This isn’t a detailed piece about Rose Gibb’s breach of contract claim against Maidstone and Tunbridge Wells trust, but win or lose - I’m not sure there can be a draw - it again shows how poorly senior managers are held to account in the NHS.
I make no claims for Rose Gibb or her managerial competence. What I do know is that she has been denied her employment rights and natural justice - the opportunity to face the music. I also know the public has been denied an examination of her stewardship of her trust in a proper disciplinary process.
Yet again, the NHS could not bring itself to string even a few vertebrae together and dare to hold a senior manager to account, fairly, openly and effectively. This failure has come at a high financial, operational and moral price. A decent process would have seen the manager sacked without a penny or still in her job; it would not have seen this squalid pig’s ear of a situation that has distressed the families of those who died avoidably while in our care and angered the public at large.
Finally, does anyone know what lessons Maidstone teaches us? I doubt it. We have failed to be systematic and open about failure and risk - again. Just some bad apples, untypical, move on, until the next time.
This ropey system - if it is a system - of accountability manages somehow to limp on. Somewhere along the line getting sacked, which is a possible consequence of a process of accountability, became confused with accountability itself. And the only way it has worked to date has been the extensive use of the NHS chequebook.
“A hysterical mob of frightened ministers, officials and non execs kicking you in the face is a life-changing experience”
Ever since health secretary Alan Johnson’s intervention in the Rose Gibb case, ministers have been trying to call time on the payments culture. (Fair enough. But the key insight has not yet been made into why the “pay and go” system came into being in the first place.)
And so officials have been busy moving goalposts. For example, a Department of Health witness gave evidence in the Gibb case that the unwritten code among senior managers in the NHS is to fall on their sword for little or no compensation. I don’t know for sure what several hundred chief executives snorting derisively sounds like, but I have a fair idea. As one leader from the North West summed up to me: actually, the unwritten code is falling quietly on your sword for at least a year’s pay. When the top of the shop starts rewriting unwritten codes, you know it’s time for change.
And man do we need change.
One of the many problems with our failing system of accountability is its inability to tell the difference between good managers in difficult jobs and bad managers making a dangerous hash of it.
Our treatment of good managers who stumble and fall is something else. A hysterical mob of frightened ministers, officials and non execs kicking you in the face is a life-changing, let alone career-changing, experience. And we wonder why there’s a shortage of quality candidates for top jobs!
Is it really as bad as all that? Look no further than the NHS Confederation’s characterisation of the treatment meted out to senior leaders as “brutal and arbitrary”. Accurate words. We’d fall into dead faints were any other group of healthcare professionals treated the same way.
“Stalinist” is another word doing the rounds. (A tactical note to trust chairs attacking strategic health authorities - not everyone considers being called ‘Stalinist’ an insult.) There are some fruity parallels with 1930s Soviet Russia to be made, I suppose, but life at the top in the NHS is often more “Kafka-esque”.
A typical conversation goes like this: “We’ve lost confidence in you.” “Why?” “Because we have lost confidence in you. That speaks for itself.” “Yes, but why? Can you give me the reasons, can you be more specific?” “Well, we’ve lost confidence in you very specifically.” “But last week you gave me a glowing review!” “Look, that was last week. Why are you being so difficult? Things have changed.” A few weeks on, someone else loses confidence in an unspecific way in the person who lost confidence in you and so it goes on.
You cannot blame individuals for this shambles. Organisational culture holds us all hostage. Who, at least once in their careers, for the perceived good of their employer or the system, hasn’t found themselves forced to give a straight-to-video performance they would much rather not have given? But, and this is where people need courage, accepting the way things are never changed anything.
Depressed? I’m not. Every attack on management, every crisis of accountability, is for me an indication of how critically important managers are in making healthcare happen. The negative can be transformed into a positive impulse, like David Nicholson’s leadership agenda. At last people who matter are talking about valuing leaders.
But we need a hard look at the standards of conduct towards senior managers. And here let’s dispense with a business case for doing the right thing. Just start being open, systematic and fair and the business benefits will flow as day follows night. And it isn’t only politicians and SHAs who need to change mindsets. Chief executives, treat your colleagues as you would want to be treated. Live by it, die by it.
Then let’s agree the standards of leadership and management against which we will measure and hold people accountable. Follow that with ensuring we have the leaders - non executive and more senior executives - who know how to hold executives accountable fairly and effectively.
Let’s agree an open and objective process and then stick with it in all cases, through thick and thin.
Finally, be sceptical but not cynical. The conditions exist for us to stop mucking about rewriting unwritten codes and get down to the serious, mature and developmental business of accountability.