“We must reject the idea - well intentioned but dead wrong - that the primary path to greatness in the social sectors is to become ‘more like a business’.
“Most businesses fall somewhere between mediocre and good. Few are great. When you compare great companies with good ones, many widely practised business norms turn out to correlate with mediocrity, not greatness. So then, why would we want to import the practices of mediocrity into the social sectors?”
Those of us seasoned by the experience of regime change know that in terms of the delivery of services, change will be slow to take off
Not my words, but those of Jim Collins. This is the opening paragraph of Good to Great and the Social Sectors, the 2005 follow-up to the legendary business tome Good to Great. I was moved to have another look at this slim volume (35 pages) after digesting the 62 page From Good to Great, Andy Burnham’s five year plan for the NHS, and Sir David Nicholson’s modus operandi, the NHS operating framework (52 pages). For good measure I would add another text, The Power of One, the Power of Many (a chunky 141 pages), inspired by the NHS Institute and lauding the worth of social movements inspired by people with a cause.
By June one thing is certain: we will have a new government. We, the many, will be pursuing current ministerial ambitions or resolutely embracing new ones. It is the nature of NHS staff - managers in particular - to fall in behind the current approach and seek to maximise the opportunities for the communities they serve. It is not in our nature to rise up in revolt at modest adjustments to emphasis on spend or the mode of delivery. In all probability, day-to-day business will continue to be conducted under the existing operating framework. Those of us seasoned by the experience of regime change know that in terms of the delivery of services, change will be slow to take off. Essentially then it will be business as usual next year. And in our hearts we know that business as usual will not be enough preparation for the rigours to come.
Inspiring people is not an exact science. Invictus, a relatively unknown poetic relic of a time gone by, has been given wings by the revelation that it inspired Nelson Mandela during his lengthy incarceration on Robben Island. Its reach also extended to the Oklahoma bomber and the current prime minister. The point is not that we should all rush around reciting Invictus, but that we should all try to use some means to distil from ourselves the words that give meaning to our mission and stir our souls.
I was travelling back from London several weeks ago on the Pendolino, the tilting train which always makes me a bit queasy. It was dark. Unable to work I was sitting back in my seat thinking deeply about several sad letters I had received from patients and relatives. While in this sombre place, the gist of a poem came into my head.
Unusually, as this happens to me from time to time, I bothered to write it down. The poets among you must forgive its schoolboy simplicity. It’s called The Man in the Next Bed.
The man in the next bed will die,
At night I feel his helpless cry,
The nurses never catch his eye,
The doctors simply pass him by,
His relatives around him sigh,
He will surely die.
I offer it to you for two reasons. First, because I would like you to be aware, if you are not already, of the helpless emptiness of a hospital ward at night and how some of our patients are feeling. My words reflect theirs and, I suspect, from some of the calls, letters and emails I receive, we can and should do much better for all our patients.
Second, I know from within my own organisation that we had many pieces of creative writing from members of staff at the time of the NHS 60th anniversary. I am not the only one who puts pen to paper to capture feelings. Rather surprised by my efforts, I sent it to a colleague for an opinion. Within minutes she responded:
Can this be true, I hear you say,
Is patient care received this way,
I never thought I’d see the day,
When all that one could do was pray.
There has to be another way,
Compassion’s not a world away.
The man in the next bed will die,
At night I soothe his weary cry,
The nurses never pass him by,
The doctors all ask how, not why,
His relatives around him cry,
In death, the joy of life looms high.
In the hard times that are yet to come we will be tested to the limit. We will get pages of ministerial blueprint. Perhaps there is also room for a few sparse words and lines to stir the inspiration from within.
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