reduction in posts. Whilst at the same time the government of the day imposed performance targets that distorted priorities. These circumstances are not unique but neither is the belief that there are ministerial finger prints all over the back-stabbing knife. Just as there were for the head of immigration.
I don’t know what is worse: that journalists swallow this, or that they expect readers of the Guardian to as well.
Macho macho management
A report in the Health Service Journal has revealed that the majority of newly set up clinical commissioning groups are led by men. Women make up only 15 per cent of chairs or leads at the 285 commissioning groups.
A similar situation exists in Local Authorities women make up 70 per cent of the Local Authority workforce but only 21 per cent of chief executives and only 30 per cent of senior managers.
In the private sector the statistics are even more depressing. A recent report by management consultants Deloitte found that 20 per cent of companies in the FTSE 100 had no women on their board. Most revealing in terms of the commitment to change is the fact that the proportion of women on boards has only increased from 5 per cent to 9 per cent in ten years.
The public sector may be further ahead in making a reality of equal opportunity rhetoric but these statistics show that there is a problem with management culture across all sectors.
The management culture at Gatwick Airport as revealed in the TV documentary Inside Gatwick may give us an insight into how those top 100 organisations are really run - and don’t forget the public sector is always being compared to successful private sector organisations.
Just because public sector managers would be much more careful about making comments about female staff that doesn’t mean that they don’t share some of their views on how staff should be managed.
Could it be, though, that the reasons why progress remains depressingly slow in public and private sectors is the persistence of a macho management culture. Could it be that in a climate of brutal budget cuts it is all to easy for the management culture to become one which uses fear and blame to motivate people, where success is measured in the short term, and competition takes president over cooperation. Could it be that despite commissioning being a new activity in the NHS the harsh financial climate means the same type of managers with the same type of leadership style are sought after?
Dancing with the devil? Exorcism in the NHS
You would not be surprised to be told that some people with mental health problems claim to hear voices and be possessed by demons. You might be a little surprised to be informed that the church still carries out exorcisms or “deliverances” (from evil) as they are now known. You probably would be surprised to learn the NHS uses exorcism as an alternative form of treatment for mental health problems. According to an article in the Times newspaper the Church and the NHS are quietly working together on exorcism.
This is not some wacky cult but mainstream religion and not some unconventional lone psychiatrist but respected professionals. The Church of England has 44 exorcists appointed by the Archbishop of Canterbury. In the article Dr Rob Waller, consultant psychiatrist and lecturer at the University of Edinburgh, referrers to medical support groups across the country include Church of England and Catholic exorcists and imams. Walker is quoted as saying that “Every consultant will see a handful of patients in their career requiring some kind of deliverance.”
Professor Robin M. Murray head of psychiatric research at Kings Collage Institute of Psychiatry is more cautious about the role of exorcism in treating mental health patients saying he doesn’t know of any scientific evidence that exorcism works but acknowledges that not all psychiatric problems respond to conventional treatments. He goes on to say that he would have thought it reasonable for a hospital chaplain to carry this out.
The Royal College of Psychiatry has produced a set of guidelines on spirituality written by Professor Christopher Cook. The article in the Times quotes Professor Cook as saying: ”There is a spiritual dimension to all health related issues and exorcism may be appropriate in some cases”.
You can see why mental health services might want to know if someone is telling their priest or imam that they have been hearing voices telling them to hurt people or themselves. You can see why the Church might want to have links with local psychiatric services for support when coming across a member of their congregation in distress. But what is being discussed here seems to go beyond this and view exorcism as an appropriate treatment for someone with a mental health problem. I didn’t even think the Church still believed in evil spirits anymore!
I find the view that it can’t do any harm to try exorcism as an alternative treatment troubling, since I would have thought colluding with the delusion that an individual is possessed by a demon could be very damaging.
A shocking indictment of corporate management culture
So Circle a private company is to take over the management of a failing NHS Hospital. This is because private sector management is better?
A lot of people will have seen the recent TV documentary Inside Gatwick about how an American company has taken over the airport and intends to make it more efficient and more profitable.
The documentary provides plenty of examples of the new style management. I wonder if private sector management practices will feature in Circle’s NHS hospital. Will they adopt Gatwick’s feared “12 o’clock meetings”?
“Someone will get shouted at, you just hope it’s not you”, says one employee.
Cut to the 12 o’clock meeting. A small room is crowded with managers all standing up. There are no chairs because this will be a short meeting and senior managers don’t want people to be comfortable. In front of colleagues the senior manager picks who he thinks is to blame and demands to know what went wrong.
Next is a presentation on how the South Koreans have developed a management model that improves efficiency, accountability and profitability. This is explained via sixty slides!
Senior management are seen doing a walkabout and saying thing like ”we need a big clock in this hall”. All the signage is being changed, new colours, new logo, to reflect the new ownership. This is costing millions of pounds!
The head of marketing has been told that passengers aren’t spending enough money in the airport shops. His strategy is to go up market, more expensive shops. There is a sequence where the blokes who sell raffle tickets for Ferrari and Lamborghini sports cars are told they will in future also be selling tickets for designer handbags.
Following the sudden departure of the head of marketing an interim specialist has been drafted in. He introduces himself to the management group by telling them things will have to change, that there is no room for failure and then proceeds to details their failings to date. He informs the audience that the previous strategy for increasing sales was completely wrong, and the new strategy is to go mid market not high end.
Interestingly when the new head of marketing on walkabout asks a passenger what needs improving and what would make the airport experience better the passenger doesn’t immediately say more shops he actually says more comfortable seating and better seating areas.
Before anyone tells me that it is ridiculous to compare the running of a hospital with that of an airport I would point out that I agree but those in the private sector probably wouldn’t. Is it not too far a leap to imagine a marketing manager being appointed to increase income from shops in hospitals?
Do you think if is beyond belief that the new private sector management would want to introduce their logo and change the signage to the company’s colours? Would it be totally unexpected if the efficiency drive led to a restructuring? Is it conceivable that the pressure to deliver would be even greater leading to a climate of fear and blame? And would anyone be surprised at the sudden departure of senior managers and the drafting in interim managers.
How long before the main hospital concourse has a Ferrari on display with raffle tickets at £10 a go?
Why can’t health and social care services get it together?
Integration is the newest NHS buzz word, and it’s not hard to see why.
Integration would remove duplication, increase efficiency be more effective and be more customer focused. We would no longer employ social workers and community nurses to do the same job with the same people asking the same questions much to the irritation of patients or service users. No longer would time and good will be wasted on arguing over who pays what on individual care packages. No more arguments about who is responsible for delayed hospital discharges. No more demarcation disputes between occupational therapist, social workers and community nurses.
It seems that integration would solve most of the problems. Yet Health Service Journal’s editorial last week reveals slow progress and considerable confusion about what is meant by “integration”.
Ask anyone in social services and they will tell you integration is the creation of seamless health and social care services and the removal of duplication. What those in social services often fail to recognise that a lot of energy is being expended trying to get coordination and cooperation between acute hospitals and GP practices, acute hospitals and the ambulance service, GP practices and mental health trusts. No wonder there is little time and energy left for the small poor cousin that is social services.
Integration is not new everywhere though: in some places they have had integrated teams of social workers and community psychiatric nurses for years. Integrated teams working with people with learning disabilities have been created in many places and integrated teams working with older people are in place in some localities. The challenges of this bringing together are illustrated by an examination of these so called integrated teams. Most of the mental health teams were integrated only in that they shared the same building. They were different teams, with different managers, their own separate budgets and totally different computer systems which couldn’t talk to each other even if there had been an agreement to share confidential information let alone have a one file per client/ patient. Much of the work over the last ten years has been to try and address these issues at a local level.
Progress has been patchy but the power to operate a pooled budget for learning disabilities was a big step forward. Of course it did raise issues of trust, transparency and different accounting systems. It also exposed a difference in culture where social service were accountable to local people through local councilors and NHS service were not. Not so much a problem when there is a growth budget and an opportunity to fund new services but a problem when budgets are cut.
Much progress around integration of health and social care has been put back by reorganisations and mergers of primary care trust because the key individuals the chief executive, Directors and head of finance changed. Deals done on the strength of personal relationships started to unravel under budget pressure. The introduction of commissioning into the NHS and further budgets cuts in local government and health will further undermine attempts at integration.
How long will the flu jab be a free jab?
I went to see the film Contagion at the weekend all about a global outbreak of a deadly virus. The film struck an uneasy chord as I had received my annual flu jab that morning.
Like a lot of other people I get it free on the NHS because I am in a high risk group. This seems a good example of a health service rather than a sick service that is keeping people well rather than only treating them when they are ill.
I first started having flu jabs when I worked for social services in a children’s home. The manager was keen to reduce the risk of lots of staff going off sick with the resulting implication for covering shifts to say nothing of the cost in overtime! As staff we agreed to this not so much for flu prevention but because we knew that as live in staff if you did go off sick and had received the flu jab you would be sympathetically treated and the opposite was also true.
As a senior manager in social services I encouraged staff working in residential homes or as home helps to have the flu jab. At the time we were happy to pay for it because we recognised we were supporting large numbers of very vulnerable people who would not be able to survive at home without their three or four visits a day to provide meals, help dress and visit the toilet, get into and out of bed and supervise the taking of medication.
These days residential care and home help services have largely been passed to the private sector. Instead of the local authority social service department providing a home help service it now has contracts with dozens of small and medium size business to provide home help. The same is true of residential care: my local authority now directly runs only a handful of homes but has contacts with over 500 in the private sector. Do these employers pay for their staff to have a flue jab?
As a senior manager I considered making it part of our contacts but the homes rightly pointed out they couldn’t make staff have the jabs. The thing is with the private sector they are only going to do something if it helps the bottom line. In other words will they save more money in reduced sickness than it costs to provide the jabs? Which of course depends on whether they pay sick pay and overtime. Staff on casual contacts or self employed don’t get sick pay and some companies don’t pay overtime.
We know what the consequences are for vulnerable and dependant people if their home help doesn’t come but what are the consequences for the provider who admits visits are being missed due to staff sickness? Do they lose the contract? What if there is no one else able or willing to take over the contract? What happens in the mean time to the frail elderly people or those suffering from dementia who missed their visit today and will miss out again tomorrow?
Which brings me back to free flu jabs and the NHS promoting health rather than just dealing with sickness. If we continue to model healthcare on the private sector as we have for social care then it won’t be long before I am paying for my flu jab.
In the drive for equality, culture eats strategy for breakfast
Culture eats strategy for breakfast: well that’s my experience as a senior manager with lead responsibility for equality and diversity.
We changed the policy. We introduced new procedures. We set targets and introduced monitoring arrangements. We developed a training programme. We provided senior management with regular progress reports. We held conferences, ran workshops and we blogged. We encouraged staff to say what they were really thinking, we challenged the myths, ignorance and stereotypes. We didn’t shirk from the awkward questions. We promoted best practise. Yet nothing changed.
We were enthusiastic and energetic champions of the strategy. It was a good strategy. So why did people tell us nothing had really changed?
We had underestimated how difficult it was to change “the way things are done round here”. People said the right things, reluctantly followed the new procedures and attended the conferences, workshops and training courses with varying degrees of enthusiasm. No one actually disagreed with the policy, at least not publically. Some complained that the procedures were long, time consuming and unnecessary. Others said they couldn’t afford the time to go on the training courses. The targets were described as over ambitious, the monitoring arrangements too time consuming and some argued it was counterproductive to report such a lack of progress to senior management.
So we shifted the focus away from policy, procedures and targets and the implied criticism of managers’ performance. We set out to help managers deal with the day to day issues in managing a diverse workforce.
The young woman who finds herself managing staff much older than her who have been in the job much longer than her. The member of staff who complains to their manager that they are the butt of jokes about their sexuality. The only black member of the team who says she feels isolated and excluded as other members of the team don’t include her in their out of work activities or conversations. A manager who tackles a member of their team about frequent absences only to be accused of failing to take proper account of her disability. The manager who picks up on grumbles in the team about a colleague’s frequent requests for time off during religious festivals. The frustration of being part of a management team where every meeting starts with a chat about the weekend’s football results. The command and control traditional management style where decisions are made without real debate, questioning is discouraged even considered disloyal.
These may be viewed as personality conflicts rather than equality and diversity issues, however how these issues are dealt with says much about the management culture in the organisation and the likely success of an equality and diversity strategy. The aim is to provide support to managers, increase their confidence in dealing with people issues and in so doing create a “safe” work environment in which the equality and diversity strategy could be successfully delivered.
Peer group support is provided through management learning sets which help managers appreciate that all managers face people management issues. Practical support, confidence building and skills development is provided through executive coaching, management surgeries and mentoring. Ownership of strategies is achieved through regular meetings between senior managers and the wider management group to talk things through.
It’s not a quick fix but stops culture eating strategy.
It's time to talk about values
I read an article that said public sector organisations were obsessed with getting it right. Getting it right involves embracing the latest management theory, responding to the agenda of whatever political party is in power and adopting a new business model. The article suggested that instead of constantly reorganising services and restructuring management in an attempt to get it right organisations should concentrate on doing the right thing.
I think the author had in mind identifying what was important and where leaders should put their time and effort.
I like the idea of doing the right thing rather than trying to get it right but for me doing the right thing is about values. The public sector in its enthusiasm to be more businesslike, more efficient and more competitive has neglected the values that made us different from the private sector.
Who talks now of the public sector ethos? Some would have us believe the only way the public sector can be as efficient as the private sector is if services are provided by the private sector but funded by the state.
Maybe aiming to be as efficient as the private sector is the wrong aim.
So yes, I do think it is time to talk about values.
Public sector values are about prompting the interest of the wider community, they are about services for all not just those who can afford them. The public sector ethos is that the state has a duty to help and protect the poor, the vulnerable and the disadvantaged. These are the values that underpin the NHS and local authority social services, housing and schools.
Adopting a more businesslike approach in the public sector was appropriate when the agenda was to improve quality. Dropping the “take it or leave it” approach and replacing it with being customer focused had to be an improvement. Business planning, benchmarking, league tables, targets and annual appraisals were useful tools borrowed from the private sector to help us manage performance and make sure we got value for our money. But we have moved way beyond improving services and delivering efficiencies. In the current financial climate the public sector is required to reduce services and manage down demand. We have become finance led.
Public sector values would see us practice driven. We would again be talking about patient and client rights, improving the quality of services and empowering service users. We would be measuring success in terms of quality of life, reducing the gap in life expectancy between the rich and the poor and celebrating the increasing numbers of over 80s.
Of course we will have to spend more on our public services and naturally we want to ensure this money is well spent but if we don’t do the right thing we won’t be able to distinguish between the private sector and the public sector.
Don’t make decisions on an empty…bladder?
Did you know you make better decisions when your bladder is full?
Mirjam Tuk and her colleagues from the faculty of behavioural science at the University of Twente in Holland have just been awarded the Ig Nobel prize for their research into the effects of bladder control on decision making. The Ig Nobels are awarded for research that “first makes people laugh and them makes them think”.
This made me think about a manager I worked for who always left it untill the last possible moment before going to the toilet. It was an open plan office and she sat opposite me. I knew she routinely left it to the last possible moment because she would tell me. ”I need to go. I needed to go before I took that phonecall. I thought it was just going to be a simple query. I really need to go now.”
Not that she needed to tell me: for the last ten minutes she had been standing up, talking on the phone and contorting her lower body.
I assumed this behaviour was the result of a combination of a small bladder, too much coffee and an inability to terminate a conversation. But now I think about it she was a well regarded manager who went on to get a top job in the Department of Health. I had always assumed her success was down to ambition, enthusiasm, experience and a lot of management skill. Clearly she had secret weapon!
Just another thought you know when you go for an interview and they place a glass of water on the table in front of you, rather than take a few small sips may be you should down it in one. Makes you think.
Is the public sector running out of ideas?
Is the public sector running out of ideas or just running out of room to manoeuvre? I ask this question following a publication by a very high profile local authority chief executive.
In this article he acknowledges that public sector managers have been very good at “squeezing efficiencies out of budgets by smart management and clever accounting”, he refers to changes in procurement, reforms of back office services and outsourcing of services. He could also have referred to pay cuts and redundancies but I suspect that in chief exec speak these human resource casualties are assumed as part of the changes and reforms.
This was the reality of the recent past, year on year efficiencies. Sometimes these efficiencies were delivered within the context of a small growth in budget to take account of population changes which would cause an increase in demand like the growth in the numbers of older people. In effect this was giving with one hand but taking away with the other.
Today as managers start to work on next year’s budget the reality is very different: the ”new normal” is to spend less each year. This is not expected to be a one off scenario but the normal state of affairs for the next four or five years. The management task shifts from making efficiency savings to “lowering costs and managing demand”.
This, of course, is chief exec speak for lowering wages, as this is the single biggest cost element, and rationing or disqualifying people from a service. We have already seen evidence of this in how local authorities manage their adult social care budget with the tightening of eligibility criteria to exclude all but the most severely disabled, whilst freezing or even reducing the fee level they pay to resident home owners and home care providers.
Whereas efficiency savings required some creativity and some different ways of doing things, cutting wages and “managing demand” is more about ruthlessly determined management, stopping some services because we can no longer afford them, and being fairly arbitrary in who gets a service.
Public sector managers will always have ideas about how services can be improved and efficiencies made but this is no longer the name of the game. The new normal is about reducing spending and reducing demand. For many managers in the public sector this means there is no room to manoeuvre, no way to protect the service and no way to protect their clients. Which of course many will view as no way to run a public service.
The art of headhunting
My holiday reading included Head Hunters by Jo Nesbo, a thriller about a number one management head hunter who is also a successful art thief. No doubt all those management recruitment consultants I came across as a director would say that the fiction bears no relation to the reality.
Well, all I can say is the tone of the interview, the attempt to throw you off balance, the importance attached to a hand shake, the way you dressed and the significance of how tall you are brought it all back. And the relationship with the client? That explained a lot, too.
“I don’t aim to recruit the best candidate but the one the client will like the best. My reputation and that of the firm is based on being able to come up with someone I know the client will like.
Oh, I will give them a short list of “good” people all of whom could do the job but I will recommend only one. The others are there to flatter the client, to show that there is a lot of interest from able and experienced managers for a post in their organisation.
The client always likes to see one or two candidates from big organisations or people already operating at this level - which of course is why I advised them to offer more money. My success depends on being able to identify the real client, the one who will really be making the decision. In some organisations that is the chief executive, in others it is the leader of the council or chair of the board. My particular skill is working that out.”
(With apologies to Jo Nesbo).
Say no to 'yes' men and women
A couple of weeks ago, the papers were again full of criticism of the former prime minister. His one time chancellor Alistair Darling was sticking the boot in. It was an attack on the man’s personality, not his policies: a savage criticism of his management style, not his achievements. He stands accused of being a bully who did not tolerate dissent and didn’t encourage debate.
The hypocrisy in all this is the pretence that this is an unacceptable and untypical management style when in fact it is part of a widespread culture in politics and the public sector. The people who rise to the top tend to be the scary bullies.
They are the ones with the personalities so dominant and self belief so uncritical that people around them shrink. They promote Yes men and Yes women. Their decisions and mistakes go unchallenged. Without genuine debate, collective responsibility becomes a question of personal loyalty or fear. Senior colleagues own the decisions through commitment to the leader or through fear of the leader. Neither, however, make for good decisions.
The argument centres on Nick Clegg now. Is Clegg just a Yes man to David Cameron’s policies? Are the Liberal Democrats being bullied by their Conservative counterparts? Many would claim so, although the recent Health Bill concessions would suggest some balance is in operation.
However, the majority of observers would agree that the coalition is not run on a 50-50 split. Moreover, Cameron and Osborne are trying to push policies which many Lib Dem MPs and supporters directly oppose.
It might not be on the same level as Alistair Darling’s comments on Gordon Brown, but if we don’t want this type of leadership to prevail - and we shouldn’t - then we need to stop focusing on the individual and concentrate on the merits of the arguments. Where they exist, we need people who will stand up to the bullies, not Yes men and women.
A story about responsibility…
The curtains were drawn and the flat was in darkness even though it was mid afternoon. There was a strong smell of burning. The lights didn’t work. The electricity had been cut off. It was colder inside the flat than out side. There was not a stick of furniture in the living room and no carpet on the floor.
In the centre of the room were the charred remains of a recent fire made of twigs, waste paper and broken furniture. A quick check revealed the tenant was known to mental health services but they said he did not have a mental health problem. According to the psychiatrist he just had an awkward personality and possibly a mild learning disability.
The combined health and social service leaning disability team disagreed. There was no evidence of a learning disability. The local social service team for older people didn’t want to know because he was under 65. Housing said they had received complaints from neighbours but had failed to find anyone in when they called. The benefits agency said he had failed to keep a number of appointments despite several letters so they had stopped his money weeks ago. “That usually does the trick,” the benefits officer said.
No one wanted to accept responsibility but everyone felt someone should do something.
The story has a happy ending. The worker at the drop in centre got the benefits restarted, the electricity back on and some second hand furniture.
The issue is not, what powers do agencies have?, or what rights an individual has, but who is going to take responsibility to sort out the problems.
In the end it wasn’t that difficult but it could have been a very different ending: an eviction, a charge of arson or a compulsory admission to psychiatric hospital. Or something even more tragic.
Leaders lack confidence in the changes they've been asked to make
Transforming the public sector on the scale the government requires was always going to be difficult. A recent Ipsos MORI survey of public sector leaders reveals just how difficult as three quarters believe the changes will not improve services.
The government should be worried if the majority of those responsible for driving through changes don’t share their belief that this will result in better services. Yet rather perversely these same public sector leaders think the government plans are the right thing to do!
The explanation for this contradiction is that public sector leaders have taken on board that their number one task is to make cuts to budgets and deliver savings. Where they disagree with the government is that it is possible to do more with less. In fact many see efficiency initiatives not as delivering the same with less but delivering less with less. In other words reduced budgets even if spent in a different way will result in fewer people receiving a service and or a reduction in the quality of service.
Seven out of ten leaders polled felt that the government was forcing the pace of change too quickly by making budget cuts too fast. A view they believe is shared by the majority of the general public judging by the lobbying of local politicians and the reaction of local media.
Whilst the government still seems to think the Big Society will fill the gaps the majority of public sector leaders think it won’t. Almost half those polled thought it would make no difference locally.
Is it any wonder that staff, service users and the general public have picked up on this scepticism and responded with accusations that changes are not about improving services but saving money!
The reality is confirmed by the nature of senior managers’ ”conversations” with staff and service users. Chief executives talk to staff of standing on a burning platform to illustrate the need for fast and dramatic action. Senior managers “consult” with service user groups not over whether libraries, museums, swimming pools and sports centres will close but which ones. The debate in youth services is not about how best to spend the budget to better engage with disaffected young people but how much can we get away with cutting the budget by?
The talk of increased choice and control by users of social care has been replaced by how much can be saved if help and support is restricted only to those older people in greatest need.
In the NHS managers now openly admit waiting lists are getting longer. No one is pretending this is improving services. No one, that is, except the government.
Apple of the eye? Why leaders should never be seen as indispensible
The announcement last month that Steve Jobs was stepping down as chief executive of Apple for health reasons had an immediate impact on share prices and has prompted discussion about whether it is good for a company to be so identified with one individual.
The so called “cult of the chief executive” is also recognised in the public sector. These are individuals who are credited with turning around failing organisations or for making mediocre organisations great. Some come in at a point of crisis, work their magic and go on to bigger and greater things; others build over many years and go only reluctantly when retirement beckons.
But whichever type they are, they present the same problem: what happens when they leave?
I am sure even Steve Jobs, credited as he is for making Apple a globally successful company, has a very competent team of senior managers backing him up and that Apple has some of the brightest and most innovative people in the industry working for them. So why was the stock exchange so nervous?
Put another way - why does any successful organisation, service or team worry about the impact of a high profile leader leaving, unless they think what has been achieved is all down to that individual?
Some of this can be explained by natural anxiety along the lines of, what if the replacement isn’t any good or wants to change everything? There may be a concern that some of the most able and experienced managers will see this as the time to go, their loyalty was to the individual not the organisation. New chief executives, like new senior managers, want to surround themselves with their own appointments, people who think like them and don’t keep referring to how things were done under the predecessor. So some closely associated with the old order may be encouraged to go. There may be concern that these changes of key personnel will adversely affect the organisation albeit in the short term.
It could also be that this high profile, highly regarded charismatic leader’s achievements were down to their sheer force of personality, people at all levels in the organisation believed in this person and were prepared to go along with their vision and their decisions because they liked and respected them.
Nothing wrong with that, you might say, we want and need leaders who inspire their staff. Well in my view we don’t.
This type of leadership may be very effective in a crisis but this “cult of the leader” is very damaging for an organisation in the longer term. To use a sporting analogy this would be the difference between a great team and a great club.
A great team goes a whole season without losing, a great club is one that has a succession of successful teams: even though the individuals change the philosophy behind the way the club is run doesn’t. In organisational terms the culture is not follow the leader, the culture is based on a shared set of values, a shared vision of the future and an agreed way of doing things. This will not change - even if the leader does.
Don't make me think...
There are two types of manager: those who tell people what to think and those who want to make people think.
Now that all managers are expected to be leaders, to inspire their staff and take responsibility for making things happen, it is all too easy to claim to be the latter but perceived to be the former. When you address staff your passion and enthusiasm, your dismissal of the sceptics and cynics, your conviction that this is the right way can be heard as lecturing and sound like you’re telling people what to think.
Are you going to concentrate on changing behaviour or influencing thinking? Organisations often claim to want to change the culture but in focusing on the way things are done they end up with new policies and procedures but no new mind set.
Staff know what they are supposed to do but they don’t necessarily think it is right. You can give the staff the “have a nice day” script but that doesn’t guarantee they will be customer friendly.
If you want to make people think, you don’t simply tell them your vision and what you believe in. That can come across as preaching. You tell stories, you quote some challenging statistics and you ask questions. You give people the opportunity and space to think about the issues and you create a safe environment to challenge and be challenged. Naturally this involves a lot more risk.
Applying these two approaches to the challenge of employing more staff with a disability would involve different initiatives. You can change behaviour by introducing an interview guaranteed scheme for all applicants registered as disabled. You can set recruitment targets, you can change the wording on application forms and job adverts to make it explicit that the organisation positively welcomes applications from people with a disability but this is unlikely to challenge the stereotypes and myths of those on the interview panel or make work colleagues think about disability.
The most effective way I have experienced of getting people to think about disability was when a young person with a learning disability was placed in the admin team supporting the senior management team. This was more than work experience, some hours were taken from an existing vacancy to create a part time post for someone with a learning disability as part of meeting a recruitment target, but also to identify and overcome any problems, real or perceived, in employing someone with a learning disability.
The result was a lot more thinking, debate and shift in views than would happen through any exhortation to equality or training course because of course this was no longer about people with a disability - this was about an individual.
Of course this was risky and involved a lot more management input. Which is why so many managers resort to telling staff what to think: it’s easier!
Leadership: not as dangerous as some might make out
Leadership is dangerous work - so claim two Harvard professors Ronald Heifetz and Marty Linsky in their book Leadership on the Line. The book uses case examples to give tips on team management, keeping your emotions in check and dealing effectively with opposition - because leadership is risky and dangerous.
Leaders are people who are prepared to put themselves ”on the line”, they are courageous, they have the “guts” to challenge and the confidence to hold their nerve in the face of overwhelming opposition. I am picturing a John Wayne western or Bruce Willis in one of the Die Hard movies. But to be a leader you need to be more than a maverick with balls; you need to be able to see the bigger picture, to be “on the balcony not the dance floor”.
A modern leader encourages passionate debate by making it clear it is ok to say what you think and to challenge but never lets things get out of control and knows when to step to reduce the temperature.
The clever leader does not allow themselves to become the sole target for those resisting change but ensures others take appropriate responsibility.
I certainly recognise this leadership behaviour but as a model it doesn’t set the right tone. For me this style of leadership too closely resembles macho management and Machiavellian management. It lacks the subtlety of the leadership required in complex organisations which operate within a political environment like local government or the NHS.
Is it really so “dangerous” being the chief executive? Leading a polar expedition, maybe, leading a patrol in Afghanistan, definitetly, but chairing a discussion on the future of the library service or awarding an IT contract…?
Is it really “dangerous” to express an opinion, will challenging and questioning inevitably jeopardise your career? Are you putting your career and personal life on the line every time you make a decision? Leadership is rarely so dramatic.
It is more about influencing and shaping rather than dictating and controlling. The main personality characteristic required is not courage but stamina. Having the energy and the persistence to keep chipping away at the myths, to keep challenging the accepted wisdom and the existing ways of doing things,to repeatedly repeat the message even though you are sick of hearing it yourself.
Leadership is not dangerous - it is wearing. The biggest risk is your hair turning grey and the loss of your idealism.
If bullying doesn't bother staff, why are so many absent?
According to research undertaken by the Salisbury Foundation Trust bullying doesn’t bother most staff. A survey of 300 nursing staff to identify the work issues that most concern them put excessive workloads and abusive patients at the top of the list, leading to an eyebrow-raising headline on HSJ.co.uk that questioned whether bullying bothers staff.
In the same issue there was reference to another report highlighting the continued high levels of absenteeism in the NHS.
I am sure I am not the only one to recognise the link between absenteeism, heavy workloads, management bullying and abusive patients.
A previous survey commissioned by the Royal College of Nursing reported exhausted nurses being pressurised by managers to work overtime and do extra shifts to cover for absent colleagues and vacant posts. Staffing shortages obviously have an impact on patient care. If staff are rushing round trying to do two people’s jobs then some patients will have to wait longer than they think they should to get the attention they need. Some, inevitably, will respond by being abusive.
Staff should not have to put up with abusive patients, management bullying or excessive workloads. But they do and it has an impact on their wellbeing and their attendance.
Asking staff what bothers them most and them listing their concerns in the order they cause most distress fails to recognise the vicious circle. A circle that senior managers need to break. And I don’t mean sacking staff who are off sick. I mean establishing adequate staffing levels, ensuring vacancies are filled quickly, supporting staff who are subject of abuse and refusing to view it as just “part of the job”, and employing managers who can see beyond the immediate budget issue and short term performance targets.
Trying to force equality in leadership is an unbalanced approach
Quick fixes rarely work on complex organisational problems. Cultural change involves a sustained effort and a prolonged commitment. Judging by the number of vitriolic comments on the website many staff in the NHS don’t accept the need or appropriateness of “special treatment”.
What’s revealing about this is that most of these comments are anonymous. This tells me that when it comes to issues of race or other areas of equality people in the NHS don’t feel able to say what they are really thinking. Which in turn means that if a trust is not a safe place to have this type of discussion then it is the type of place where the discussion doesn’t happen except in whispered corners? How can the culture of an organisation be changed if there is not the opportunity to challenge myths, stereotypes and accepted ways of doing things?
In most trusts it will be HR who try to change behaviour when it comes to recruitment. They will introduce policies to require all management posts to be advertised externally and open to competitive recruitment, they will require each advert to be supported with a person specification detailing the skills, experience and qualifications necessary. Shortlisting will be carried out against this person specification so any decision can be backed up by reference to the candidates match against the person specification. Appointments will be made on the basis of performance at interview.
To minimise the risk of bias and reassure candidates interview panels may have an HR rep present or be balanced in terms of gender and race. Candidates have feedback that an all male, all white interview panel can raise a doubt in their mind about an organisation’s commitment to equality. These procedures are supplemented by the two-day race awareness training course for all those involved in recruitment. None of which influences the views of those making anonymous comments on the blog.
Senior managers have to be prepared to debate these polices in open meetings with staff. Something they are often very reluctant to do. They need to answer questions like why do we have a leadership course specifically for BME managers, why do we need balanced interview panels and why is there a separate black workers support group? Organisations need to provide forums where staff have the opportunity to explore issues of race, gender, sexuality, faith age and disability where people’s views can be challenge without fear of being denounce as a racist or supported without being labelled politically correct.
I have seen this done very well using actors to play out a typical work place scenario around homophobic bullying or sexist “jokes”. The actors then stay in character to discuss what happened with the audience. The questions and answers arising out of these sessions can be posted on the organisation’s intranet so they can be accessed by the whole staff group.
These events can be used to recruit equality champions who will take the issues back into teams and provide to senior management new questions to be answered. If you are interested in a case study bringing together these approaches, plus more examples and training material, you will find it in An Elephant in the Room, an equality and diversity training manual published by www.russellhouse.co.uk.
What happens when pleasing the boss goes too far?
Some people are good at their job and some are good at pleasing their boss. These are not mutually exclusive. It’s no good being brilliant at your job but constantly at war with your boss; neither is it helpful if you can’t do the job but your boss thinks you’re brilliant.
Keeping the boss happy makes perfect sense, they allocate your work, set your targets, complete your annual appraisal, determine your bonus, influence your promotion prospects and make your life easy or hard. It doesn’t seem to matter where you are in the organisation, whether you’re the chief executive keeping the leader of the council happy or an admin assistant trying to keep on the right side of your team leader, there is a lot of pleasing the boss going on. Only it does matter.
I have experienced senior management teams where the directors vie to keep the chief executive happy, only telling them what they want to hear, trying to outdo each other in setting targets and agreeing deadlines, competing to come up with plans and suggestions that the boss will like. Don’t expect any debate at senior management team meetings if everyone is competing to please the boss. Don’t expect anyone to challenge or to ask awkward questions. Don’t expect to be given a rationale: just accept this is what the boss wants. It’s not hard to see how this might lead to over ambitious targets, unrealistic time scales, self censorship and a growing gap between the rhetoric and the reality.
In my experience senior managers are even more prone to trying to please the boss than those further down the organisation. I have heard a chief exec say: “Look it doesn’t matter whether we think this will work or whether we think it is the best or even a sensible use of resources it’s what the leader wants.”
The implication was “keep the leader happy and we will all be able to get on with our jobs with minimal inteference”. Of course at the root of this is fear, fear of being marginalised, simply excluded from the discussions and the decisions despite your position, fear that despite your commitment and ability you will be portrayed as cynical and resistant to change and fear that you will be unsupported and made the scapegoat when something goes wrong, the targets aren’t met, the outcomes not achieved.
It’s not as if the boss needs to make any of this explicit. I saw a group of senior managers cowered by the simple technique of putting people on the spot by asking one of them in front of their staff to explain “our” position on this. Of course there had been no prior discuss. The director concerned either had to say they didn’t know and look stupid in front in front of their staff or guess what they were expected to say and risk being publically corrected. Either way the message was clear this director was considered not to be “on board”.
It is down to the boss to ensure people are not simply trying to keep them happy. A good boss welcomes a challenge and is prepared to accept that they are not always right. They also need to accept that sometimes, people want to be able to tell them that, too.
Changing behaviour needs more than a 'nudge'
All it takes is a nudge in the right direction - so the saying goes. Some in government believe it is true, or rather hope it is. Wouldn’t it be good if a nudge in the right direction could get people to eat healthier, drink less alcohol and exercise more? Reduced obesity, diabetes, strokes and heart attacks, improved life expectancy, improved quality of life, all at a reduced cost to the NHS.
No wonder the idea is attractive to politicians: not only does it cost less, it doesn’t require legislation. This is very appealing to politicians who don’t want to be accused of promoting a “nanny state”.
An example of nudge theory at work is the traffic light system on food labelling. This tells us if the food is high in sugar, salt or saturated fat. Armed with this information the consumer can choose to eat healthier.
So does it work? Not according to a report by Baroness Neuberger to the House of Lords, whose 12 month study has concluded you need more than just a nudge to change behaviours.
Most of us would agree that this is true. Warnings on cigarette packets don’t stop people from smoking. People don’t turn of the TV and go for a run simply because all the evidence says it will reduce the risk of a stroke or heart attack. It took a heart bypass operation before I started drinking red wine instead of beer and spirits.
So if nudge doesn’t work, what does? Car seatbelts are an example of changing people behaviour that has worked. The introduction of car seatbelts and legislation requiring passengers to wear them supported by an awareness campaign made a dramatic reduction in deaths and serious injuries.
What the popularity of “nudge theory” illustrates is the willingness of politicians and managers to grab hold of a quick fix. They know perfectly well that it takes time, effort and resources to change people’s behaviour but they are under pressure to bring about change quickly, preferably without increasing spending or upsetting invested interest.
Know what I mean, nudge nudge, wink wink.
Is your organisation accepting the unacceptable? Challenging 'ethical fading'
They call it “ethical fading”. You and I call it going along with something you know is wrong.
We are not talking about one weak or fearful individual who fails to blow the whistle on bad practice. We are talking about the type of organisation where acting unethically is acceptable, where such behaviour is no longer considered wrong but has become the way of doing things.
Well, it is still considered “morally” wrong but it is clear in reality that “everybody does it”.
It could be fiddling your expenses, massaging the figures, overcharging, omitting unhelpful information, offering or accepting inducements, putting profits before the health and safety of the workforce or cutting corners when it comes to protecting the environment. Today it is paying the police for tip-offs and hacking people’s phones to get a scoop.
The public sector is not immune from bad practice, especially as it seeks to adopt private sector business methods to compete in the market.
A new book called Blind Spots by Max Bazerman and Ann Tenbrunsel refers to this deterioration in ethical behaviour in an organisation as ”ethical fading”. When thing go wrong rather than simply identifying someone to blame and putting it down to greed or incompetence they attempt to look at how people actually make decisions under pressure, against tight deadlines, budget cuts and worries about their own future. It would appear that when the business is target obsessed and bonus driven most people just go along with how things are done and don’t ask too many questions.
So how should an organisation guard against this erosion of ethical behaviour or “ethic fading”?
The tone is set from the top of the organisation and passed on through the day-to-day behaviour of managers. The organisations leaders must model the behaviour they want others to copy. Ethical fading starts when employees suspect that those at the top say one thing and do another; when leaders make statements that contradict the experience of staff and when managers choose to ignore or deny the contradiction.
It could be a statement about valuing staff, a commitment to consultation, a promise that budget cuts won’t affect front line services or that safety is the top priority. All of which are undermined by a macho management style and a finance led target driven culture.
Put another way, an early warning sign of ethical fading is a lack of integrity from the leadership. The danger is that, unaddressed, it can quickly infiltrate an organisation from top to bottom.
Your flight has been cancelled (by your employer)
When staff can be dismissed and told they can only have their job back if they accept lower pay and less favourable terms and conditions, as has happened at a council in England, then local authority employers can do anything they like. So cancelling all leave in August due to staffing shortages is not so unimaginable.
Managers had been highlighting the problem since April but they had cried wolf too many times before for the senior management team to take their claims seriously. Naturally with one in four management posts cut and all management vacancies frozen those remaining would claim that they were struggling with the workload and cover.
There were a lot of leaving dos in March as those taking early retirement or voluntary redundancy said their goodbyes. The process of reshaping the management structure was well underway by June. The alarm bells didn’t start ringing until July when it was realised that due to the school holidays there wouldn’t be enough managers at work in August to run the department.
You can run a skeleton service on bank holidays and for that week in between Christmas and New Year but you can’t do it for a whole month. Without managers’ budget approvals elderly people would not be able to be discharged from hospital. You might be able to leave one manager covering a number of day centres for a week but a whole month?
Better to close them down than take risks with vulnerable clients and unsupervised staff.
Without line manager authorisation vacancies could not be advertised, let alone filled, yet neither could overtime be authorised or the use of agency staff approved. Leaving social work teams without proper management cover for any length of time would be very risky. What if a vulnerable client commits suicide and the staff are accused of missing the signs or failing to ensure they took their medication? A tragedy. But if the staff say they were left totally unsupervised and unsupported as they had no manager… what then?
What if staff failed to respond to reports of abuse of someone with a learning disability due to the volume of referrals and the absence of a manager to prioritise?
The director at one council had no choice: he cancelled all annual leave for mangers in the month of August. All hell, as might be expected broke loose.
People had holidays booked and paid for, bags were packed and the kids were excited. People were entitled to a holiday, their manager (since left) had approved it months ago. They wouldn’t be able to get a refund.
The trade union challenged the decision claiming it was unreasonable. HR reminded them that annual leave had to be approved by a manager and that if the senior management team felt that vulnerable clients would be put at an unacceptable risk then in the interests of the service it was within their power to cancel leave.
They also reminded the trade union that custom and practice was for managers to arrange cover for their absence and this clearly hadn’t happened. To which the trade union responded by saying how could cover be organised when a quarter of the management posts in the department had been got rid of, the restructuring process was still not completed, all vacant management recruitment was frozen, and half the front line managers don’t have a manager and don’t know when they will. At which point someone from HR was heard to mutter well it doesn’t help that you have instructed your members not to cover vacant posts.
Things got unpleasant when it emerged that the director and at least one member of the senior management team were planning to take annual leave in August. The director protested that he had arranged cover with other members of the senior management team as he did every year but this did not appease the aggrieved.
Things got even nastier when the director’s car was vandalised in the staff car park.
The leader of the council announced on local radio that none of his senior managers in social services would be taking annual leave in August and that managers had to accept that the needs of the service came first and no one had a right to insist on taking their annual leave in school holidays.
After which he flew out to Spain to join his grandchild at their rented villa.
'Beyond samosas and reggae' - or, developing services with equal opportunities
Beyond Samosas and Reggae - what a great title for a book. The book is subtitled “A guide to developing services for black disabled people”. It was published in 1995, and is only 48 pages long, but it must be hard to get hold of because I could only find one (used) copy available on Amazon and that was going for £88.
A paper by the same author with the title I’m Not Asking to Live Like the Queen (SCIE 2005) outlined the wishes of service users on the future of social care for adults.
The author is Nasa Begum and in 2008 she appeared on the BBC programme Don’t Get Mad Get Dom with Dominic Littlewood which showed British Airways refusing to let her on a flight from India because she was unaccompanied. She fought successfully for BA to recognise her right to travel independently.
Sadly, Nasa died on 24 May 2011. But as a writer, researcher and campaigner Nasa was very clear on a one message, which lives on.
People who have a disability do not need help but simply an equal opportunity. Nasa’s hard work campaigning for equality should be inspiring as we seek to make equal the rights and opportunities for everybody in today’s society.
The difference between what is said, and what is meant
Over half of all local authorities have considered bringing services outsourced to the private sector back in-house. That is the findings of research commissioned by Unison, Britain’s largest public sector union. The report claims that officers in 60 per cent of councils have been asked to consider bringing services back into local authorities as part of achieving budget savings.
Unison general secretary Dave Prentis claimed the survey highlighted the risks of outsourcing services to the private sector and was evidence of the quality, efficiency and accountability of public sector services.
Well he would say that wouldn’t he? Outsourcing council services has led to job losses, pay cuts and reduced sickness pay for his union members. Before we dismiss this union-sponsored survey as propaganda, we should recognise that it brings out into the open that thinking at local government level has moved on even if hasn’t in central government.
Recent scandals concerning the care of people with learning disabilities in private hospitals and the finances of private sector companies caring for older people have brought into question whether the care of vulnerable people should be determined by the profit motive. Maybe health and social care just isn’t suitable to be run as a commercial business and should be a public service.
This survey may also allow officers to say what has to date been unsayable: that many local authorities got ripped off by big private sector companies whose aggressive sales tactics, slick marketing and smart legal teams took advantage of officers inexperience of entering into large scale long term contracts for services.
The promise of quick, big savings, the leap to cutting edge technology and the holy grail of doing more with less was just too much for many councillors to resist. The reality has been a mixture of systems that over promised and under delivered, where people were sold a Rolls Royce when all they needed was a Ford Mondeo and where the biggest saving came from employing less staff and paying them less.
Of course it is true that that in the past public sector services found it very difficult to move from traditional ways of doing things in response to changing customer needs and expectations. Local authority workers had a reputation for being inflexible and for running services to meet their own convenience rather than the needs of those they were providing a service to.
I remember when the Home Help service operated around the working day of mums with young children: the service was only on offer Monday to Friday once the mums had dropped off the kids at school and very little was available after 3.30pm or at weekends. But this was 30 years ago.
We now live in the 24-hour, seven day a week society. These days you don’t have to outsource to get flexibility. These days you outsource to get the service cheaper. This survey reveals that many local authorities are questioning whether this is such a good deal and whether it is even true.
Watching what you say (part 2)
No longer a senior manager, I don’t have to worry about upsetting social workers, nurses, auxiliary staff or their managers. This doesn’t mean I don’t care what they think. In fact my motivation to write is because I do care what people think. I am just less bothered about what they think of me.
As a senior manager I was always keen to stimulate debate believing that open discussion was the best way to challenge attitudes and change behaviour. I also believed that speaking out openly was the most effective way of supporting staff who felt the organisation had good sounding polices but failed to back them up. I am referring to bullying, harassment and equal opportunities particularly around race and sexuality. These were the areas where staff and managers tended to shy away from making comments for fear of saying the wrong thing or opening up a can of worms.
A detailed description of how we went about creating a safe environment in order for staff to challenge and be challenged can be found in An Elephant in the Room – an equality and diversity training manual - but real progress only came through incorporating this approach into an house management development programme. A case study is included in Equipping Managers for an Uncertain Future published by www.russellhouse.co.uk
The great care divide
“I don’t want to sell my house to pay for my care because I want to leave it to my grandchildren.”
As an assistant director of social services I frequently heard of an elderly person living alone who was struggling to cope but who didn’t want to go into a home once they realised they would have to pay for it.
Even more disturbing was the number of times we came across a son or daughter who was determined not to see their inheritance spent on their parents’ care. When you work in social services you are often exposed to the unpleasant side of human nature - greed, cruelty and indifference.
But why should the taxpayer pay for the care of someone who has a quarter of a million in the bank, or the equivalent in capital resources? With the average house price, even in the current depressed market, worth over a £100,000 why should the individual not be expected to use their resources to pay for their care? If someone has savings or an occupational pension why should they not be expected to contribute to the cost of providing help in their own home?
I thought the whole idea of contributing to a works pension and paying off your mortgage was to provide for your old age. So when old age comes why are people so reluctant to spend their savings? The blunt answer is people just don’t like the idea of having to pay for something that other people who have not saved get free. Another comment on human nature!
So the answer is everyone needs to be required through a compulsory scheme to make provision for their old age. Otherwise, the pressure on taxpayer money will grow, as will the value of the assets belonging to the people who don’t want to pay for care out of their own pocket.
Why you should keep the 'smiling assassins' in HR on your side
They have been described as smiling assassins for appearing pleasant and friendly whilst informing you that you no longer have a job. They have been compared to estate agents in appearing to be an impartial broker when they turn out to be nothing of the kind. Most frequently they are seen as the people who do management’s dirty work. I am of course referring to Human Resources staff.
I suppose in a climate of redundancies, redeployments and restructuring there is a tendency to shoot the messenger and the messenger is often HR. The name on the bottom of the letter may be that of a senior manager but the contact person, the one who will be “advising you on your options”, will be from HR.
If you are unfortunate enough to be the subject of a disciplinary hearing then management will present the case supported by someone from HR. They will tell managers how to present you in the worst possible light. If you’re appearing before an attendance panel as a result of your absences from work then it will be the person from HR who ensures all the dates are laid out, the relevant sections of the occupation health report are highlighted and the chair briefed with policy quotes like: ”In view of the fact there is no immediate prospect of a return to work…”.
You can understand why staff might see HR as on management’s side. You might be surprised to learn that first line and middle managers are no fans of HR either. This is because they view HR as the ones who say “you can’t do that” in response to a manager’s proposal to sack someone, to refuse to take them on redeployment or to appoint them without following the formal recruitment process.
HR police the organisation’s policies and procedures and so they are often seen as bureaucratic and obstructive by operational mangers who just want to get things done quickly.
An HR colleague once told me my managers were in the habit of ring up HR staff asking for “advice” and when they didn’t get the answer they wanted they would simply ring another member of HR phrasing the questions slightly differently until they got the answer they wanted. They would then act and claim they were following HR advice.
The other reason managers are often antagonistic towards HR staff is due to what happens when a member of staff accuses a manager of harassment or bullying. Managers tend to resent having to justify their decisions to anyone other than their line manager, and view being asked by HR to show they acted reasonably as being guilty until they prove their innocence.
In fact HR are just following the agreed formal procedures knowing full well that not to do so would invite criticism from the trade unions with whom the procedure was agreed. Even more significant is the fact that to ignore agreed procedures would expose the organisation to future claims of unfair dismissal.
HR don’t work for management - they work for the organisation. Their job is to promote good employee relations hence their focus on recruitment, disciplinaries, absence management and health and safety. The true value of HR is their unseen work. It’s members of the HR team who meet regularly with trade union reps and sort out potential “misunderstandings”. These are often the result of senior managers getting carried away and being indiscreet or too bullish in their comments to a group of staff. On more than one occasion I have been thankful for HR digging me out of that particular hole.
HR actively encourage managers and staff to resolve problems informally (i.e. sitting down and talking about it with the union rep present) because they know that once the formal process is begun, attitudes harden. Some of the most difficult issues for managers to deal with are conflicts within their team, people who just don’t get on, the individual who upsets everyone by not taking their turn to make the drinks or do the washing up, the person who can cause a major falling out over whether an open window is too draughty or a closed one too stuffy.
More serious and more sensitive are accusations of homophobic bullying, sexist comments or inappropriate “jokes”. On these occasions managers are very grateful for the advice, support and guidance of HR, and perhaps they should be considered the diplomats who try to ensure disagreements don’t turn into conflicts, and where conflicts do arise, to bring them to a swift resolution.
I am not surprised if staff and managers don’t put up much resistance to cuts in HR. But I would be surprised if they didn’t come to regret it.
Is enthusiasm the key skill to look for in public sector recruitment?
The final of Britain’s Got Talent has only just finished and the British public is already awaiting The X Factor. These shows are certainly very popular with the public and they also give an opportunity for absolutely any one to show they have talent and potential.
Could this approach be applied to recruiting staff in the public sector?
I have always felt that we put too much emphasis on experience and qualifications and not enough on enthusiasm and values. It may be that a change of emphasis would result in appointing people with a more positive attitude to those they cared for and so would be less likely to abuse them.
When I was recruiting staff to work in large residential homes, I was desperate to change staff attitudes.
I had good managers who were champions of independence, choice, dignity and respect but who struggled to defeat the staff room culture. When they were on duty, walking around the building promoting and encouraging everything happened as it should but when they were on their days off, holiday or attending a meeting everything reverted back.
The majority of staff could be influenced by the manager or the staff room leaders. Training resulted in people knowing exactly what was expected but even this did not stop them reverting to doing what was easiest when the manager was not about.
When the opportunity arose to recruit new members of staff it was seen as a real chance to shift the staff room culture. What was needed were people with enthusiasm, energy, creativity, a desire to make a difference and set of values compatible with improving the lives of people living in the home.
Specifications were drawn up for the vacant posts which were as inclusive as possible; no requirement for experience in care work, no requirement for working with the client group and no requirement for qualifications. The essential requirements were a positive attitude to the client group, willingness to work shifts and willingness to undertake training.
The result was a large number of applicants and very little criteria to short list so we interviewed large numbers over several days. A bit like the early rounds of Britain’s Got Talent; we had to see a lot of no hopers to unearth a few gems. The interview questions were all based around the ability to apply values like choice, dignity and privacy in relation to situations within the home. We were also looking for enthusiasm.
This may appear a bit hit and miss. Someone might state that they would go to the laundry to find the dress a resident wanted to wear rather than persuade them to put something on that was in the wardrobe but how do you know they are not just saying what they think you want to hear?
However couldn’t that be said for all interviews? How do you determine if someone is enthusiastic and how do you score it in an interview? It seems to work well enough on Britain’s Got Talent; both the panel and the audience seem to be able to identify those with potential and you know a positive and enthusiastic person when you meet one.
This talent show judging approach made some HR colleagues nervous and it was certainly time consuming but the impact these new staff had on the staff room culture was dramatic. Justification, I think, for giving more weighting in the interview process to enthusiasm and values, over the traditional emphasis on experience and qualifications.
What happens when chief executives are slow to pick up on patient complaints?
It’s the sunniest day for weeks and instead of soaking it up in the garden we are in outpatients.
We’re here for a follow up on my wife’s operation that she had to remove gallstones. It should have been key hole surgery but there were complications, open surgery followed by an infection but six weeks later the scare has healed up nicely and here we are at the hospital.
A positive start; it’s a touch screen electronic registration which would make our process more efficient. However the message comes up: “report to reception” – not so efficient then.
Reception examines our letter from the consultant and informs us we are in the wrong place. “You need to go to ‘Shaftsbury’ - end of the corridor, turn left.”
We see the signpost for Shaftsbury and then McMillan cancer information centre. We present the consultant’s letter and the receptionist checks are details and confirms she has Brenda’s medical notes. “Take a seat and you will be called.”
There is no one else in this smartly furnished waiting area and the first thing we notice is that there are neat racks of leaflets, all of them about cancer! Why have they sent us here?
If there was a problem with the post-op test they would have informed our GP first, wouldn’t they?
My wife is convinced she has cancer - why else would they send us to the cancer outpatients clinic?
There was no mix up, the receptionist has her notes and the date of birth and address are correct. I try and reassure her by saying there is no way they would let anyone find out they had cancer this way - but I am not convincing her, or myself.
There follows an extremely long ten minutes filled with dread and anxiety before we are invited to see the doctor. We are shown into a consulting room and informed by the nurse that the doctor will be along shortly. We take a sneaky look at the notes she has left; they say “refer to specialist” - andwe fear the worst.
Through panic I announce: “This is the cancer unit.”
However the response was astonishing. “We get complaints about this all the time, it has been raised with the chief executive. This is the biggest outpatients unit so when the others are busy we use these consulting rooms. You don’t have cancer. This is just a courtesy follow up because your op had complications.”
If I hadn’t been so relieved, I would have set off looking to kick that chief executive somewhere very painful.
All is not as it seems behind chief executive closed doors
The most interesting conversations, the ones that provide a real insight are when senior managers go off the record.
When a director or chief executive comes to give a talk to colleagues from other organisations and starts by confirming Chatham House rules apply, you know it is going to have been worth turning up.
If you are in a management learning set or on an MBA course this hour will be one of the very few occasions you get to learn about what it is really like to be a senior manager operating in a political environment.
The session will be part gossip, part Machiavellian manoeuvres - with the odd reference to some skeletons in cupboards - and part learning some valuable lessons.
You might get the real story about why the last chief executive left, how the leader of the council was ousted by their own party and how deals were struck in deciding who got what job in the cabinet.
You may learn how much influence a local MP has; who plays golf with the editor of the local paper and who drinks with the regional trade union organiser. Or that when something big goes wrong, like the death of a child in care, what makes some local authorities stand by their chief officers whilst others throw then to the wolves.
Of course you can’t repeat any of this or say who told you but you will listen to reports in the media in a different way, and when you hear those carefully worded press statements you will be able to read between the lines.
Can local authorities step up as good providers of care?
One of the largest providers of private residential care for older people is at serious risk of going bust.
A private residential hospital providing care for people with a learning disability is exposed on national television for routinely abusing residents.
Questions are raised in the House of Commons, as the care commission responsible for inspecting homes admits it failed to protect residents.
What is the common link between these failures? The increased generality of the private care sector.
Many local authorities no longer provide residential care for older people or people with a learning disability. Why? Because they were expected to compete with the private sector on price and couldn’t. This price war also meant small homes could not compete; 12 beds may be cosy, but 60 is cost effective.
At a time when the authorities did not have the money to build new homes, the private sector seduced many with their purpose built units with en suite facilities, walk in showers, fitted wardrobes and fitted carpets and a television and phone in every room just like a hotel. And of course succumbing to the private sector will be attractive when the quality of care will be regularly inspected.
Local authorities’ budget cuts meant they did not up rate care home fees when faced with rising costs. This and the staffing cuts in the reorganised inspection service resulted in a “light touch”, and consequently the reports of abuse, weak management, poorly trained inadequately supervised staff.
The private sector, which was once a choice, is now in many places the only option. It had once offered something different for those who could afford it but now it provides care for all.
So is it finally time to recognise the folly of turning care into a business - and reinvent public sector care?
Senior managers need to get 'hands on' with customers
How do you know what’s going on? I don’t mean the budget position or performance against targets or even staff moral. I mean how do you know what it is like to use your services, to be a customer of your organisation? Those who deal with customers directly know but how do their managers get to know and how do those at the top of the organisation find out?
Frontline managers know because they are the ones who deal with complaints, whereas senior managers may rely on customer satisfaction surveys. Frontline managers have the anecdotal evidence whereas senior managers have the numbers. This hasn’t always been the case and it still isn’t in many parts of the public sector.
Since the introduction of streamlined back offices and call centres it has become very difficult to complain directly to someone at the top. There was once a time when if you had a bad experience on a Virgin flight, you could write to Richard Branson and get a reply from his personal office. You could cut through the layers of management and get a response from some one senior enough to be able to do more than simply quote back company policy.
In the post-call centre era things are different. My wife’s recent experience appears typical. Having been incapacitated whilst waiting for an operation, she spent a week in hospital and had a six week convalescence period so she was not able to work out at the gym or attend classes. Therefore she asked the gym staff if she could have an extension as she had not been able to use her membership for three months. They referred her to the manager who said that it was not company policy to make refunds and she did not have the authority to make such a decision.
At this point the problems started. My wife asked for the email address of the celebrity whose name is on this chain of health centres. We don’t have an email address for him, the said. Well, what about the postal address for head office? “We are not allowed to give that out”. Well how do I take this up with someone in senior management? The answer: put your request in writing with supporting medical evidence and it would be forwarded. She did. No response.
A search of the internet revealed a site set up by disgruntled members all with similar stories about how difficult it was to make a complaint if it could not be resolved by the local manager. My wife did eventually get a short letter saying how sorry they were to learn of her illness but pointing out that the contract she signed on becoming a member was quiet clear on their no refund policy.
It was a similar story when my local bank manager was replaced by a personal account manager based in a national call centre. The arrangement seemed deliberately designed to make it as difficult as possible to directly contact those at the top of the organisation.
Contrast this experience with my own as a director within a large local authority. If an MP wrote directly to me on behalf of a constituent I asked the relevant manager to investigate and draft a response for me to sign.
If a member of the public wrote to the director dissatisfied with how their complaint had been dealt with by the front line manager, I would ask the appropriate service head to organise a response and for the reply to go out in their name.
In this way the senior management team had a very good handle on the type of complaints we were receiving and as a result agreed actions to not only resolve the individual complaint by reduce the risk of similar complaints. Our anecdotal evidence supplemented the statistics and helped us get a feel for what it was like to use our services. Our direct experience stopped us being complacent if the number of complaints had fallen or the satisfaction rates had risen.
It would be a terrible mistake if local authorities, in their enthusiasm to reduce costs, introduced streamlined back offices and call centres which would end up denying senior managers snap shots of real life.
Life after senior management: it's not over for the over 50s
Redundancies and redeployment present a challenge to the over 50s. One minute you are fielding phone calls from head hunters for top jobs, the next you’re trying to demonstrate you still have the drive and energy for a post in the new structure.
If your post doesn’t exist in the new structure and early retirement is neither desirable or an option then how do you go about getting a job somewhere else in the organisation?
If you work in the public sector the current harsh financial climate will mean job losses for managers but there is still room for success. The new slimmer management structure may have fewer managers but there will still be good jobs to be had for the right people. Why shouldn’t that be you?
Some of your colleagues will take early retirement and a few will take voluntary redundancy, but the rest will be your competition. The winners get a new job title and possibly more money and definitely a bigger work load. The losers get redundancy.
Being in the public sector you are unlikely to be in competition from individuals outside the organisation.They don’t like to make people redundant then advertise new higher paid posts, it simply looks bad.
So what’s likely to be your biggest obstacle acquiring this new post? New structures are usually announced in a language which refers to the need for dynamic, enthusiastic and energetic leadership with an emphasis on innovation and new ways of doing things. Subconsciously both those applying and those appointing may hear this to mean “young” managers.
The stereotype is that older managers are set in their ways, lack ambition, are less likely to be up for a new challenge and lack the energy to drive the changes required. Of course this may well be true of some older managers, just as it is true of younger managers. It not really an age thing but more of an attitude.
Nevertheless if you are over 50, you will have to challenge the stereotype and demonstrate you’re up for the challenge.
Start with the personal statement section on your job application. List your top ten achievements in relation to bringing about change. Use all that experience to show how you have transferable skills on occasions when there were budget cuts, service reductions, redeployments and restructurings. This is not the cynical “seen it all before, try it, found it doesn’t work” attitude but the “I have faced these challenges, know what to expect and am therefore confident I can lead staff through a period of change”.
The next task is to demonstrate your creativity. Why not start by referring to the proposals you submitted for achieving the efficiency targets and delivering the budget savings. This will help convey your enthusiasm for looking at new ways of doing things and provide the opportunity to show that you appreciate the political climate has changed and that councillors and staff are willing to think the unthinkable.
This statement should be about two sides of typed A4, short, sharp and punchy, not long, repetitive and irrelevant. The interview is your chance to build on this so prepare accordingly. You will have a lot more examples to draw upon than your less experienced colleagues.
As a former director who chaired many interview panels I was always looking for someone who could inspire staff and take responsibility for getting things done but I also wanted evidence of wisdom to go with all that drive and ambition.
The end of the start for personalisation in adult social care?
It has been the buzzword in social work and adult social care for at least the last three years. “Personalisation” was set to be the vehicle that would transform adult social services.
The idea was simple enough: just give money to people with a disability, enabling them to buy their own support services, rather than have a whole industry telling people what they could have from a very limited ”take it or leave it” local authority list.
Yet personalisation was never championed by social workers but instead by service user groups, politicians and senior managers. Hardly surprising, therefore, is the news that a recent survey has found that social workers believe personalisation will fail and that only a minority believe service users will benefit from individual budgets.
It was always in danger of over promising and under delivering; all the more so now it is finance driven rather than practise led. The brave thing to do would be to retain it as an option but recognise it has been oversold and scale the whole thing back. In reality this is what is likely to happen but not likely to be ever stated.
Personalisation fits with the Tory party ideology on choice and control; it shifts service away from the public sector, but giving people the money isn’t very attractive when budgets are being cut. What you’re likely to be given isn’t likely to buy you what you need, never mind what you want.
So targets for personalisation are likely to be quietly dropped, the government’s way of indicating to senior managers and local politicians that they have lost interest and moved on to something else.
Not much point in introducing it into the NHS then.
The never asked question: 'What if I am wrong?'
Managers don’t spend a lot of time thinking they might be wrong. They do, however, spend a lot of time trying to persuade staff they are right. This is not surprising but if we are so sure we are right, why do we think everyone else is wrong, and how does this affect the way we act towards them?
If people don’t agree with us we assume they have not understood what we are saying and that once they are in possession of the full facts they will come round to our way of thinking. Isn’t this the real motivating behind those ”consultation” exercises? And isn’t this the purpose of the “discussion” in the senior management team or the open meetings with large staff groups?
If despite being made aware of the facts they still don’t understand then they must be idiots, right? Either that or they do know the truth but are denying it because it suits their own self interest to do so. Isn’t that when someone says “turkeys don’t vote for Christmas”?
Why are we so sure we are right and so adamant that others are wrong? It’s not just at work either: have you had the right way to load the dishwasher debate? The best way to get to my/your mother’s? Ask yourself how often are you wrong in a day? Hardly ever? 50 per cent of the time? How do you feel about being wrong? Embarrassed? Like when you were a child being told off?
Well that’s not surprising. We learn in school at a young age that people who get it wrong are stupid and people who get on don’t make mistakes, that getting something wrong means there is something wrong with us so we just stick to being right. Once we have used up our arguments if pressed we may say “well it just feels right”.
In our personal life and in our professional life we would concede that we have got things wrong in the past, our problem is conceding this possibility in the present. This is not about admitting you got it wrong after the event or being prepared to say sorry; this is about conceding during the decision making process that you might be wrong.
According to Kathryn Schulz in her book “Being Wrong” that’s why we should ask ourselves, what if I am wrong? She is talking in general terms about all of us but I think it is a question all managers would do well to think about a little more often.
Giving the bad news
I’m giving the captaincy to someone else. Your job doesn’t exist in the new structure. On this occasion you have been unsuccessful. The budget cuts mean we can’t continue to fund your post. There is a lot of bad news around at the moment and it’s down to managers to tell people what they don’t want to hear.
Is there a good way to break bad news? No, bad news is bad news however it is delivered and whoever delivers it. This does not let line managers off the hook, you can’t delegate this task to HR or send a text. Well not if you want to retain any credible claim as a decent human being!
If you are interviewed for a job you know there is chance you will be unsuccessful. If there is a major restructuring you know there is a possibility your job will go. If there are big budget cuts you know there may be no money for your post. If bad news is expected it is less of a shock. Most people say the worst part is waiting to hear. They want a clear time scale for when they will know and the sooner the better. They want to hear first not read about it in the local paper. No one wants to find out from a colleague the bad news that your manager hasn’t yet found the right moment to tell you.
Everyone is happy to ring up the successful candidate and give them the good news but I appreciate a manager who rings up the unsuccessful candidates to tell them the outcome of their interview and provide some helpful feedback.
As a general rule, I feel, bad news should be given face to face. In the current financial climate bad news is often about service reductions. This is a different audience. The politicians and senior managers will talk to the media to explain the budget positions, the tough choices to be made and awkward questions to be answered. But it is the local line manager who finds themselves standing in front of parents of people with a learning disability attending a Day Centre earmarked for closure or relatives of the elderly person in a home to be closed. People will be upset and angry. You are the figure of authority they direct their feelings at.
You can’t duck this: staff need to see you giving the bad news and not leaving them to take the stick. The services users have a right to hear it direct from management and a right to tell you the problems and distress this will cause. It’s difficult, you probably don’t want the place to close either. It’s not for you to defend the council’s policy or criticise the covernment. You are there to give the facts, explain what will happen next and absorb the pain and frustration. It’s not pleasant but it is in the job description.
Collective failures can hinder social care
On the news and in the papers this week was a highly critical report by the Independent Police Complaints Commission.
The report details the repeated failure of Leicestershire police to recognise that a single parent with a daughter with learning disabilities was vulnerable and was a repeat victim. Fiona Pilkington and her daughter suffered 10 years of abuse, threats and vandalism until in a state of utter despair she locked herself, her daughter and the family pet rabbit in the car and set it alight.
This was not just a failure by the police, it was a failure by the housing department, by the social services, by the community health services, her neighbours: all failed to act. This collective failure is now being repeated by the media who continue to fail to recognise and describe this for what it is - hate crime.
This is what I wrote at the time of their deaths. Unfortunately it is still needed saying:
“We know that people are abused, assaulted and even killed because of the colour of their skin. We know that people have been the subject of violence and death threats due to their religion. We know of people who have been kicked to death for no other reason than they were believed to be gay.
We know of people with a learning disability whose lives are made hell by local children shouting abuse and throwing stones at them in the street. We know from a survey carried out by Leonard Cheshire Foundation that one in ten disabled people have been the victim of hate crime.
To abuse and assault someone simply because of their colour, religion, sexuality or disability is a crime motivated by hate. Whilst such crimes are recognised in law as different and more serious because of their motivation, do public sector services and the general public see it this way?
If you work with people who have a learning disability your aim is to help them have a job, a home and a social life but the more you succeed the greater the risk of exposing them to the ” hate” of some in the community. Those people who don’t want “them” living here.
The abuse can get so bad it drives the individual to suicide. It happened in Leicestershire recently; a mother killed herself and her disabled daughter by dousing her car in petrol and setting it alight with the two of them inside. They were driven to this level of despair by a local gang of youths who had terrorised them for years.
Why was this allowed to happen? The main reason seems to be that those who should have offered protection did not recognise this as hate crime, dismissing it instead as antisocial behaviour. I am sure this will not be the only place or the only example of the public sector services failing to recognise hate crime.
How do we get agencies to recognise hate crime?
Clearly there is much that can be done through raising awareness. Police, housing, schools and social service staff can gain an insight into the experience of those who have been the subject of prolonged and ongoing abuse and violence by hearing their stories. Agencies can adopt a more sympathetic response and challenge their own attitudes in much the same way as police and housing officers have done in relation to domestic violence.
And like domestic violence this is not just about getting agencies to treat these offences more seriously and use the law more effectively, it is about changing attitudes in the wider community.
This starts in schools and involves recognising the difference between bullying which is unpleasant and unacceptable and homophobic bullying or racism which is a crime. It means being able to defend this position against the popular media’s cries of political correctness, in much the same way as treating this in the wider community not as antisocial behaviour but criminal behaviour.”
Undermanaged NHS needs step change in appointment process
Many people will be surprised at the statement that NHS trusts are undermanaged, although perhaps not surprised to learn they are over administered.
This is the conclusion of a report by The Kings Fund following a nine-month inquiry into leadership and management in the NHS. The report states that NHS trusts are in need of a new style of management leadership. A situation they describe as urgent in view of the harsh financial climate and big changes required in the NHS.
As the report states big changes are required in how things are done in most trusts. The culture change is to convince managers that poor performance is an issue for the line manager to address and can’t be simply passed over to HR.
However this is a deep rooted problem which stems from the traditional way of appointing managers. All too often excellent professionals are appointed to management posts with no clear understanding of what being a manager is all about and no desire to get involved in the messy business of taking people to task over their performance, attendance or behaviour.
In future when posts are filled people need to be recruited for their people management skills as well as their budget management skills and relevant professional background. Existing managers need to be given support to acquire the necessary skills and confidence to lead their staff.
Most organisations start with rewriting the job description and person specifications for management posts and go as far as redesigning their management development programmes. It is a start but the real challenge is, as this report states, to develop managers’ leadership skills. If you are interested in reading a case study of introducing such an in-house management leadership development programme, you will find a detailed case study in Equipping managers for an Uncertain Future, published by Russell House.
Chief executives say the daftest things
So I read in the Guardian this article by an NHS chief executive on their top tips for making savings. The timing of this helpful advice couldn’t be better because as you know the public sector is having to make savings. Up to 30 per cent in the case of some local authorities.
Most chief executives will have been struggling with demanding budget reductions for many months leading up to the new financial year in April. They will now be monitoring how effective their plans are in practise. What better time to get a master class from a high profile chief executive of a foundation trust who is also chair of a mental health confederation.
So this is how you do it:
- Cancel meetings to save travel costs;
- Stop using outside venues for meetings and training sessions;
- Stop staff attending conferences;
- Tackle sickness levels;
- Use less agency staff;
- Set targets for savings.
I am reminded of the comedy sketch where “Blue Peter” children’s presenters announce they are going to show the audience how to play the flute and how to cure all know diseases. The instructions for the flute are ”blow down here and place your figures over the holes”. They go on to say that in order to cure all know diseases they must “first become a doctor and then invent a cure for all known diseases”.
Simple really.
The culture shift required to achieve equality in the workplace
Most organisations don’t know how many disabled people they employ, how many gay people work for them or which faiths make up the staff group. All they do know with any degree of certainty is the age and gender profile of their organisation, plus maybe some information on ethnicity.
The reason for this is that staff have proved very reluctant to disclose what they consider to be highly sensitive information about their sexuality, a disability or even their faith for fear of prejudice and discrimination.
People can see if you’re black but not if you’re gay or hard of hearing. Why tell them if you don’t have to?
If you don’t know who you have employed, how do you know if your recruitment policies and practices are fair? How can an employer demonstrate that their workforce is in fact representative? How would you know if discrimination is taking place?
The challenge is to create a safe environment within your organisation so that staff feel able to identify themselves for who they are without fear of prejudice.
It’s going to take more than a two-day awareness training course to bring about what is a culture change in most organisations. The starting point has to be with senior managers to show leadership and give permission for people to discuss issues of race, gender, disability, sexuality and faith openly.
The aim is for people to say what they are really thinking in order that they can be challenged or supported. Of course senior managers and HR (Human Resources - Personnel and Training section) will be only too aware that this process has to be managed since it will unleash some powerful emotions.
Some skilled facilitation is required within a range of forums designed to increase awareness and encourage discussion. A case example of applying his approach and the discussion material used can be found in An Elephant in the Room-an equality and diversity training manual published by Russell House.
Encouraging staff to talk openly involves finding innovative ways to get hot issues out into the open. This gives the organisation/senior managers the opportunity to challenge myths and explain policies. The case study shows how a large organisation used its intranet to get these questions out in the open - and answered - however uncomfortable the questions might be. A lot of the questions came from a series of two-day equality and diversity awareness courses. The case study includes some of the most frequently asked questions and the answers that were provided.
The case study also details how equality and diversity champions were recruited and supported. These were people from all levels within the organisation who were prepared to put time and energy into raising awareness. Typically with in organisations groups set up to address equality issues all too often become characterised by inertia and a lack of passion. The case study shows how this was avoided by replacing nominated representatives with people who identified themselves as champions and examines the issues this raised and how they were addressed.
The powers of the dynamic duo
Batman and Robin were the original dynamic duo. Batman was the leader, older, wiser and stronger, but he could not have defeated his wicked and often devious opponents without his loyal side kick Robin.
So it is with many successful leaders that they work best with a deputy. Look at Brian Clough and Peter Taylor: brilliantly successful together managing Derby City and Nottingham Forest football clubs, but on their own, well, just ordinary.
The post of deputy is in the news due to the coalition government but in local government and other parts of the public sector deputies are no longer fashionable. The harsh financial climate in the public sector has led to a cull of management posts and deputies were early casualties of management restructuring.
In many authorities the post of deputy has been replaced by a rotating deputising role. In other words people take it in turns to deputise for the boss in their absence. This devalues the role to just covering whereas a deputy does so much more. A deputy is part of a double act - good cop bad cop, one is good with the politicians the other is good with the troops, one has all the ideas the other knows how to turn them into reality. In short, complementary skills.
One characteristic common to all deputies is loyalty whatever happens the deputy and boss must appear to be united. The deputy can listen to criticism of the boss but never appear to agree with it.
But sooner or later every deputy wonders if they couldn’t step up. Maybe they will be tempted to apply for the top job elsewhere, occasionally they decide to go for the top job where they are even if the post isn’t vacant!
This is one of the risks in having a deputy: if things aren’t going too well and the members are unhappy with you and they have a ready-made replacement in your deputy they might decide they can afford to let you go.
I can understand why a recently appointed chief executive might want to bring their deputy with them and possibly other members of their successful team. This happens in sport and may be acceptable in the private sector but it’s not the way thing are done in local government.
Members are not prepared to give up their power to appoint all senior officers especially as this often involves some horse trading behind the scenes between the leader and cabinet members along the lines that I will let you have your way on this one on the understanding I get my way when it comes to my area of responsibility.
Of course all chief executives want to recruit their own senior management team and a high turnover of senior managers following the appointment on a new chief executive is not uncommon. Members wish to retain the power and the organisations equal opportunities policy may mean the new chief executive can’t bring their team with them but that doesn’t meant they can’t get in touch to encourage them to apply for the up and coming vacancy. You might not be surprised how often they are successful.
Heroes and villains
The actor who played Dr Who a few years back, Christopher Eccleston, was asked whether he preferred playing heroes rather than villains. He replied that acting was all about finding the hero in the villain and the villain in the hero.
Management is also about heroes and villains. The manager cutting services, increasing workloads and making people redundant is often seen as a villain. The same manager champions equal opportunities, upholds professional values, challenges bad practice and inspires staff.
So if you are a manager who is asked to play the villain then the bad guy you will be but you need to find the hero within the role. You may be carrying out unpopular decisions but only a pantomime villain would judge success by the volume of boos.
Being a hero doesn’t involve a big dramatic show of defiance - “the manager who resigned rather than cut services” - it involves struggling on day in day out just trying to make a difference in a thousand little ways that go unnoticed by the majority.
Fast, cheap and intimidating - the future of NHS services?
I’ve been to New York, and seen the future. Our public services, if they follow the previous pattern of imitating the US business model, will be like a New York breakfast.
That is, fast, efficient, cheap and intimidating.
It needs to be fast because everyone is in a hurry. It needs to be efficient because it’s very busy and people don’t like waiting. It needs to be cheap or people will go elsewhere and of course there needs to be extensive choice because the customer expects it.
If you know exactly what you want and you know how the system works you can get a cheap, quick breakfast of your choice. But efficiency depends on people being decisive and the speed depends on people knowing what to do and not asking lots of “dumb” questions in a hard to follow accent.
For those not used to this self service system it is off-putting, even intimidating.
The result for me was not getting the breakfast I wanted but the one easiest to order. Cheap and quick but not a satisfying experience. The thing is, you do get used to it.
No doubt this is how our health service would be if the public sector adopted the US fast food business model. I can see that in personal social services people with a physical disability would soon get to understand the system, the middle class parents of people with a learning disability would exploit it to their benefit, most elderly people would be put off except those lucky enough to have a capable son or daughter to guide them.
This approach is not a million miles away from the “Easy Council” and its no frills service based on the economy airline model. This too requires a certain amount of no how and confidence to book on line, to understand the need to travel light due to weight restrictions and limits on hand luggage, the implications of not having allocated seating and the fact that every thing is an extra which is charged for.
What these models have in common is that they are cheap, they are efficient and, insofar as they do what they say they do, good value for money.
But I can’t help thinking they are neither customer friendly or accessible to the whole community. Cost and choice are not the only measures of success. The danger is that the supporters of NHS reform think they are.
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Make ‘em laugh
Whoever the audience, whatever the topic, it helps if you can make them laugh. Humour can defuse a tense situation and it’s hard to stay angry if you’re smiling. People like a laugh and they like people who make them laugh.
But it’s risky, as the PM found out. Service cuts and redundancies are no laughing matter so your joke may be seen as flippant and be taken to show you neither understand the implications for your audience nor care.
There are three things to remember. First it’s not how funny the joke is, it’s how appropriate it is. Second, making a joke at your own expense shows you have a sense of humour; if it’s at someone else’s expense, it shows you are insensitive.
Third, people laugh at the boss’s jokes, even if they are not funny.
When it goes horribly wrong, not only do they not laugh but they get upset, and saying it was only a joke is not a good defence. To then accuse the offended person of lacking a sense of humour just proves how insensitive someone is.
Those guilty of sexist, racist and homophobic remarks often claim they were only joking and say the person who complains is being ”over sensitive” or excuse themselves saying ”other people thought it was funny”. As someone who has chaired many disciplinary hearings, if that’s your defence, expect the worst.
The advice to managers is clear. Don’t make inappropriate jokes, only tell funny stories at your own expense and if you upset some of your audience apologise immediately. Otherwise you risk being considered a bit of a clown - and not a very funny one at that.
Making time for successful management development
Management development programmes are no longer about giving managers a qualification to put on their CV. They are about changing the organisations culture in response to a harsh financial climate. No longer being able to afford to do things the way they have always been done means things must be done differently.
Most management development programmes fail to change the organisation’s culture for two reasons. They run out of steam before they reach the critical mass of managers and they fail to build on the initial programme.
The harsh financial climate means that organisations have cut back on training and management development. However organisations need to deliver a transformation agenda in response to budget cuts and they need to do it at a time when some of their most experienced managers have taken voluntary redundancy or early retirement.
The resulting skills gap needs to be met by an in-house programme that can train up large numbers of managers quickly. This is about a cultural change since these organisations will look and behave very differently as a result of 30 per cent budget cuts over three years.
Corporate management development programmes are not new. Sometimes they are delivered in partnership with other agencies in the locality; often there is an input from a university or management consultants. They start at the top with senior managers with the aim of working their way through to middle managers and eventually cascading down to all managers but invariable run out of momentum and money before significant numbers of middle managers have been on the programme.
Organisational change will only happen if a critical mass is reached in numbers and tiers of management. Whether the programme is delivered as a block or one day a month such large scale programmes typically take years to deliver and all the time there is a turnover of managers.
What’s more, like any training, if it is not built on its impact on the individual quickly dissipates. Then a new chief executive arrives and asks: “what we have got for all this money we have spent over the last few years?” and the programme gets scaled back or wound up.
You can reasonably predict that in a medium to large organisation if you get two thirds of managers through a management programme within three to four years you will have dramatic and powerful organisational cultural change, provided you have installed the follow up to build on the initial programme. This critical mass may vary from organisation to organisation and may depend on how dramatic the shift required is.
Programmes fail when not enough planning goes into achieving a critical mass within a realistic time scale and insufficient thought goes into supporting managers when they come off the initial programme. Inevitably over a three to four year period there will be shifts in priorities and changes of policy what won’t change is the need for managers with good people management skills.
The aim of the programme should be to get senior managers to have a common understanding of what type of managers and what type of management behaviour the organisation wants. The management development programme is just one way of reinforcing this message. Managers can be supported and the programme built on through mentoring and management learning sets.
A detailed case study of a successful management development programme in a large organisation can be found in Equipping Managers for an Uncertain Future published by Russell House.
The health secretary will hear you now
The politicians may claim to be listening but what’s the betting at the end of the consultation there will be many who say they were not heard. By consultation a politician doesn’t mean “we are seeking a consensus”, what they mean is “we recognise that what we propose is unpopular in some quarters but we think that if people better understood our plans more would support them”.
Politicians recognise that it is not simply about making a good business case for these change; there are interest groups to placate and a calculation about whether short term unpopularity will carry through to the next election.
Put another way politics is always a balance between pragmatism and idealism: what a politician says and what they mean.
So when a politician says “We have no plans to privatise this service”, this does not mean they are not thinking about it.
”There will be a full consultation process before any decisions are made” translates roughly as the politicians and their political advisors know what they want to do.
“Nothing has been agreed until it has been put before Parliament”, but the cabinet have already calculated what they can get through.
Some compromises may be made along the way, a few sops to the more vocal pressure groups, a phased introduction or a toning down of some of the most radical changes in response to the more powerful interest groups - but the plans that were consulted on will be implemented.
The casualties of workplace conflict aren't just the staff
It is probably not a big surprise to learn that work place conflict is on the increase. Redundancies, pay freezes, changes in working practises, fewer holidays, loss of bonuses and reduced pension entitlements, it would be surprising if these unwanted changes didn’t increased conflict in the work place.
So no one will be particularly shocked by the findings of a recent Charted Institute of Personnel Development survey that grievances, disputes and the threat of industrial action have increased in the public sector over the last 12 months. But managers still need to get on and manage the business day to day despite all this going on around them. So how do you manage through a period of conflict?
You might be able to get away with saying pay freezes and pension changes are outside your control but redundancies, management restructuring and changes in working practises will still be seen as management decisions.
Is it possible to claim to value staff and cut their pay? Can you maintain a position of openness and honesty when you are going to make people redundant? Can you afford to be sensitive and caring when you are going to cut services to vulnerable people?
Perhaps managers in the current financial climate need to develop a thicker skin to do the unpleasant stuff and to let the anger and frustration wash over them without taking it personally.
But some managers find it very difficult to be the bad guy, to introduce a more “efficient” shift system: which involves staff working longer hours often under so much pressure they are unable to take the rest breaks they are entitled to, cutting staffing levels and refusing to fill vacant posts to save money - and then pressurising people to cover for colleagues at short notice.
It is one thing to bring in changes that are unpopular with staff that still offer a better service to customer/patient or reduce costs, but it is another to makes changes that will affect care, increase waiting times, leave people in pain longer, reduce help and support to stressed cares or leave vulnerable people more exposed.
This is the difference: conflict in the workplace due to unpopular changes in working practises and terms of employment are to be expected, managers must use their negotiating skills to bring about these changes as best as possible. But conflict in the workplace due to the impact budget cuts are having on the quality of care to the sick and vulnerable? That’s a different battle altogether.
The days are already getting longer in the NHS
I have already seen effects of the above first hand.
My wife is in hospital having her gall stones removed. The hospital is clean, the care is good, the food is excellent, so no story there.
She did however comment on the long hours the staff routinely work. It appears that auxiliary staff do one week on, one week off. That nurses come on duty at 6am and go off duty at 8pm when the night staff come on duty. So instead of the traditional three shift system early, late and night, there are two shifts, the day shift and the night shift. The consultant was still on the ward when visiting ended at 8pm Saturday evening.
Then in my Sunday paper I read that research by ICM on behalf of the Royal College of Nursing found 95 per cent of NHS nurses worked more than their contracted hours and one in five does so every shift.
The findings also reported that 25 per cent of nurses provided last minute cover for a colleague at least once a fortnight. Many nurses told the survey that they have to skip meals and rarely or never have time to take the rest breaks they are entitled to.
On my way out of the ward I saw on the staff notice board that management were focusing on absenteeism. I wondered if they might make a connection!
Graduates need more than a degree from the university of life
Your income, your lifestyle and more importantly your life expectancy is determined by your job, which in turn is determined by which university you went to - which is largely determined by which school you went to. Nothing new in this, why do you think the rich pay so much for their kids to go to private school? Don’t Oxford and Cambridge have more pupils from private schools? Isn’t the Cabinet made up of people who went to Eton and then Oxford or Cambridge?
What is new is how competitive and expensive it is to get into university. Which means brains and academic achievement do not in themselves guarantee a place. Your university application needs to be supported by an impressive list of interests and skills which make you stand out.
Sporting prowess has always been valued by university admission tutors but we are not talking about playing for the school first eleven, you need to have represented at a county level at least. Being a chess champion, playing a musical instrument and voluntary work with the homeless are clearly not something you can suddenly embark on in your last year in sixth form. You need to demonstrate that you have always been a talented, creative and interesting person with a social conscience and a good team spirit.
What better than voluntary work in your local hospital?
Obviously you have a much better chance of getting into medical school if one of your parents is a doctor but perhaps each GP surgery could be linked with a local school so that bright sixth formers from deprived back grounds could shadow the practice nurse or be mentored by one of the GPs.
Just as your parents started your university fund when you were born acquiring the right experiences can’t start too early. You need to do your homework to get your grades but you also need to keep at the piano lesions, if bat and ball aren’t your thing then swimming or cross country will have to do and of course you can’t drop either of those foreign languages but they may be helpful on your gap year in Africa.
In other words your very bright working class kid has even less chance of getting a place at the right uni and therefore going on to enjoy a healthier and longer life. Unless of course you were sponsored by your local GP commissioning consortium - cheaper in the long term!
Getting the message across
As NHS providers increasingly have to compete for customers/patients they need to get better at marketing their services. Advertising is no longer about just providing information, it is making people want what you are selling. You’re not selling shoes; you’re selling beautiful feet.
Marketing is about identifying who is going to buy your services and making them believe only you can give them what they really want. Even if they don’t know yet that they want it!
After all, you didn’t know you wanted 3D TV until you heard how much more “real” the pictures were.
When it comes to the NHS, never underestimate the power of a pretty girl. Sex has sold everything from sofas to chocolate bars. What you need is a photogenic nurse for the promotional literature and may be a TV star from Casualty or Holby City to front the campaign.
On second thoughts that may conjure up images of old style NHS hospitals when you’re selling a five star hotel experience. You’re giving them private rooms with en suite facilities, al a carte menus and a decent wine cellar. Of course in reality the last thing on their mind before the operation will be which wine to have with the chef’s special. The staff will be pushing fluids after the op but it won’t be alcohol!
Having your own toilet is not a luxury these days but after the op you will have a catheter and be severely constipated so you won’t get much use out of it. Your own single room will at least provide you with a bit of peace and quite unlike those noisy old fashioned wards. Or it would if it wasn’t for the fact that after the op you’re on 24-hour observation which means they have put you in the room opposite the nurse station and have wedged the door open.
Now you hear all the conversations about what staff watched on TV last night, what they are having for tea tonight, why they are not going to sort out the linen cupboard before their break and what they really think of that young girl from the agency.
It’s a pity you’ll be discharged before you can enjoy the “superior experience”. But hey, at least you’re not on reality 3D TV, warts and all. Be thankful for that.
Stuck in the middle
When I worked on the front line I used to say it, when I was a senior manager I used to hear it and when I was a middle manager I used to defend it. The latest policy on the use of agency staff or overtime, the new idea for making efficiency savings, the tough approach to absenteeism or the revised procedures for staff recruitment are rubbish and won’t work.
It’s uncomfortable being in the middle being responsible for ensuring senior managers’ messages are passed to the front line and their expectations carried out. There is a tendency to shoot the messenger.
Unfortunately, this means dodging the bullets from both directions because senior management don’t want to hear why their initiatives won’t work any more than front line managers want to hear yet another initiative or new set of priorities.
You can’t deflect the antagonism by saying, “don’t blame me it’s a senior management decision.” Well, you can and some do, but in practice if you don’t own the initiative you will never get your staff to commit to it and it never does any good to tell your boss it’s not happening because your staff think it’s stupid and unworkable.
Life for middle managers is particularly tough at the moment. They have felt the full impact of the public sector management cull. This is the level at which proportionately most posts have been dis-established, it’s the level at which most of the resulting redistributed work is picked up and it is also the level responsible for ensuring senior management strategies get translated into action.
Traditionally there is a lot of ambivalence about middle management. First line managers think they are the ones who deliver the service and middle managers are just a mouth piece for senior management. Senior management blame them if they think their policies have not been properly explained to staff but give them little credit if their polices and strategies work.
Both groups question why there are so many of them.
It is in the nature of middle management that your best work will go unseen and unrecognised by all but the most perceptive of observers. This is because your job is largely that of “behind the scenes fixer”. The first line managers who claim not to know what middle managers actually do are the same people who say they need more support whether that be in dealing with personality conflicts in their team, complaints from service users, undue pressure from a councillor or MP, getting HR to release posts, finance to be more flexible or dealing with staff resistance to change.
Middle managers don’t just explain polices and strategies, they take their experience of the front line and try and use it to influence how strategies will be delivered. That is why they are involved in so many projects and working groups.
As more of the change agenda has to be delivered in partnership with other organisations, senior managers find themselves more and more reliant on their middle managers to represent them at all those multi-agency meetings, workshops and conferences designed to develop a shared understanding, a common language and good working relationships at a grass roots level.
Perhaps it is time to re evaluate the role and value of middle management.
Learning the management lingo
As we look increasingly like adopting the American model of health care, welfare and education we also use American business expressions. Or “expressionisms” as George Bush Jnr. might have called them. So ambitious managers need to learn the management language and the rest of us need to understand what they are on about.
The USA is the land of the sports fan and America’s business and sport have one big thing in common: they are both very, very competitive. So it is not surprising that American business language is full of sporting expressions. The three big sports in the USA are basketball, baseball and (American) football - not to be confused with soccer. Some of the expressions may not, therefore, be as familiar to a British/European audience.
My favourite at the moment is a “slam dunk” which is a basketball expression for when a player gets a basket with an emphatic delivery. It means can’t miss, a sure thing, the opposite of a long shot. “Stepping up to the plate” is a baseball phrase used to mean taking responsibility and “the ballpark figure” you hear so much about is the estimated or rounded up number, as in the attendance at a sporting event.
“The whole nine yards” is an American football expression meaning to go the full distance.
Of course not all expressions have a sporting origin: some just creep into common usage or become popular because someone famous used it on TV or in a film. Remember the Godfather: “I’ll make him an offer he can’t refuse”? Well here’s another one that has American gangster overtones.
“What would it take to make this go away?” This means, how can we fix this between us, what do I have to give you to change your mind? This might sound like a bribe to a British/European ear but it is in fact a plea for a frank negotiation. A popular expression in the American business community is “leverage” as in, “what leverage have we got?” meaning what pressure we can bring to bear.
“Wake up and smell the coffee” was made popular on the American election campaign and means read the writing on the wall - it’s obvious if you think about it. Another favourite of America politicians was “where is the meat?” This was apparently taken from a TV advert for beef burgers and came to mean “this is just froth, where is the substance?”
Some of the old favourites are still in use. “It’s not rocket science” is intended to emphasise that something is not difficult. Running an idea “up the flagpole” is about drawing an idea to everyone’s attention like waving a flag.
“You can’t make an omelette without breaking eggs” is a cooking-themed way of saying, you can’t get something done without upsetting someone and ultimately the end result is worth the short term pain. And you’ll hear “we are all on message” or “singing from the same song sheet” when everyone is clear what is expected and we are all saying the same thing to our staff and customers.
A much used management expression at the moment is “this is not an exercise in ticking the boxes”. This is intended to convince staff that we are not just going through the motions but want to see real action. The expression comes from the fact that we have all become used to completing computerised tick box forms. If you want to negotiate a good deal or make a persuasive argument, you need to get everything in order, or get all your ducks in line. In the current harsh financial climate senior managers can be heard referring to the low hanging fruit meaning all the easy pickings for making savings have been taken. Finally senior managers can be heard trying to impress upon staff the dramatic nature of the budget situation and a sense of urgency by referring to standing on a burning platform.
If we sometimes find it hard to understand our American cousins they also have difficulty with our expressions; after all if we make a “cock-up”, they won’t understand. And looking it up on Google could lead to a disciplinary.
Life would be a lot less confusing if we all just said what we mean, and managers and staff at all levels “cut out the BS”.
As the Americans would say: “it’s a no brainer”.
Management in 100 words - inspired by Fabio Capello
The England football manager claims he only needs 100 words of English to manage the team. On the assumption that, like the England team, your team understands the basics, what would your 100 words be?
I came up with “Yes, top priority, well done”. After some thought I added “No, not good enough” and “stay in budget”.
After all, if you cut out the small talk about holidays, football and kids, what’s left? Just a few motivational phrases? “Don’t let me down”, “don’t let yourself down”, “just do what we did last time”, “you can do it”.
Of course, body language greatly extends the vocabulary, he said, head bowed, hands in pockets as he scurried back to the car park after another boring and frustrating meeting in which Wayne forgot his papers and Joe knocked over the water jug.
That’s enough words. Now get out there and get the job done!
When looking the part goes too far
I have heard local authority councillors reject a candidate for a senior management job because he wore brown shoes. I have heard councillors complain that a senior manager looked scruffy and needed a haircut. I have heard councillors complain that an officer came to committee without a jacket and tie. But I have never before heard two councillors complaining that the chief executive was too smartly dressed for the job.
Their complaint was that their chief executive looked “too glamorous” and expensively dressed for the current harsh financial climate. As evidence they quoted the cost of her designer handbag and the frequency with which she changed her hairstyle.
Their argument seems to be that the chief executive was being insensitive in having a photo in the local press looking glamorous alongside of an article on the council’s budget cuts.
The lesson here for all chief execs in the public sector, including those who work for the NHS, is that there now appears to be a dress code for announcing budget cuts.
To ensure no one else falls foul of this unspoken code I thought it might be helpful to spell it out.
“In future all senior managers should wear black or dark blue when discussing redundancies, service cuts or closures. Whilst senior managers and especially chief executives should look professional they should not look prosperous. They should avoid designer labels, not drive expensive cars and of course they should holiday in this country whilst the current economic situation exists. And it is very bad form to have private health care.”
Complying with this simple voluntary code will avoid the need for the board to ensure all senior managers promote the right image by insisting a proportion of a manager’s salary is paid in ASDA vouchers.
Sometimes the best thing to happen to a candidate is not getting the job
“I really enjoyed that interview.” The rest of the interview panel nodded in agreement. “But they’re not appointable.” The interview panel again nodded in agreement.
The candidate was enthusiastic, engaging, well prepared and a little bit cheeky. The presentation was one of the most entertaining, original and well informed I have heard in many years of interviewing. The candidate established an instant rapport with the interview panel and I knew this person would be a big success with councillors and board members.
If the interview had ended there the job would have been theirs, no question. But the interview didn’t end there. The panel had a few questions. Nothing I thought that should prove a problem to this candidate based on their presentation. But I was wrong.
This was a senior management post and the advert had stressed the strategic nature of the post; the job was all about changing people’s lives for the better through strategic partnerships. This exciting and inspiring candidate was unable to make the step up from partnership working to strategic partnership working. Their focus was on the individual. I was willing them to make the connection with the bigger picture but each answer stopped short. Increasingly it became obvious just how “small town” their experience was.
The questions presented the challenges posed by working in a complex organisation with a large staff group and a large budget, challenges the individual just didn’t recognise. Enthusiasm and charm can’t overcome lack of managerial skills and experience. Enthusiasm can carry you a long way: it certainly helps in engaging with people but it needs to be tempered with a recognition of the constraints as well as the opportunities of working in a political environment.
Sometimes very able people try to hop up a couple of rungs on the career ladder before they’re ready. Sometimes their sheer enthusiasm and engaging personality can help them gain a post they are not yet equipped to deal with. Once in post the lack of experience resulting from being promoted too soon is exposed, their credibility is questioned and their confidence undermined.
So sometimes the best thing that can happen to a candidate is not to be offered the post.
***
Lobster on the menu
Put a live lobster on in a pot of boiling water and it will jump out. Put a lobster in a pot of cold water and slowly raise the temperature and it will just lie there until cooked. The temperature in the public sector has been slowly rising but most people haven’t yet felt the burn.
Plenty of professionals have given warnings, and common sense tells you budget cuts of 28 per cent are not efficiency savings. They are a fundamental change in what the public sector can do.
The first to feel the impact will be the old, the sick and the poor. Money is a good insulation from the effects of a reduction in state support. Private education, private health insurance, private security, private pension and a private jet. I doubt the “well off” will notice the difference.
It will be a few years down the road before the average person starts to feel the full force of a “stand on your own two feet” government approach. By which time the public sector ethos will have been so diluted as to be unidentifiable, the structures dismantled beyond recognition and our lobster will be well and truly cooked.
Charm might not be on the job description, but you won't get far without it
They don’t blame you for the cuts, the redundancies or the pay freeze. They believe you when you say there is no choice. You smile, you sympathise, you share a glimpse into your family life, you’re not so different from them. But actually, you are.
You’re well paid with a very generous pension. You don’t need another job but if you want one it will be offered.
You truly believe what you say when you say it, and your sincerity is delivered with well practiced conviction.
You’re friendly, approachable with a easy smile and a good memory for names and a total lack of integrity. Everyone agrees you’re a charming man.
You don’t take sides and you don’t take a stance. You’re everyone’s friend; who could possibly dislike such an agreeable sort? Sometimes unpleasant things do have to be said in this harsh financial climate but you will get someone else to play bad cop to your good cop. Your values are unstated; your vision adaptable; your nick name is ‘Teflon’ because nothing bad ever sticks.
You look good in a suit, your shoes are always shinny, your hair well cut, you look the part. You say the right things, you know the right people, you’re comfortable in the presence of the powerful and at ease with your own elevated status.
With your winning smile and affable nature everyone agrees you’re a charming man.
Those who have followed your career know you did not get where you are today without a ruthless streak to go with that easy charm. After all the ends justify the means and the name of the game is survival.
You may think I am talking about a particular political leader but in fact I’m describing a style of management and leadership increasingly to be found in the public sector. A management style that would be recognised by chief executives and board members across local government and the NHS.
You won’t see it on the person specification or job description, you won’t see it in the advert. But charm is an unspoken requirement for senior management.
How to win praise and influence people
A recent national survey of NHS staff revealed a worryingly high proportion felt undervalued. Managers are often accused of being quick to blame and slow to praise. All too often the first time you hear your manager publicly praise you is at your leaving drinks. Employees say if managers just said “thank you” once in a while they would feel less taken for granted.
I once worked for a chief executive who really took this on board. I regularly received a personal thank you note acknowledging my helpful contribution to a meeting or my stimulating presentation in a workshop. My initial pleasure and feelings of appreciation were short lived once I realised everyone else who attended the meeting or made a presentation received a similar thank you note, not only that but it soon became clear that this was standard practice after every workshop or away day.
The idea was good but it had become devalued with indiscriminate use. It would have been much more effective simply to take individuals aside and thank them for their contribution and save the personal thank you note for something special.
Whilst we all want to be appreciated for what we do, we also need to recognise this is a job and we are paid to do it. We do however expect some acknowledgement that the caring business operates on a lot of good will.
We rely on people being prepared to stay after their shift has officially finished to see something through or the willingness of people to change shifts at short notice to cover for colleagues. Team work requires people to be prepared to muck in and help out as opposed to saying “it’s not my job”, and we need people who will take responsibility rather than leaving it to someone else.
Positive feedback from our boss or colleagues will make us feel valued so how can we ensure we get our fair share?
Part of the secret of how to get noticed at work is presentation and professionalism. How you look will determine whether you’re treated seriously. I once worked with an ambitious and able PCT chief executive who insisted on wearing low cut tops and short skirts. A female chief executive, of course.
She considered her dress part of expressing her individuality, but this coupled with the fact that her office was full of wobbly towers of files precariously balanced on filing cabinets and chairs, thus totally obscuring her desk and most of the floor space, gave the impression of someone who was at best eccentric and at worst not on top of things.
Being professional includes preparing well for meetings so that you can make lots of useful and considered comments and suggestions as opposed to scanning the papers for the meeting whilst the chair is doing the introductions. If you want to be noticed you need to put yourself forward for some tasks as opposed to trying to avoid the chair’s eye contact at this point in the meeting.
Your boss and colleagues will value you more if they think you are the type of person who will help them.
But how will people know what you have done if you don’t tell them? It is unrealistic to expect your boss or your colleagues to keep up with what you have been doing as they are all just as busy doing their own jobs. Don’t leave it until your annual appraisal to list everything you have been doing over the past twelve months, this just comes over as someone who is trying to prove they have been working hard.
Instead find opportunities during informal conversations to let others know what you have been up to. This is not about telling people how great you are, it is about letting people know what you are doing, particularly how you are trying to influence others on issues that affect the team. This might be your work with HR, finance or partner agencies.
It is also the perfect opportunity to praise others - and if you note their successes, soon they note yours, too.
Replacing the 'irreplaceable'
Received management wisdom is that no-one is indispensable. No matter how dynamic, knowledgeable or experienced you are, you can be replaced.
We know that this is the case because people leave and someone else is always found to cover their work. We know that however well regarded an individual is, once they have left, they are quickly forgotten, people adjust, things still get done, they may be missed as a likeable person, but the work carries on.
This can happen even if you haven’t left, but have been absent through a long period of ill health, or you return from maternity leave to find not only did they cope without you, you’re not sure they still need you. Businesses (have to) adapt and find solutions to new circumstances or they fail.
Unfortunately, it has to be like this in large organisations. Everything can’t come to a halt because one individual isn’t around. But that individual would be wrong to conclude from this that he or she doesn’t make a difference.
There is increasing concern that early retirements and an ageing workforce mean that organisations are haemorrhaging skills and knowledge which cannot be quickly or easily replaced. Hence, ideas around flexible retirement and the increased use of experienced interim managers abound. Often, you find experienced managers who have retired doing some short term work to fill gaps.
It’s not just the expertise that can be missed. Some research into successful organisations identified that many were particularly good at developing their managers, resulting in a steady stream of able, enthusiastic and ambitious managers.
One organisation in particular seemed to be generating, developing and retaining a lot of talent. When the researchers interviewed managers who had come up through the organisation, they found a very high proportion could be traced back to having had a period with one particular manager.
This manager had a phenomenal track record of spotting and nurturing talent, giving people opportunities, stretching them and inspiring them. This manager acted as an unofficial mentor as their career developed. When this individual retired, his post was easily filled, but what he offered the organisation was never replaced.
It is unfortunate that the something extra an individual can bring to an organisation is often not fully appreciated until they’ve left. Avoiding this mistake is vital to continually developing and improving a workforce and its capabilities.
Headhunters, beauty parades and trial by sherry
Headhunters, beauty parades and trial by sherry are the characteristics of modern senior management recruitment in local government.
The standard process for recruiting staff in local government is fairly straightforward. The post is advertised in the professional press, candidates are selected for interview on the basis of their application form and the successful candidate is identified on the basis of their performance in the interview.
The process is a lot more complex and drawn out when it comes to recruiting senior managers.
In most cases the recruitment process is contracted out to an executive recruitment agency. Their fee is based on their ability to deliver a strong shortlist from which the council can choose from. The agency will ring people up and say “Have you seen this post? Would you be interested in getting the details, if not do you know someone who might be?” This is called headhunting.
The first time you are headhunted it is difficult not to feel flattered. However, you quickly come to realise that a lot of people are getting these calls and it does not indicate your name is being mentioned in high places for great things.
The first surprise is that headhunters most often ask you to submit a CV rather than a local authority application form. From these CVs they draw up a long list of people to be invited to an “informal interview”. This interview will be held in the up-market city centre offices of the recruitment agency – a world away from the average local authority office accommodation.
The informal interview is in fact a structured interview where you are asked the type of questions you would expect to be asked in a management interview: “Tell us a bit more about your current post and responsibilities. How would you/your team describe your management style, what are your strengths and areas for development, what do you think are the key drivers for change in local government?”
Don’t be surprised if the interviewers are two white males, the headhunter with an HR background, the other “a specialist adviser”; someone who knows something about the area of work you have applied for. The specialist adviser is most often a current or recently retired senior local government officer; a director or chief exec. They will recommend to the leader of the council/cabinet members who should be shortlisted and invited for what is most often a two-day assessment process.
Headhunters are therefore influential people. They decide who to longlist and who to put forward for the shortlist. Their activities fall outside the local authority’s recruitment and selection process. Three big recruitment agencies have the largest share of the business so you are likely to keep coming across the same individuals if you are interested in a senior management post.
It has become the norm to have a two-day final assessment phase. This can involve psychometric tests, in-tray exercises, role play, an evening event and a bumpy trip around the patch in a draughty minibus.
I quite enjoy the battery of tests and exercises, however, some people describe this as like sitting exams. Since everyone shortlisted has a degree or equivalent and most have a management qualification I am not sure how these tests help select an applicant. Most candidates think that this part of the process is not going to determine who gets the job.
However, candidates do think evening social events with elected members and partner agencies have the potential to rule you out of the running. These social events can be a formal sit-down meal at which the candidates change seats after each course so as to have the opportunity to talk to everyone or a buffet in which the challenge is to balance a plate of food and a drink whilst appearing intelligent. Such events are sometimes referred to as ‘trial by sherry’.
The secret is not to eat or drink and smile a lot.
Sometimes there is an opportunity to have a one-to-one with the chief exec or members of the senior management team. This is usually included to give you an opportunity to find out more about what it’s like to work here. Never forget that anything you say could be fed back to your disadvantage. Some people seem to delight in putting you off by telling you at this late stage how bad the budget position is or how poor the relationship is between officers and members. However, this could be just that they favour the internal candidate.
At some stage there will be a formal interview with the leader, cabinet members and opposition spokesperson and there will be the requirement to do a short presentation. This is where the decision is made by an interview panel of anything of six-12 people. A 10-minute presentation is followed by an interview that lasts no more than an hour. The presentation is a challenge; you are required to demonstrate clarity, brevity and passion. Content doesn’t seem to be as important as you might expect.
Successful candidates seem to be those who come over as confident and agreeable. Since all the candidates can demonstrate they have the experience, skills and knowledge to do the job, the senior management recruitment process is often described as a beauty parade. The final decision being based on whether you look and sound like the type of person the panel could work with.
Taking the fight to bullies in the workplace
Budget cuts, redundancies, increased completion, the demands for more efficiency and concerns about patient care can result in management bullying. This is where managers make unreasonable demands, set impossible targets with unrealistic timescales. But managers get bullied too.
In fact if there is a culture of bullying in an organisation it probably comes from the top.
I have been subjected to bullying behaviour, as I’m sure most senior managers have at some point in their career. It is probably not surprising that some of those subjected to this type of behaviour transfer it to those they manage.
The best managers protect their staff from this behaviour and model a different style of management. But what do you do if you find yourself being bullied? It’s no use hoping they will go away or leave you alone - you need to change jobs. But this can take months. How do you survive a bad manager in the meantime?
Manging your manager
You need to manage your manager. Bullies are insecure people often afraid of being exposed as incompetent or unworthy of their position and are probably being bullied themselves by someone higher up.
Don’t feed their insecurities, don’t be secretive and don’t talk about them behind their back. Let them take the credit, be prepared to appear to accept the blame however unjustified. Don’t make them feel any more inadequate than they already feel. So ask their opinion and acknowledge their experience rather than expose their ignorance. Don’t complain about them to colleagues, or you risk it getting back to them.
A bully is someone who tries to make you feel bad about yourself. Bullies seek to undermine confidence so look elsewhere for feedback and recognition. Make allies elsewhere in the organisation and in partner organisations to prove you can get on with others, are easy to work with and do deliver. In other words, do all the things the bully says you can’t.
There are formal processes open to staff subject to bullying but these are really designed for staff feeling bullied by their manager not managers being bullied by senior managers or politicians.
These processes work where a manager’s behaviour can be independently investigated and if substantiated pressure can be bought to bear. No manager wants to be exposed as a bully because this means they are a poor manager and all managers think they are good managers just as everyone thinks they are a good driver.
Avoid the bully
It’s amazing how much of your job you can do without seeing your manager or talking about work. Keep them off work topics by talking about whatever they are interested in whenever possible. Don’t take your holidays at the same time: this way you can spend the best part of summer without seeing them. Six weeks’ annual leave is twelve weeks you don’t have to meet.
One to ones can be stressful so seize the initiative: fill the agenda with information about what’s happening in your section/service. Fill the time and don’t leave space for the introduction of contentious areas or opportunities to criticise you or your work. Offer to turn the notes you made in preparation for the meeting into a record of the meeting. That way you control the record of the meeting reducing the chances that they will be used to further undermine you. Never re-arrange a meeting they have cancelled and make sure your diary has no gaps when they are free.
Resisting new and unreasonable demands can be difficult since you are clearly not supposed to say no or point out you already have too much to do. One perfectly reasonable strategy is to say that you are happy to take on new pieces of work but as you are fully stretched with existing work what would they advise are priorities.
You then run through all your existing pieces of work just to remind them. I once did this and my manager stormed out of his own office. I’m not sure whether this is a good recommendation for this course of action but at the time it felt like a small victory of sorts.
Rubber stamp
I survived the last six months by changing his diary when his PA was out to lunch. All meetings were entered in pencil because if someone more senior wanted his attendance this took priority. He was forever cancelling his meetings and rearranging his diary. I just rubbed out the meetings. The space would be quickly filled.
I didn’t complain about the lack of opportunities to meet and he either didn’t notice or didn’t care. Not a long term strategy but sometimes you just have to do whatever it takes to get you through the next few weeks.
Poor elderly care is more than circumstantial
It is comforting to assume that those who neglect and abuse vulnerable people are themselves bad people. Better that than acknowledge they are the same as you and me and that given a certain set of circumstances we are all capable of the indifference recently revealed to be widespread in the care of elderly hospital patients.
A few bad apples can be removed and better recruitment and supervision could identify the “wrong uns” at an early stage. So why is abuse and neglect of people with a learning disability and older people such a recurring problem?
Neglect and abuse persists despite recruitment practises aimed at selecting people who have a positive attitude to old age. Bad practise and indifference to the discomfort of individuals continues despite renewed emphasis on supervision.
We should acknowledge that the problem is not simply one or two bad people. We need to recognise that disciplining and dismissing the worst offenders and providing more training for the rest won’t stop abuse and neglect from happening if the causes lie outside of the individual.
Of course we should dismiss those who are found to carry out their duties inadequately but we know this is just the tip of the iceberg. Those who shout or swear at a patient for being incontinent, or steal their money and valuables, or bruise them through rough handling are easily identified and dealt with.
But neglect and indifference is subtler than this: it is ignoring requests for assistance so that the individual soils or wets themselves, it is putting off cleaning them up in the hope that it can be left to someone on the next shift. It’s making the individual feel that they are being a nuisance with their requests for a drink or to be helped sit up when you are so busy. It is giving a patient a bath whilst carrying on a conversation with a colleague as if you were washing a car not a person as you share what you did last night and what you are having for tea later.
This is the real problem - the staff group as a whole stop seeing patients as individuals. They are just another incontinent, confused, feeble body that needs washing, feeding and toileting. The way things get done is organised to make life easier for the overworked under-resourced staff. The good patient is the one who places no demands on staff but is grateful for any help, the good patient is cooperative and cheerful.
It is the group who decides how things are done, not management, who are considered distant and out of touch. Educating the group is as important as identifying underperforming individuals if the record in elderly care is to turn around.
'Living on pizza saved my life'
Did you hear the one about the pizza delivery driver who saved a customer’s life?
It happened in Memphis, Tennessee. Every day for the last three years an elderly woman, who lives alone, ordered a large pepperoni pizza. The pizza parlour would even prepare the woman’s order before she called!
When she went three days without placing her usual order, however, her regular delivery driver became concerned and called in to check she was ok.
Unable to get an answer, the delivery lady, Susan Guy, called the police, who broke into the house. The frail elderly customer had fallen and, unable to get up or summon help, had lost consciousness.
Now recovering in hospital, she owed her life to her regular pizza; or more accurately her regular pizza delivery driver.
My initial reaction was not that this is an example of the big society in action, but only in the USA would someone manage to prolong their life by living on pizza.
Then I thought: hold on, this is a glimpse of the future!
A future where there is no Home Help service for frail elderly people and the Meals on Wheels service has been privatised.
Are there any leaders who don't do U-turns?
I was in the car with the boss. We were late for a meeting. A song came on the radio, Tom Petty and the Heartbreakers’ “I Won’t Back Down”.
Turning up the volume he shouted: “this is one of my favourites”, and then added with bashful pride: “I think it sums up my management style”.
He was clearly unaware of his reputation for being a bit of a wuss.
Aware or not, it shows that often, leaders are people who are confident in their convictions. Effective leaders don’t often suffer self doubt - but this doesn’t also mean that they never change their minds. It is quite an important distinction.
So how do you know when to stick to your guns and when to rethink your plans?
What is the difference between a leader who is focused and one who is blinkered, one who is strong and one who is simply rigid, one who demonstrates single-minded determination and one who is stubbornly obstinate? When does that lack of self doubt become misplaced arrogance? Which voices should you listen to and which should you ignore?
Being prepared to change your mind does not make you a weak or indecisive leader. But being unable to make your mind up makes you appear indecisive and changing your mind based on whoever you spoke to last makes you weak.
People expect a leader to be explicit in what they want to see happen and prepared to give the reasoning behind their decision. People don’t have to agree with a decision but they need to understand the thinking behind it. And having heard your reasoning, they may provide you with a new piece of information which may or may not cause you to think again.
Effective leaders are the ones who can respond to a necessary change in direction by taking the best decision for those they’re in charge of - even if it means turning 180 degrees.
The blame game won't halt elderly care failings
I don’t blame the nurses. I don’t blame the hospital managers. I don’t even blame the budget cuts for the pain and suffering inflicted on elderly patients.
It is all too tempting to try and find someone to blame for the appalling care identified in the health services ombudsman’s report.
But the thing is in the same hospitals where elderly patients suffered appalling care other patients were receiving excellent treatment.
The same nurses who were indifferent to the needs of elderly patients have proved themselves capable of providing first class care on specialists’ wards. So what’s the answer?
It might be uncomfortable for professionals to admit but the obvious explanation is ageism. An attitude towards older people that sees the incontinence, the confusion, the frailty - but not the grandparent, the husband or wife, the political activist, the person who built up their own successful business.
Why do we expect hospital staff to be any less ageist than the rest of society? The unpleasant truth is that as a society we don’t value people once they become dependent and passive and we don’t value those who care for them.
Is it any surprise if nurses think that toileting, feeding and dressing such patients doesn’t make the best use of their training and skills?
Of course to undertake these tasks in such a way as to protect the individuals’ dignity, privacy and individuality does in fact require considerable skill, training and a positive attitude to old age.
But perhaps the ombudsman’s report highlights that these essentials are missing from the training now as well as the service.
Hospital food is a recipe of contrary ingredients
Cigarette vending machines on the cancer ward, a free bar on the liver transplant unit, McDonald’s and Burger King outlets in hospitals and fried breakfasts on offer to coronary patients.
The doctors would never stand for it. Would they?
Well, according to a leading cardiologist there is not much they can do about it.
I made up the part about the free bar and the cigarette machine, but they are no more ridiculous suggestions than the other examples of providing unhealthy food to hospital patients. Worryingly, they happen to be true.
Dr Aseen Malhotra spends his days repairing the damage to arteries and hearts caused by a poor lifestyle and an unhealthy diet. He believes hospitals should set an example of what healthy eating means.
In an article in the Observer, he says patients deserve to be served fresh, healthy food that is cooked on site not frozen and reheated, cheap but not nutritious.
Some places can do it like the Royal Brompton Trust in London so why not everywhere?
He suggests the best way to achieve this would be one menu across the whole NHS.
And while they are at it, Dr Malhotra says vending machines selling chocolate, crisps and fizzy drinks should be banned from hospital grounds. If they can do it in schools…
Taking action on workplace discrimination
The dismissal of two well known sports commentators from their high paid TV jobs serves as a timely reminder about the issues of discrimination and bullying in work situations.
But just as bullying and racism are present in the workplace, so too are those who watch it happen - and do nothing.
Often those present know instinctively what’s happening is not right, yet they do nothing to stop it. Why? Is it fear that they too will become a target for the bullies or is it that they feel powerless in the face of the prevailing ward/office/staff room culture?
We are not talking here about physical abuse, overt racism or inappropriate sexual behaviour. We are talking about the office “banter”, the sexist joke, the insensitive remark about a disabled person, the ageist assumption or the inappropriate reference to a person’s sexuality.
If you’re the only woman, the only Muslim or the only disabled person in the team, if you’re new to the office, the most junior member of the team or if your line manager appears to collude with this behaviour, a reluctance to challenge is certainly understandable.
Staff on equality and diversity courses have spoken about their concern that they will be dismissed by colleagues as being too “PC” [politically correct] and oversensitive, or labelled “difficult” by their manager and accused of seeing offence where none was intended.
An organisation that states everyone is responsible for equality and diversity needs to teach people how to challenge appropriately, to challenge without damaging your career prospects or ending in no one talking to you in the canteen/staff room.
At the same time, as we raise people’s awareness and instill a personal responsibility we must prepare people for retuning to the reality of their workplace.
As part of taking the equality message to a large group of front line staff, an organisation I worked for ran conferences which involve workshops and a theatre group. A play they produced takes a typical work situation and uses it to illustrate discrimination, prejudice, myths and stereotypes in the workplace.
When we briefed the actors we deliberately chose a setting that none of the audience worked in, because we did not want people to get distracted by challenging the accuracy of the action, nor did we want people to think we were saying this type of behaviour was typical of their workplace.
The play is set in an old people’s home and is about the induction of a new member of staff by a colleague who has worked at the home for years. She has some rather negative attitudes to older people and is preoccupied with not “catching anything” from the residents.
Our new member of staff meanwhile is a male in a predominantly female environment. He is also east European, providing plenty of scope for the actors to explore attitudes to non-British workers.
As a new member of staff, “Illich” has concerns about the care practice in the home and the attitude of staff to the elderly residents but he quickly learns that he is not expected to question the actions of experienced staff.
The manager of the home calls him into her office to ask him how his first day has been, where he tries, unsuccessfully, to raise his concerns. Illich remains in character to ask the audience how he should challenge both staff and the manager.
Illich meets with the manager at the end of his first week and intends to challenge her about what’s going on in the home but struggles as he is on his probationary period and can’t afford to lose this job.
The audience are asked to stop the action at any point and advise him what to do and say. Despite a large audience of over one hundred participation is high and people get really involved.
And, unsurprisingly, the feedback was excellent.
'You're going home': improving the interview process
It can be very boring doing interviews. Interview days start early and end late as you try to see as many candidates as possible. The public sector’s strict adherence to equal opportunity best practice means all candidates do the same presentation and are asked the same questions.
(To avoid death by Powerpoint I banned it and said a flip chart would be available if required. The idea was to make candidates look and talk to us rather than read, at high speed, their slides.)
In any case, you still have to listen carefully and take detailed notes because each question is scored and if your scoring is challenged at some point then you will need to refer to your notes. Plus if you’re giving feedback to unsuccessful candidates you need to say which questions they did not answer well by referring to what they said.
So you don’t just have to listen to the answers to your own questions but to everyone else’s as well. This requires a lot of concentration.
Towards the end of the day your brain starts to go numb. You are in need of a comfort break but you’re running late. You pray for someone to do something different with the presentation. You realise you are in danger of giving bonus points to those who keep their answers short.
People on interview panels do watch TV and sometimes it would be nice to mimic Simon Cowell’s X Factor approach and say: “I am going to stop you there, we’ve heard enough”, especially when a candidate who couldn’t think of the answer hoped if they talked for long enough they would eventually hit on the right words.
Whilst the candidates can do all this - keep their answers short and relevant, speak slowly, maintain eye contact and even crack a smile - they can only answer the questions you ask. So it is up to the interview panel to come up with ways of making it livelier.
I deliberately didn’t say “entertaining” because I am not suggesting using a talent show format where the chair comments on the outcome of the assessment centre tasks in the style of The Apprentice’s Alan Sugar: “Well, you claim to be good with figures but you made a right mess of that didn’t you!”
In fact, after a recent episode I could no longer ask candidates “tell me why I should appoint you?”, because it sounds too much like Lord Sugar’s “tell me why I shouldn’t fire you” - which invariably gets the most grovelling, cringe-inducing responses.
In terms of the format, then, how about giving a choice of presentation topics? That way each candidate doesn’t choose the same one. After all this is more about communications skills than knowledge since there is only so much you can get into a 10-minute presentation.
How about a question that allows the candidate to talk about their experience and their achievement? Then encourage the panel to ask supplementary questions to probe this.
Finally tell the candidate at the beginning of the interview how many questions they will be asked and how long the interview will last, making it clear you intend to stick rigidly to the time and it is up to them to manage it.
Plan B - or not plan B?
What happens if your department doesn’t make the savings? What if the ambitious efficiency targets turn out to be hopelessly unrealistic?
What if the savings plans turn out to be undeliverable? What if it’s all a lot messier, a lot more complicated and takes a lot more time than assumed? Do you have a plan B?
Of course you may not be around to deliver it since a plan B often starts with the sacking of the architect of plan A. The chances of survival, yours and the department’s, will be increased if there is a well worked out back up plan to be referred to at the same time as giving the bad news that plan A needs to be changed.
Unfortunately as this is likely to happen half way through the financial year, it is going to need to be pretty dramatic because it has a lot less time to be delivered.
Furthermore, who exactly should know about the existence of plan B?
The timing will be sensitive because if people get wind of it too early they will assume you have no confidence in the original plan, the plan you sold to the chief executive and members. If your staff get the idea you don’t think it is deliverable then it will become a self-fulfilling prophecy.
On the other hand, of course, you don’t want to give the impression this is something cobbled together at the last minute to try and save your skin.
But plan B usually consists of the options in plan A that were discarded as too radical, too painful or politically unacceptable. As such it might well be in your head and not written down - allowing, for example, the head of communications to brief the media that there is no plan B.
Which might cause confusion when there’s a necessary and dramatic switch to it further down the line…
There's something fishy about all this change...
Ambitious managers are like sharks. They need to keep moving or they die.
This is why they change jobs so frequently. Eighteen months is not too short a time, and three years is more than long enough in one job.
Managers on their way up are expected to be dynamic and energetic and the evidence of this is the amount of change they introduce.
If you want to get ahead you have to be dedicated and hard working to give the appearance of being very active, whether or not all this activity leads to any measurable improvements.
Restructuring is an excellent way of demonstrating big changes and for creating a huge amount of activity. This, of course, is the equivalent of shifting the office furniture around. After much discussion and a few sweaty hours things look different.
The opportunity may even have been used to have ‘a bit of a clear out’ but nothing has really changed. A few people may had changed seats; one or two may have a slightly different view out the window, but the reasons given for change - greater efficiency and a better way of doing things - are not much in evidence.
Leaders are judged by their ability to make change happen and managers by their enthusiasm for change. Change is very much on the current agenda, driven by the demands of making budget savings; and what better way to make those savings than by a management restructuring?
But will the latest management restructuring make the savings claimed? Will this be enough or will most of the saving still have to come from services cuts?
Will the costs of management early retirements and voluntary redundancies make this an expensive exercise? Will the disruption to services caused by distracted managers and the loss of management expertise be justified by improved services?
Ambitious managers won’t hang around to find out the answers to these questions.
We will let you know by the weekend...
How do you prolong the torture that is ‘the interview process’?
Try telling the candidates that you will let them know by the weekend, and then don’t.
You are having a problem chasing up a reference for the candidate you want to offer the job to. Friday turns out to be unexpectedly hectic and there simply wasn’t time to ring everyone. You didn’t think through the implications of making all those phone calls and frankly it has been a long day at the end of a long week and the last thing you want to do is ring people up to tell them they haven’t got a job. What’s the betting they will want to know why? Some will hide their disappointment better than others and some will want instant feedback. You could ring up the successful candidate - that’s always a pleasure. It would be a good ending to your week and make their weekend. You could ring the unsuccessful candidates on Monday or get HR or one of the secretaries to send out a standard ‘thank you for attending interview but on this occasion you have been unsuccessful’ letter.
You could do any of those things, but here is why you shouldn’t:
- You said you would contact them by the weekend, and they understood that to be by phone.
- If they don’t hear by Friday evening they will fear the worst but still hope that there is some other reason why you have not called. They will spend the whole weekend thinking about it, trying to convince themselves that they are still in with a chance.
- It’s bad enough not getting the job, but after all that effort just to get a standard letter. What about feedback?
- You may have interviewed some very capable candidates who may be not right for this job at this time but are certainly someone for the future. How will they know unless you have that conversation?
- If there is an internal candidate they are going to continue to work for you at least in the short term, so it makes sense to keep a good working relationship.
- You just never know. Your professional paths may well cross again and your personal and professional reputation, and that of your organisation, will be enhanced by the courteous and sensitive approach you take. The opposite is also true.
Planning for interviews involves more than just drawing up an interview schedule. Leave sufficient time after the last interview for the panel to make their decision. Don’t assume it will be clear cut; there may have to be time for debating the merits of individual candidates, plus you need to be able to give helpful feedback to the unsuccessful candidates so you need to agree on their strengths and weaknesses.
Ideally, ring people at home that evening - much easier than trying to get hold of people at work. People always know what they are going to say to the successful candidate but what are you going to say to the unsuccessful candidates? After all, you don’t want them to feel the whole process has been a complete waste of their time and you certainly don’t want them to feel it was a fix. They are less likely to feel either of these if you ring them when you said you would.
Equipping managers for an uncertain future
After savage budget cuts public sector organisations will look very different.They will require a very different type of manager.
New smaller organisations will have fewer staff and a lot fewer managers. Fewer managers means greater spans of responsibility. Managers will find themselves responsible for a very broad range of services in which they have no professional background and no technical expertise. They will have to rely on their management skills and be enthusiastic delegators.
The job you are doing now will not be the job you are doing in two or three years’ time. The pace of change is getting faster and managers need to be equipped to keep up.
To equip managers for an uncertain future we will need to change the emphasis from professional expertise to management competence. The new public sector will require all managers to have a set of core management competencies that include managing finance, managing information, managing equipment and buildings and, most significantly, managing people.
When it comes to managing people all managers will be expected to show leadership skills, to take responsibility and be able to inspire their staff.
Managers’ people skills are even more relevant in a harsh financial climate when they are required to do more with less, to increase their spans of responsibility, to negotiate new ways of working and to keep partners on board when their instincts are to retreat to their core business.
This type of manager requires a management development programme that aims to develop generic managers, people with transferable management skills, people who have the confidence and ability to move from one service to another, people who are equipped for a fast changing and uncertain future. Yet there will be no big training budget for expensive management development and a new public sector cannot afford to invest in training for only the few - it needs all its managers equipped for the future.
This means managers and aspiring managers will have to take a lot more responsibility for their own development. We can expect to see a growth in the use of management learning sets and mentoring to explore a range of typical management issues, to think about how their behaviour affects others and to identify the type of management behaviour their organisation is seeking to encourage.
Management development will be less about acquiring qualifications and more about the benefits to the organisation, less academic and more focused on life as a manager at a time of budget cuts, services reductions and redundancies. The aim will be to get mangers thinking and talking about how you keep staff motivated, how you keep customers satisfied and how you will develop as a manager in the new climate of austerity and uncertainty.
'She looked like she was on a big ride at Alton Towers'
The hospital porter was pulling the wheelchair at speed from the x-ray department to the ward. The elderly patient was tipped back in the chair, gripping the arms tightly, her face frozen in fear all she could see was the ceiling lights flashing past.
It was like someone persuaded against their better judgement to go on one of those big rides at Alton Towers.
As they raced in, the ward sister halted their progress and demanded to know why he was pulling the wheelchair backwards.
The porter replied “it’s faster”.
This incident seemed to sum up the NHS transformation journey, going backwards fast without any regards to patient experience and no way of seeing where they were going.
'Pensioner crime wave challenges public sector leaders'
Where life means life, in the USA, the problem of elderly prisoners has been around for a long time but it is a relatively new feature of British prisons.
The over 60s are the fastest growing section of the prison population. Kingston prison in Portsmouth is the first in the country to provide a specialist “elderly wing” equipped with stair lifts and other adaptations. Others will undoubtedly follow as the numbers grow and the inappropriateness of mixing frail elderly people in with the general prison population is recognised.
There are currently around 2,500 elderly prisoners in British prisons. While this represents only 3% of the total prison population it is a growing problem for governors. Who should care for frail and disabled elderly prisoners? Prison officers say it is not part of their job to wash, dress, feed and toilet prisoners. Prison governors think the NHS should provide nursing auxiliaries as the health of prisoners is the responsibility of the NHS. Health service managers think local authority social services should provide care, arguing that if they were in their own home or sheltered housing they would. But they are not so they won’t. So who does? The other prisoners, which is neither satisfactory nor appropriate.
Budget cuts across the public sector are likely to entrench views about whose responsibility it is to fund the care costs of elderly prisoners. In the meantime, more elderly people are appearing before the courts. It is not clear whether this is because older people are committing more offences or whether the police and courts have adopted a harsher attitude towards older people breaking the law. What has become apparent is that this trend is not restricted to this country. Both Holland and France have reported a growth in the number of older criminals.
Research in Holland found that a high proportion of those over 60 appearing before the courts had undiagnosed dementia. The implication being that their antisocial and disinhibited behaviour was not a disregard for the law but a result of their illness
Whatever the reasons for more elderly people finding themselves before the courts, the growth in the number of elderly people in prison presents a leadership challenge that the NHS, the prison service and social services cannot ignore.
Any sudden death
Public sector agencies are being encouraged to work closer together.
A good, if little known example of this already in practice is the work of coroners’ offices, to which any sudden death is referred.
High-profile cases such as the Hillsborough tragedy, the Harold Shipman case, the shooting of Jean Paul de Menezes, and the recent death at the G2 demonstrations have highlighted the role of coroners, the complexity of some of the cases they deal with and the length of time that can elapse between death and the completion of a hearing.
The number of motorways, hospitals and prisons within an area will determine how busy a coroner’s office is and whether it requires a full time post-holder and in some cases, a deputy too. Coroners can find themselves suddenly thrown into the limelight, some sudden deaths attracting a lot of media attention - death whilst in custody being a prime example.
Coroners themselves are either qualified doctors or solicitors; some are both. Support for a coroner is provided by the local authority, who ensure the coroner has both appropriate accommodation to hold hearings and office accommodation for themselves and their admin team. The local authority provides IT support, employs the admin staff, and funds the coroner and deputies’ salaries. Yet the LA does not employ them; coroners are appointed and work for the crown, making the arrangement a very unusual one within local authorities.
Modern office support requires regularly upgraded IT. Admin posts have core duties and responsibilities, but the nature of the work in the coroner’s office has more of a medical and legal nature to it, so this always needs to be reflected in a job description. An additional requirement which is not made explicit in the job description, but mentioned in interviews is a strong stomach. Case files are often accompanied by explicit photographs of the deceased and graphic accounts of violent deaths.
The role of a coroner is one that ranges from ensuring cultural sensitivity required in negotiating out-of-hours arrangements with sections of the Muslim community around issuing death certificates and sending bodies back to Pakistan, to the mundane practicalities of revising fees paid to funeral directors for transporting bodies to mortuaries for examination: does the body of a 30-stone man on the 15th floor of a tower block warrant an additional payment?
Low morale: does it really matter?
He had noticed the atmosphere in the office and knew that staff were unhappy.
The way he looked at it was to let them moan as long as they got on with their work. Paul had worked out that his boss, like most senior managers, did not want to hear the moans and groans of staff and had a tendency to shoot the messenger. Senior managers knew staff were unhappy - they expected them to be unhappy - after all, people don’t like change, budget cuts or restructuring. They didn’t need their managers reminding them of this; they needed managers to get on with implementing changes and delivering cuts.
Paul thought that even before the budget cuts, staff were always complaining about workloads. The last thing he wanted was to do was to listen to a group of staff telling him in detail about how staffing cuts had increased their workload.
What was he supposed to do? If he acknowledged the implications, he would either have to fund more staff (which he could not do) or he would have to say what could be left undone (which he wouldn’t). So, best to let it be known what he expected people to do - just get on with it.
When Paul made this clear to his managers they said “well, OK.
If that is the attitude of senior management there is not much we can do about it, Paul thought, but we are likely to get more complaints about the service.
Paul said senior managers would expect people to be unhappy about budget cuts and staff shortages and would recognise that waiting lists may get longer. Senior managers were confident that politicians knew this too.
Paul pondered: what if staff shortages lead to mistakes; what if we have to ask people to take on work above their grade and experience or we haven’t got enough staff to provide correct levels of supervision; or what if staff simply take shortcuts with disastrous consequences? Who will get the blame?
Who do you think?
Can we still afford equality for women?
The CBI wants all companies to disclose their targets for promoting women and then report on their progress.
They claim a similar scheme in Australia has already resulted in a 27% rise in female appointments. The CBI proposal is part of their submission to the government-sponsored review of women in board rooms.
I can’t explain the sudden rise in the appointment of women to senior posts in Australia but the experience of the public sector in this country is that setting targets and publishing progress has not made a dramatic difference.
The Equality and Human Rights Commission recently published a major report that concludes that while attitudes to race, gender and sexuality have changed significantly, inequality persists. Women are still paid less than men, black people are still underrepresented in the top jobs and people with a disability struggle to get any kind of paid employment (How fair is Britain?) This prompts the question: in this harsh financial climate is it going to be even harder for women to get senior management posts?
There is already evidence that women lose out in management restructurings designed to cut costs and reduce the number of management posts.
In filling management posts in new structures there is a real risk that the unofficial criteria will be “commitment”. In other words, those who are prepared to put in the long hours to cover the reduced number of posts? This sort of thinking leads to discrimination against women who have family commitments such as young children or an elderly relative, it can makes it less likely that posts will be considered for job share and it may also reinforce a macho management culture which turns women off.
The increased pressure on managers may result in them being less prepared to give up time to mentor others, yet we know that mentoring is one of the most effective ways of encouraging and supporting people from under-represented groups into senior management. Development opportunities for aspiring managers are unlikely to be considered essential in a harsh financial climate where the training budget is an easy target.
It will take more than disclosing targets and reporting progress to get a gender balance at the top of most organisations.
The Book of the Dead
The Book of the Dead is the name of the current Egyptian exhibition at the British museum. It would have made a good alternative title for Dr Foster’s hospital guide
Nineteen hospitals are identified as having high death rates. The report names those hospitals where unexpectedly high numbers of patients have died after developing complications following routine operations, suggesting poor quality care.
Poor quality care was also highlighted in the Mid Staffordshire Hospital Trust inquiry, which concluded that a preoccupation with cost cutting led to appalling standards of care.
The message is clear: if you cut ward staff to save money, the result is poor quality care and higher death rates.
Just to be clear, we are not talking about indifferent or callous ward staff, we are talking about too few staff on duty for the number and needs of the patients.
It’s no good simply saying to a frail elderly person “you must eat to keep up your strength” and it no good saying “you need to tell someone in plenty of time if you need to go to the toilet”. You need staffing levels that take into account that these patients need help and encouragement to drink, eat and go to the toilet.
'Gypsies and Travellers are the most disadvantaged minority within our society'
There is a unpleasant smell of hypocrisy as the French government is condemned by other European governments for its mass expulsion of Romany Gypsies.
Gypsies are a recognised ethnic minority group but as anyone who works in the public sector knows, people are openly hostile towards them in a way that they would recognise as racist if the same prejudices and negative stereotypes were aimed at the Asian or African Caribbean community. Local authorities struggle to balance the rights of Gypsies and Travellers against the concerns and complaints of local residents. Health agencies struggle to tackle health inequality issues. Mistrust and misunderstandings characterise the relationship with officialdom.
There are some examples of successful engagement which provide a way forward for working with a range of groups who have in the past been described as hard to reach.
Esmeralda is well travelled. She has been to the Appleby Fair and travelled the length and breadth of Lancashire. She is much admired wherever she goes. Mayors, local councillors and community leaders all want to meet her.
She wears a dress made by a group of teenage girls from the Travellers’ community. Part of a project run by the school’s Travellers’ unit and staff from the library service, the dress is made up of pictures which illustrate the girls’ life as Travellers.
The dress is on a mannequin. She is called Esmeralda; in her back pocket she has a CD and a CD player which tells the girls’ stories in their own words. Esmeralda speaks with many voices. Esmeralda has long flowing hair made up of words and phrases that have significance within the traveller community.
For those who made her, she is the product of their creative skills and an expression of what it’s like to be a Traveller and lead a Traveller’s life. For a senior manager, she is a model for how to go about engaging with hard to reach communities.
Gypsies and Travellers are the most disadvantaged minority within our society. They are officially recognised as an ethnic group. A long history of prejudice makes them very wary of officials. Infant mortality and mental health rates are higher and life expectancy significantly lower (10-12 years lower) in the Gypsy - Traveller community. Travellers face major difficulties in accessing healthcare. The reluctance of some GPs to register Gypsy and Traveller families has been as a result of a perception that they are demanding patients who miss appointments and don’t comply with treatment plans. Bullied at school and a tradition of working with father means that formal education often ends at 11 with the transfer to secondary school. Discrimination and lack of formal education means job opportunities are limited. The schools Travellers’ service aims to continue education and the library service seeks to promote literacy. Together they wish to present the friendly face of officialdom.
There are parallels with other minority communities. The focus on family values, marrying within the community, traditional roles for women as mothers and wives, attitudes to sex outside of marriage, different fractions or groups within the community who don’t get on, myths, negative stereotypes and discrimination.
So what can we learn from Esmeralda about engaging with minority communities? We can recognise that the way into communities is through those who are already accepted, that it takes time to build up trust and progress is slow so expectations should be realistic. That we need to find creative ways of listening to people and helping them express themselves. We need to find ways of helping them to educate us about their lives. We need ensure colleagues understand and support what we are trying to do. Encouraging youngsters into the library and museum could have fallen at the first attempt if the staff who work there had reacted to the noise and boisterous behaviour with a ‘not in here you don’t’ attitude. Instead time was taken to raise staff awareness about this community, what to expect and why it was so important to be welcoming and understanding to people who are expecting to be rejected and ejected.
We can learn that it takes a lot of effort, creativity and time to engage with minority communities but not necessarily a lot of money. Esmeralda was created out of a budget of just £200.
Blair McPherson is author of An Elephant in the Room, an equality and diversity training manual, and People Management in a Harsh Financial Climate both published by www.russellhouse.co.uk
'It won’t be lack of money that does for the public sector'
In the end it won’t be lack of money that does for the public sector. It won’t be the loss of skills or the lack of experience due to early retirements and redundancies. It won’t be the increased role of the private sector and a greater reliance on faith, community and voluntary groups. It won’t be the erosion of the public sector ethos as a more business like approach takes over. No, what will do for the public sector is pessimism and cynicism.
Pessimism and cynicism are corrosive. If you don’t think things will get better, if you believe there is no hope for improvement and even that things can only get worse, then why would you struggle on? If you start to believe that the real motivation for change is self interest, career advancement and some well paid jobs for a select few, then why would you try harder, work longer or do anything other than as little as possible?
This could be summed up as a loss of faith. No longer believing you can make a difference, no longer believing others are motivated by the same desire and no longer believing that what makes the public sector different is the aim of doing what’s best for the wider community rather than making a profit.
Maybe this doesn’t matter when it comes to emptying the bins. If the private sector can do it cheaper and make a profit then why not give them a contract for refuse disposal or office cleaning? But is it right and proper to increasingly give over the care of frail and vulnerable older people to companies whose primary aim is to do it as cheap as possible in order to make as much profit as possible? If that is acceptable presumably it’s acceptable to do the same with the care of people who have a learning disability and the care of people who have mental health problems? And what about child protection services?
The vulnerable are by definition not able to stand up for themselves. They need people and organisations whose overriding motivation is to help them enjoy a better quality of life. Already many local authorities no longer directly provide residential care or home helps instead placing contracts for these services to be provided by a range of businesses. And what is the difference between a foundation hospital that takes private patients and a private hospital that takes NHS patients?
The danger is that pessimism and cynicism leads to people being unable to distinguish between the private and public sector at which point why have a public sector?
So what’s wrong with wearing a dress to work?
Ben had since adolescence felt uncomfortable in a man’s body, so after much careful thought and counselling had decided to have a sex change. As part of changing her life and preparing socially and emotionally for the operation, she made it know that in future she wished to be called Barbara. This was accepted by her work colleagues as Barbara was a popular and longstanding member of the team. Other people in the office were less accepting, unkind comments and hurtful remarks were made behind her back. These people acknowledged she could call herself what she wanted but were unhappy when Barbara started wearing a dress to work and drew the line at Barbara’s decision to use the female toilets.
Management came up with a compromise and suggested Barbara use the disabled toilets as these were unisex. Barbara was unhappy with this suggestion as she said she wasn’t disabled and understandably she didn’t want to use the men’s toilets. Under protest she used the disabled toilets but not long after she resigned saying she did not feel management had supported her and had colluded with some staff’s discriminatory behaviour. She initiated proceedings to take the trust to an industrial tribunal claiming constructive dismissal and stating that she had been forced out of her job by the failure of management to address the prejudices of some staff.
In the organisation, views were divided. Some managers and staff felt that Barbara had herself been insensitive to the feelings of others and been inflexible over what they thought was a reasonable compromise. Others within the trust felt that this whole episode exposed the shallowness of management’s commitment to equal opportunities and human rights. They felt whether the issues were race, gender or sexuality, managers said the right thing but failed to challenge inappropriate behaviour or back up the trust’s polices with strong actions to support the individual and confront staff.
HR advised a settlement prior to tribunal and a revision of polices to specifically include transsexuals. Legal did the deal. No one was happy
Blair McPherson was until recently a senior manager in a large local authority and is author of An Elephant in the Room, an equality and diversity training manual. www.blairmcpherson.co.uk
How to fail without really trying
You need three ingredients to be really unsuccessful. You need to be blind, you need to be blind to the fact that you’re blind and you need to have very selective hearing. That’s according to Sir David Varney and he should know - he has recently resigned after only six months as chair of the worst performing NHS trust.
As a highly respected and experienced troubleshooter, he has held senior posts at Shell and British Gas and was adviser to the previous prime minister on public service transformation. He learnt the hard way that senior management teams need to see the bigger picture, be aware that they only ever have a snapshot of what going on and accept that they don’t always know best.
Varney refers to his experience of working for Shell during the Brent Spar fiasco when Shells plans to dispose of the oil platform at sea provoked a very high profile environmental campaign and resulted in an embarrassing and expensive climbdown. In an interview with the Guardian, he states that “we didn’t see at an early stage that what was a technically correct answer was not politically acceptable. Then we insisted on going ahead despite the fact that we had evidence that we shouldn’t. And then when voices started to say internally this may not be the right thing to do, people tended to define the issue in terms of loyalty to the organisation”.
As a former senior manager in a large local authority, I recognise this scenario all too clearly. The determination to bring about radical change can result in leaders and their senior managers forcing ahead, ignoring information that doesn’t support their view and being dismissive of those who ask awkward questions or put forward alternatives. When the changes are unpopular it is all too easy to see all opposition as motivated by self interest and dismiss it as “well they would say that wouldn’t they” or “turkeys don’t vote for Christmas”.
A willingness to listen does not show a lack of resolve. The ability to take on board criticism without appearing defensive and the willingness to explain decisions shows true confidence without arrogance and the recognition that sometimes even the right decisions have to be reversed shows insight and courage. This is very difficult in the political environment in which the public sector operates where party political point scoring can get in the way of good management and the media don’t let the facts get in the way of a good human interest story.
The harsh financial climate in the public sector requires the highest quality of leadership - managers who can take unpopular decisions and can deliver change - bu if you are part of a senior management team you have a responsibility not to become so hardened in your resolve and so certain of your beliefs that you can’t see alternative views.
Blair McPherson is a former senior manager in a large local authority and author of People Management in a Harsh Financial Climate published by www.russellhouse.co.uk
'Managers need more than a short course to lead a diverse workforce'
Managers in the public sector are often not well equipped to manage an increasingly diverse workforce. Many managers have not acquired the necessary confidence and skills to deal with situations which regularly arise in the modern workplace when these situations have a racial dimension or involve a gay or disabled member of staff.
In the past the response has been a short recruitment and selection course to ensure managers follow procedures designed to reduce the risk of unintended discrimination supplemented with an equal opportunity training course aimed at making managers more culturally sensitive and aware. However, this limited training does not equip managers to manage a diverse workforce, to deal with people who hold different values and views, who spend their time outside of work very differently. It doesn’t equip managers to resolve conflicts between members of staff which may or may not be to do with their race or sexuality. It doesn’t equip managers with the necessary people management skills.
Managers need to recognise that people bring into the world of work their experience of the wider world. If that experience is of prejudice and discrimination, of constant negative stereotypes in the media, then when they are overlooked for promotion, when they are unsuccessful in gaining a place on a course, when they are excluded from conversations or believe people are talking about them behind their back they will ask themselves, is it because I am black? If the response of management is dismissive, then these staff will take this as further evidence the organisation does not recognise prejudice and discrimination except in its most blatant forms. However, if management appears to willing to interpret any complaint by a black member of staff as evidence of racism then the staff group as a whole will lose confidence in management and lose faith in the fairness of the organisations procedures and policies. What’s true about race is also true about sexuality, gender, disability and faith.
Management is about managing people and the more diverse the people the more challenging the task.
If a manager lacks the skill and confidence to address an issue of poor attendance when faced with a member of staff who claims this is harassment; if a manager struggles to deal with a member of staff who responses to being taken to task for failing to meet agreed deadlines by claiming bullying - how much more difficult will they find it to deal with a member of staff who responds with allegations of racism, complains of harassment due to their sexuality or accuses the manager of insensitivity to their disability.
The individual may well perceive that their treatment is because they are black or gay or disabled but that does not make it so. The manager needs to have the skill and confidence to manage a diverse workforce, to be sensitive to issues of race, gender, disability, faith, age, and sexuality yet not to let poor practice go unchallenged, inappropriate behaviour go unchecked or tolerate lower standards of work.
To gain the skills and confidence to manage a diverse workforce, managers need to develop their people management skills. This can best be achieved through management development programmes that emphasise 360 degree feedback, coaching, mentoring and action learning sets. These support / learning forums can then be used to explore scenarios based on the type of situations managers find themselves in. Either with their mentor or in their learning set, managers can work through scenarios such as dealing with an attendance issue when the member of staff has a disability, dealing with a conflict between two members of the team when one is black, responding appropriately to a member of the team who claims they are being excluded and people are talking behind their back because of their sexuality or dealing with resentment arising out of a member of staff’s request for annual leave to fit in with religious festivals.
Blair McPherson was until recently a senior manager with a large local authority. He is author of An Elephant in the Room, an equality and diversity training manual, and People Management in a Harsh Financial Climate, both published by www.russellhouse.co.uk
How can managers keep staff happy amid pay freezes and layoffs?
Happy staff work harder and achieve more. This is probably not a big surprise to most managers, nor I suspect is the view that if staff are unhappy it affects their work. A team of researchers from the Warwick Business School led by Professor Andrew Oswald have conducted a number of experiments on students which confirm this.
One experiment involved participants completing routine tasks involving adding up numbers. The task was broken up by showing one group a 10 minute video of comedy clips and another a clip showing patterns of different coloured sticks. Those in the group who had a laugh performed the tasks better, 12 per cent better.
In the past there has been much debate about the impact of skill training, new technology and reward schemes on improving performance. The researchers believe that their findings, published in Warwick’s Economic Research Journal, highlight the importance of “human emotions”.
In the current harsh economic climate, it would be a lot more helpful to managers if researchers could suggest how to keep staff happy whilst freezing their pay, making their colleagues redundant and charging them more for office car parking. I don’t think that posting a “joke of the day” on the office intranet or showing clips of “mock the week” is going to do the trick.
So how are managers to keep staff motivated whilst budgets are cut? It is true that external factors influence people’s feelings of wellbeing. If England had won the world cup then the feel good factor would have resulted in increased productivity in the short term. If an individual is experiencing personal problems like going through a divorce then we know their work can suffer. But in general we know that people report they feel happy in work if they get on with their colleagues and their line manager. The implication is that the organisation may be going through a bad time but in this team we still enjoy coming to work. The other key factor for staff in the public sector is why they do the job in the first place. Auxiliary nurses, care assistants and hospital porters are low paid. They could earn more money stacking shelves in their local supermarket, but they get satisfaction from helping vulnerable people who are grateful for the support they receive. Contrast this with staff who deal directly with the public on reception or in a call centre and who are often subjected to verbal abuse from frustrated and distressed callers.
Happiness at work for public sector workers is determined by their relationships with colleagues and their interaction with the public. Managers are responsible for fostering good working relationships within the team and supporting staff in their dealings with the public. This is not always easy as personality conflicts can erupt within teams, an individual can be viewed by others as not pulling their weight or getting favourable treatment. The manager cannot ignore this if they want staff to feel happy coming to work. When staff are dealing with customers who are angry that their service has been reduced or taken away as a result of budget cuts then a manager’s support needs to be tangible. This means being prepared to take the call and take the brunt of the caller’s anger.
A manager is responsible for keeping their staff happy at work but this doesn’t involve telling jokes or performing amusing impressions of senior managers -not unless you want to be known as a bit of a comedian.
'Meeting big challenges means radically changing how people behave'
This is not a blog about budget cuts, the challenge presented by an ageing population or the threat posed by the private sector. This is a blog about values, passion and inspiration.
My passion is equality. It seems to me that equality is what the public sector is all about. It is the emphasis on the moral case for equality rather than the legal or business case that makes the public sector different from the private sector, the not for profit sector and the voluntary sector.
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.
Staff who are customer focused quickly realise you need a range of providers and services to meet the needs of a diverse population. That means working with a range of partners. 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 engage communities and work in partnership. Such skills will stand the organisation in good stead for promoting health equality.
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. League 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 or admitting someone into a psychiatric ward against their wishes. And despite the traditional emphasis on charismatic leadership, frontline 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. 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 focusing 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.
'The NHS needs to recognise it is wasting talent'
Apparently the NHS isn’t sexist. The fact that fewer than 30 per cent of consultants are women when they make up two thirds of doctors doesn’t indicate prejudice or discrimination. Women simply don’t put themselves forward for these posts.
Worryingly, this comment is from the BMA’s equality and diversity chair. This justification is not just spouted in the NHS but throughout the public sector. Those responsible for recruitment to senior posts claim they would like to appoint more women but they simply don’t apply. It would appear these days no one is saying women can’t do the top jobs - just that they don’t want to do these jobs. Is this complacency acceptable? Wouldn’t you expect that organisations would want to know why capable competent and experienced women were not applying for these jobs?
In a typical public sector organisation, women make up 80% of the workforce but only 20% of senior managers are women. In my own small survey of 50 women managers in a large local authority, women stated that they rarely came across overt discrimination. The women in the survey gave a number of reason why they were not seeking the top jobs. These included the long hours culture which did not fit with their family commitments, the perceived macho management style of senior management which they did not feel comfortable with and a tendency to undervalue their skills. Occasionally they referred to a “boys” culture where meetings started with a discussion of the weekend’s football results, but no one stated that their career opportunities had been restricted by overt discrimination or prejudice.
Here we are struggling to meet some of the biggest challenges we have faced in generations and we are content to waste 50% of our most talented people because they are not prepared to fit in with the way we have traditionally operated.
If the NHS wants to make the most of the talent it has then it needs to convince individuals their skills are valued - for example by showing it is serious about job shares for top jobs. Organisations need to judge people by what they deliver, not make assumptions about “commitment”. They need to spot those with talent who inspire their staff and show leadership skills and encourage them to aspire to the top jobs. Most of all, organisations need to recognise they are wasting talent and they need to do something about it.
'Many managers will be sweating on the beach over their future'
I once worked for someone who never took a holiday. He would have a few days off at Christmas. but in the years I worked for him he didn’t take a summer holiday. One year at his wife’s insistence he joined her and their youngest son for a break. He was supposed to be on holiday for two weeks but he didn’t last the first week. He returned to the office saying holidays were “boring”. I don’t know what he told his wife.
Every day he was away he rang the office to check everything was alright. He said we should ring him if there were any problems. He would start the conversation with “have you been trying to get hold of me?” I hadn’t nor had anyone else. He seemed genuinely disappointed when everyone he spoke to said everything was fine. He would prolong the conversation with lots of specific questions about where the rest of the team was and what they were doing and had any of the board members or chief executive been around.
Some managers are afraid to go on holiday or be away from the office for any length of time - they think decisions will be made in their absence about their department and their future.
My boss was one of these managers. He didn’t trust his colleagues. He knew whispering campaigns could be started against people in their absence. He also knew that if he was out of the way, other departments could use the opportunity to influence budget discussions to the disadvantage of his department. It is, after all, easier to see examples of overstaffing, top heavy management structures and outdated working practices in other departments.
This is just an example of some of the worst aspects of office politics at a senior level, but in the current public sector financial climate many managers will be sweating on the beach over their future and the future of their departments. Whilst back in the office ideas are being floated about management restructurings, service reorganisations and radical solutions.
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