Humpy Dumpty sat on the wall, Humpty Dumpty had a great fall, all the King’s horses and all the King’s men couldn’t put Humpty together again …

I am not a particularly controversial person, I have an opinion but don’t think that I am opinionated, I don’t rock the boat for the sake of rocking the boat (well maybe sometimes), my intention is not to insult, upset or be offensive but I do usually verbalise what I think needs saying even when it might not go down well, and I know that sometimes silence says far more than words ever do.

I come to work to do a good job; not to be popular, not to make friends (although I try not to have enemies), my drive, as for many of us in the NHS, is to ensure we offer as good and as effective a service to patients as we possibly can. 

Someone said to me a few weeks ago (after reading a blog) that they thought I might be living dangerously and that I might ‘fall off the wall’.  I thought about this and decided that whilst I don’t want to fall off the wall, I certainly don’t want to sit on the fence either.   I’ve tried the fence, it’s uncomfortable and it makes my bottom hurt.   There are many on the fence and whilst there are times when sitting on the fence is appropriate there are many times when it is not, and people need to take the plunge and go one way or another.

I have, over the years, sat in meeting after meeting, at varying levels of seniority, with varying levels of decision being discussed or agreed.  I am always struck with how many times prior to a meeting people can articulate very strongly how they disagree with this and that or such and such was a very bad way forward, yet in the meeting often do not say one word.  I can’t count the number of times after meetings where people have said to me ‘that needed to be said’ or ‘I completely agreed with you over that’, and whilst that is fine and someone needed to say something, I did wonder why their very strong opinions pre meeting seemed to have taken a recess during the meeting.   People are afraid for some reason; perhaps it’s that if they speak out they may end up with extra work or perhaps sadly it’s that they are scared to speak out and say what they really think for fear of how it will be received.

Is it good or bad to speak out?   If you have well founded views about a topic then as a matter of integrity you as a leader or manager are obligated to express your views as a matter of influencing decision making.    Timing is important, as is the method of feedback.  More often than not my views have been respected, occasionally acted on, and only rarely treated disparagingly.  For me it is a matter of integrity.  Managers (especially Exec and Senior Managers) need to be able to speak out constructively, to not be fearful and their managers need to listen, actively encourage it and in turn not be fearful.

In this climate leadership counts more than ever, there is going to be some very difficult and challenging change, both to services and people, and we need to get our heads round the fact that this is going to be more difficult than it ever has been. When leading people through difficult change we challenge what people hold on to;  ways of thinking, routines with nothing concrete to move to, usually only options and sometimes not even that; you can see why people don’t like it much.  Change also implies that things are not good enough now and whilst that is often true we must remember at the time things were put in place it was because they were considered the right thing to do.

In tough times people demonstrate concerns and stress in many ways; some by undermining, eliminating or targeting, but some rise to the challenge by truly engaging their teams, being clear about the situation yet being human about it.   It’s this group that need to be expanded; the other group need to fall off the wall.  

Leadership quite often means exceeding the authority you are given to tackle a challenge, this is hard and it needs courage.  

NHS Managers must not sit on the wall; none of us want the NHS to fall over.  Most people and certainly most who work in it believe in it, but we will fall off the wall or the wall will crumble if we don’t change and change starts at a local level with, amongst others, people reading this magazine.  You wouldn’t read it if you were not interested (unless you were just navigating to the jobs section). 

Humpty Dumpty was in a precarious position sitting on the wall in the first place; he also needed to lose some pounds, much like the NHS.

Incidentally, for those of you who are interested, there is a Humpty Dumpty Institute in NYC.  Established in 1998 by a small group of innovative and successful business entrepreneurs it forges innovative public-private partnerships to find creative solutions to difficult humanitarian problems.   The Humpty Dumpty Institute is found at