Just to be clear

Commissioning isn’t about quality, it is about quantity. Contracting is about price. Inspection is about ensuring minimum standards. Professionalism is about skill, knowledge and behaviour. Management is about getting people to do what needs to be done and as such is concerned with trust and integrity. Leadership is about taking responsibility and inspiring others with your vision of a better future.

‘Some organisations have become very good at putting on a show for the inspectors’

I say this because there appears to be some confusion. For instance, some people in the NHS seem to think commissioning will improve the quality of services. It won’t. Commissioning will shape the balance of services − more of this, less of the other. So commissioning could be used to change the balance between hospital and community services and between the private sector and the public sector.

Contracting is the agreement with the provider on how much you will pay and what you expect for your money. You can try and encourage providers by rewarding quality but this is a blunt instrument unless you make it really worth their while. If you go for the cheapest then you will get what you pay for.

Inspection does not ensure best practice or prevent abuse but it should identify bad practice and ensure minimum standards. But it only gives a picture of what was happening at the time of the inspection. Some organisations have become very good at putting on a show for the inspectors, particularly as inspections become less frequent and more “light touch”. 

Is this leadership?

Professionalism does imply individuals are qualified and have the skills, knowledge and values to enable them to provide a high-quality service but do they have the resources? Are they able and willing to speak out if they don’t?

Mangers get the job done within the resources available but are they open and honest in the way they go about this? Do they acknowledge that services are being rationed, are they explicit about the criteria being used? How do they respond to complaints? Are they willing or able to tell senior managers and the board about the impact of decisions on front line services even if it’s not what senior managers want to hear?

Is this leadership if you can’t convince those who are delivering the service that it’s going to result in better care? Is it leadership if you don’t believe in what you’re doing? Leaders can’t be held responsible for everything that goes wrong in an organisation but a chief executive sets the tone. Of course you think care standards are as important as staying within budget and hitting performance targets, but if something has to give then what do your mangers and staff think that is?  

The pig and the scorpion

Competition is good for creating choice and keeping prices down. So the public sector should be competitive. Cooperation is essential if NHS is to pull together and coordinate across sectors and services. So we try and cooperate with those who by nature are competitive…

‘Many public sector organisations have already been stung by predatory private sector organisations’

A pig and a scorpion stood on an island in the middle of a fast-flowing river swollen by recent heavy rains. The pig said: “We will have to swim for it before the water rises much higher.” The scorpion replied that he couldn’t swim but if the pig would let him rid on his back he would use his vantage point to guide them both safely across. The pig did not trust the scorpion but felt that he should do the right thing.

The pig said, “If I let you ride on my back how do I know you will not sting me?” To which the scorpion replied: “It’s not in my interest to sting you.” So the pig let the scorpion on to his back and plunged into the muddy waters. It soon became clear the scorpion would be washed off the pigs back in the choppy waters unless he climbed on the pigs head. So with the pig’s agreement he sat on top of the his head. The effort of keeping his head above water meant the pig could not see where he was going but the scorpion told him not to worry he could direct him to the safety of the river bank. Halfway across the scorpion stung the pig. “Why did you do that?!” The pig cried out in pain and disbelief,” Now we shall both surely die.” To which the scorpion replied, “I couldn’t help it, it’s in my nature.”

Many public sector organisations have already been stung by predatory private sector organisations. You can’t blame them though, it’s in their nature.