The People Manager
All posts from: January 2011
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.
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.
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?
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?
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.