Leading the charge for change? An HSJ Summit review

I arrived at the HSJ summit the day after a cluster staff meeting at which a culture of cynicism was very evident. Staff where tired of applying for their own jobs and unsupportive of NHS reforms. To be honest, they did not feel engaged with today let alone the future. How much longer did they have to deal with further change? What will be different this time?

I had mentioned that I was going to the summit. After much ribbing that I would be turned to the dark side, the general comments I received were that very senior managers and leaders in the NHS appeared fearful to criticise the reforms in any public forum. They failed to stand up to the coalition government’s constant use of the term “management” as a way to belittle people who were often clinicians progressing into alternative roles to provide much needed skills that were vital to the running of the service.

Staff argued the simplest “reform” programme would have been to reduce primary care trusts to 50, put more doctors on the board, impose a management cost cap and light the blue touch paper. They argued that senior leaders had not presented a clear compelling case for change to them, and even if they do it is predicated on them turning somersaults to keep their jobs. Staff did not view the NHS as a brand, it is a multi faceted work place that needs to foster an organisational commitment based on values and beliefs.

They argued NHS leaders needed to be more upfront about the reforms - no good going on trying to meet staff preferences in regard to future work streams if you know you cannot.

After a coffee I approached the hall with the great and the good. I was very aware that I was a staff member who might not know all the policy “wonk” but did understand how it feels to work in an atmosphere where you feel that one reorganisation will inevitably follow another, without anyone checking to see what difference was being made.

Many of the people I met were super confident and I admired that, but the quiet people were often the most rewarding to talk to and the most interested in meeting me. I found the best speakers were those who translated the gruesome management speak into personal stories about how they tried to effect change and influence events or who reflected that health is more than the NHS and that true transformation takes time - which, of course, is not helped when every five minutes you have to reorganise.

I was also impressed by those who recognised that piling more work onto GPs without thought about changing demographics, the impact of the economic downturn and the importing of health inequalities though immigration (controversial, but excellent point) created the risk of system failure.

Although workforce risks were highlighted - that the best and most capable would move to more secure environments - I found the summit spent little time assessing what the future workforce would need to be. I remain concerned about a possible “drag and drop” approach to integrated care. Working outside hospitals requires very different skills.

I vividly remember the shock of leaving paediatric intensive care for health visiting and discovering that in the patient’s own home, people did not agree with my pearls of wisdom. Also, actually getting around the patch needs to be factored in. Driving is not an essential skill for many hospital staff. Additionally, the ideal of “no bed like your own bed” has its limits. I think a triple heart bypass in my bed might be pushing it.

There was certainly passion in the room, but at times I felt we needed to make the patient more present. I thought that inviting more patient group representatives might be a beneficial approach, such as Barbara Pointon with her brilliant chart that shows all the professional and agencies involved in her husband’s care and support, but particularly highlights the lack of co-ordination of their input. This might help to illustrate the story rather than endless standing up and talking. It might also help to provide the opportunity to talk to people who do not think like “we do”.

I heard the term “emotional intelligence” only once, yet I feel it is vital to the future of healthcare in this country. If you cannot connect with staff and the patients you will find it difficult to engage people in necessary change.  

I was not surprised to hear some people equating healthcare to selling baked beans at Tesco or stating that staff where overly resistant to change. But it was also great to meet passionate leaders who clearly recognised that staff needed to be part of the changes, that patients are different - that one hip operation is not the same as the next one - and that social issues are vital to recovery. In fact, I certainly came away recognising how easy it is to regard senior leaders as divorced from reality until you actually get a chance to talk to them and discover how much they care for the NHS.

Now, and I include myself in this, some concerns about the age range of those present. I really think that we need to invite more young leaders, with mentors so we can hear younger voices. I can totally appreciate how intimidating attendance at an event like this can be. I struggled initially but then thought - come on, you are doing the work they are talking about – so get in there.

I also want to highlight how white and middle class the event was, not a surprise I guess, but we need to continue to  take note of that fact and address it.  

I felt that as a group of leaders there was a need to be careful that their own values do unduly affect how they drive change. When they talk about choice what do they mean? I do not doubt that the sharp elbowed will be first in line. Who stands up for those with less ability? How, with a personal budget do you plan an integrated service? Those patients engaging with their own health care are often still those in the know, rather than the many people we meet everyday who have no access to technology and appreciate the one to one in the GP surgery. For some, it is the only person they will speak to all week - is that too expensive?

I came away thinking I had met and heard some great people. But staff may not always be listening to them because they are fearful for their jobs and patients do not always understand them.

I think having a senior role must be such a politically sensitive place to be. Is it possible to lead both rationally and emotionally? How do we take staff and patients with us through a very difficult time in the history of the NHS if speaking out about reorganisations you do not agree with may end your career?