The People Manager
What on earth is going on? I missed the first ten minutes of the meeting now I’m playing catch up. Quickly scanning the minutes of last meeting leaves I am none the wiser. It doesn't help that I’m not sure who's who, clearly I'm not the only substitute. The agenda seems to be jumping around, people’s names are dropped but I have no idea why they are important. The chair seems keen for everyone to have a say and some people have clearly come with something to say although the relevance of their contribution is not yet clear. A couple of people seem preoccupied with what’s happened in the past, going into great detail about who agreed what with whom. I listen intently hoping for clues. By the time we get to the last agenda item I think I am on safer ground and able to ask a question without appearing foolish. I don't want people to say he came and didn’t say a word.
On my way out I over hear one of my colleagues say to the person she was sitting next to " so just to recap .....did we decide we were or we weren't doing ...." It appears I was not the only one confused.
Blair McPherson former director, author and blogger www.blairmcpherson.co.uk
Questions of justice and fairness are only relevant between those with an equal power to enforce them.
Do not rock the boat
Loyalty to your boss is expected to your organisation required
The reputation of the organisation must be protected
It is not the done thing to criticise a fellow officer to members.
This rule does not apply to private conversations.
Gossip is useful, gossiping isn't gossiping if it is putting your boss in the picture.
Tell the boss what they want to here let some one else tell the boss what they don't want to hear.
Always present the service/department/organisation in the best possible light.
Of course their is a blame culture so cover your back .
People like and promote people who are like them, be like them.
Blair McPherson former director, author and blogger www.blairmcpherson.co.uk
We repeatedly hear that what the NHS needs is leaders that inspire their staff, that there are only a few made of the right stuff, that the task is immense and requires someone special.
We are encouraged to identify these “special ones” who have made a real difference and regard them as heroes.
Would it not be better to demonstrate a little more maturity, to draw from experience and without becoming disillusioned or cynical recognise that leaders make mistakes that they have weaknesses as well as strengths, that we can have leaders at every level in the organisation as long as they have skill, integrity and a willingness to listen.
The young may need their heroes but the rest of us should be wise enough to set our expectations at a more realistic level, competent leadership.
Blair McPherson form director of community services, author and bloggerwww.blairmcpherson.co.uk
The General Medical Council has issued tough new rules to doctors, nurses and midwives about admitting mistakes and apologising. The NHS doesn't do sorry. NHS managers will tell you that Legal have told them that apologising could be seen as admitting liability and weaken the Trust's position in any subsequent negligence claim. Professionals in all areas of business don't like admitting they get it wrong but the medical profession has traditionally had more difficult than most. Hence the need for the GMC to issue new rules.
Perhaps its the aura of infallibility consultants like to project, after all you do need to have absolute confidence in your surgeon, perhaps it's because if you take off the wrong leg it's a very big deal but a culture of not saying sorry runs through the NHS. Whether its managers fearing legal proceedings or clinicians protecting an image it can result in a reluctance to apologise for any mistake.
So I am glad that the General Medical Council has made clear it expects doctors,nurses and midwives to say sorry I just hope their employing Trust supports them.
Blair McPherson former Director of community services author and blogger www.blairmcherson.co.uk
Outside the main hospital doors is not just the patients unofficial smoking area its where you score. It shouldn't be a surprise that illegal drugs are available to patients or that drug addicts have health problems but it does make their stay on the ward more of a challenge. The patient on methadone who also requires strong pain killers following their operation still sneaks out to score. Shooting up in the gents passes out, bangs their head and ends up in A&E with a smashed face that requires stitches and no memory of what happened. The consultant orders the ward to remove his wheelchair and so sister locks it in a store room. The patients persistent pleas to have it returned arose the suspicions of the ward staff, they search the wheelchair and find in the padded seat a hollowed out section with a wrap inside. The hospital would discharge him even though he still needs treatment but social services are adamant that with two young children on the at risk registrar he can't return to the family home whilst still using. He continues to take up an expensive hospital bed due to his drug problem and homeless rather than his medical needs. Is this the type of situation the integration of health and social care will tackle.
We could learn a lot from the private sector. But we could learn even more from large not for profit organisations that adopt the business know-how of the private sector with the social ethos of the public sector.
By examining how these organisations operate in practise we could see how hospital trusts might develop in the future. After all, isn’t that where foundation status is leading? Hospital trusts will be competitive, efficient and patent focused just like the best commercial businesses in the private sector. And those that aren’t will be taken over, merged or cease to exist just like in the private sector. But unlike the private sector they will not be profit driven, this should sit more comfortable with the medical professions ethics.
My experience of working in the not for profit sector led me to a different conclusion. The first surprise was that unlike the voluntary sector the not for profit sector did not adopt local authority pay and conditions, it paid senior managers more and frontline staff less.
In another practice taken from the private sector, no one knew what anyone else earned as senior managers negotiated their own salaries each year linked to their annual appraisal. Only after I hlft did I discover a colleague was paid several thousands more for the same job simply because they had negotiated a higher starting salary.
Profit over performance
The turnover of senior managers was dramatic; reorganisations were used to purge those not in tune with the new direction. All this was made possible by the fact that trade unions were not recognised and the board did not concern itself with HR issues. In fact, the board only concerned itself with the bottom line.
‘Success was measured in terms of growth driven by the chief executive’s ego rather than a sound business case’
As a head of service I regularly attended board meetings but not to discuss quality of care or the implications of budget decisions but plans for growth and the PR opportunities this offered. Marketing was considered important to attract new business and a considerable amount of senior management time was spent trying to win public sector contracts. Glossy brochures and expensive videos were produced in support of this.
While individual services were not required to make a profit, they needed to in order to cross-subsidise loss making services. However, if a service in a particular area was loss making with little prospect of breaking even then it was closed. This was a financial decision; it didn’t involve consulting with existing service users, staff or the local community, which gave a lie to the rhetoric on customer engagement or community involvement.
When I took up a senior management post at a large housing association I thought that the not for profit sector would offer the business know-how of the private sector and the social ethos of the public sector. I was wrong. The not for profit sector lacked the openness and accountability of local government and in the absence of the pursuit of profit it measured success in terms of growth driven by the chief executive’s ego rather than a sound business case. Not a good model for NHS trusts.
‘Many now see personal budgets as a backdoor way of getting families to top up budgets’
Personal budgets – where the client is given the money to purchase their own services – was first piloted in social services to great effect for people with a physical disability. The problem came when the government insisted that personal budgets should be made available to those over 65.
The number of people was overwhelming. Unlike the people who had a disability, there was no great enthusiasm among older people to take responsibility for organising and purchasing their own care. In a climate of financial austerity people began to realise the money they were allocated was insufficient to meet there needs.
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The government’s overambitious targets forced local authorities to introduce watered down versions of the model, so many people had a personal budget in name only; their care package remained the same, they continued to use the same traditional services from the same narrow range of providers, all that was different was that they now had a social work assessment that expressed there needs in financial terms.
While personal budgets were officially promoted as increasing people’s choice and control, many now see them as a backdoor way of getting families to top up budgets.
Social enterprises were seen as an acceptable way of outsourcing services while avoiding the accusations of privatisation. An in-house social service home care service could become a not for profit organisation in which employees were shareholders. The idea was that staff would share in the success of the organisation, employees would have a greater say in how the business was run and there would not be the huge pay differentials found in the private sector.
Freed from the bureaucracy of local government and with reduced overheads, these organisations could be competitive. Whilevery attractive to labour authorities keen not to be seen privatising social services the idea has not taken off from the small pilots dotted around the country.
‘Governments have a history of imposing what hasn’t quiet worked in one area of the public sector on to another’
The private sector is more competitive. Giving staff more say means they can veto changes to their basic pay, overtime rates, number of payed days holiday or sick pay. If they don’t have these powers and are told that the alternative to changes in pay and conditions is redundancies then they say “how is this different to working in the private sector?” Social enterprises may be more open about decisions but unless they are competitive there is no profit to share out at the end of the year. A modest profit in a small private sector company translates to a new car for the owner and a Caribbean holiday for the senior managers – the same money shared equally between all staff in a social enterprise is a new pair of shoes.
While an NHS trust could become a not for profit organisation it difficult to see how such large, complex organisations could share decision making with all staff or how they could adopt an egalitarian approach to status and pay when the gap between a porter and a consultant is so big.
Successive governments have a history of imposing what hasn’t quiet worked in one area of the public sector on to another in the hope that this time it might just work. What next: local eligibility criteria and rationing?
The theme was an authentic Viking feast in a long hall, so they were all dressed as Vikings, eating roast ox and getting drunk on mead. We were hours out ofReykjavík. Night was creeping in and the temperature was dropping, so you couldn’t leave the hall without blistering from the cold.
‘Our European neighbours were not restricted by our historic commitment to services being free at the point of delivery’
It was the final night of a three-day health and social care conference sponsored by a Russian telecoms company, hosted by a US private heath insurance firm, with conference speakers from Scandinavia and delegates from across Europe.
The conference language was English, the agenda the challenge of an ageing population (officially), the opportunities of privatisation (unofficially). NHS trusts were well represented, as were the men in grey suits from the Department of Health (all wearing horned helmets, including a drunk guy telling everyone that this stereotype was historically inaccurate).
We learned that the Scandinavian model was not as generous as we had assumed, that the German healthcare system was efficient, the French system expensive and rather inconveniently that a recent study had shown the NHS to be good vale for money and the US private healthcare system the worst value for money.
‘People living longer, new cures and more effective treatments – these are good things’
Our European neighbours were not restricted by our historic commitment to services being free at the point of delivery, so they imposed charges that the patient then claimed back if they were eligible. The French charge for a visit to a GP that some in our party thought would discourage unnecessary visits until they realised how much paper work was generated.
Encouraged by the Scandinavian contingent and much to the frustration of our US hosts, we concluded that the NHS is a ravenous animal with an insatiable appetite. This is not just because of an ageing population or developments in expensive treatments. It is also because of rising expectations.
People living longer, new cures and more effective treatments – these are good things. As a result we naturally expect to live longer and enjoy better health than our grandparents’ generation. Most of us are prepared to pay more for the peace of mind that should we become ill we will get the best treatment. Most of us realise that this means higher taxes or a greater share of taxation going on the NHS. All we need to do now is persuade the politicians.
You read it in the job adverts. It appears in the qualities necessary for the post and it’s often an interview question: are you a team player? The honest answer would be no, but you say yes. You’re good at what you do. You have a track record to back it up.
‘The star player may resent others for being ineffective, lacking imagination and having limited abilities’
You’re a leader, you’re decisive, determined, persuasive, creative and industrious. When you are in charge the team delivers. Trouble is when your not in charge. In the structure you both lead a team and are a member of a team. You are the service head but you are a member of the senior management team. The qualities that got you the senior management post were your outstanding individual talent, but your chief executive and your colleagues expect you to be a team player.
The individual who is not a team player is the one who doesn’t do their fair share; you need a member of the senior management team to open and close the conference – they’re too busy unless it directly relates to their service. Yu need a member of the team to represent the department on a corporate working group – they don’t think it’s relevant to them. You ask a member of the team to speak at the service users’ forum – they don’t think it’s the best use of their time. And then there is the special pleading around the budget cuts.
What’s best for the individual manager and their services may not be best for the rest of the organisation. The star player may resent others for being ineffective, lacking imagination and having limited abilities. But it’s a team and you can’t just do your own thing.
The team puts up with this behaviour because they recognise the talent, they admire the ability and they also bask in some reflected glory. That is until things go wrong. That’s when team spirit is most needed, but when those lacking it are most likely to disassociate themselves. Seeking to protect their own reputations, they move to a better team – assuming they have not already been shown the door.
Senior managers are by nature not good team players, but they recognise that on occasions they need to do their bit. Perhaps a better analogy is a choir, and every successful choir needs a few soloists.