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