I am not a graduate of Oxford or Cambridge, I didn’t enter the NHS on the NHS Management Training Scheme and I am not on the NHS Top Leaders Programme.
I started my NHS career as a ward clerk on an acute medical admissions unit which admitted patients with a variety of different medical complaints: from epilepsy and asthma to alcoholics with liver disease, people who self-harmed or overdosed and older people whose bodies were beginning to let them down. I saw my first death on the ward, made sweet tea for relatives and friends of patients, called the crash team, made beds, saw fear and I watched people’s hearts break with bad news. I saw young and old, rich and poor, those that were essentially healthy and those that probably would never go home.
I worked three long days a week on the ward whilst studying part time for an MSc in Comparative Health and Social Policy, and I will be forever glad that I did. My NHS career started as an A&C3; I worked my way up the grades to an A&C6, moved into management and have now reached the upper echelons (whatever they are) of senior management. I am a Leadership Fellow with the Health Foundation and whilst definitely not one of most academic people in the NHS, I have sound operational experience of working at many different levels within organisations with many different levels of staff and I am fiercely passionate about the impact of good leadership on quality.
Why am I telling you this? I’m telling you this because whilst working my way up I have seen at every level excellent managers and administrators but I have also seen mediocre and weak ones. I have seen departments that are justified in crying out for additional support and I have seen people in jobs which have been created, either by people or for people, which are not needed. I have seen a blind eye being turned regarding under / poor performance time and time again and I have seen good people not performing because they are either bored, not motivated, are in the wrong jobs or because they are not getting the right level of support.
Here is my question. Why is the ‘line’ that there will not be a reduction in staff in the NHS? Why is it so wrong to say that there will be? There should be. There needs to be. Since when has keeping poor performers in jobs been the role of the NHS or did a government policy pass me by? This has nothing to do with the economic situation.
I can appreciate that certain roles might cease and the people in them redeployed to vacant posts in other organisations / departments and I can see head count in organisations / departments reducing with the same process happening. I agree with this, but not if the individuals are underperforming in the first place. What has the NHS become? Is it a special organisation to house all under performing people? It certainly shouldn’t be.
It is a well known fact that creating a bit of disequilibrium sparks innovation and motivation and that people tend to improve their outputs. So let’s create it, give people a chance and if they don’t shape up appropriate action should be taken. This does not need to be unfair in any way; simple, if you are really not performing and you are given time to raise your game but you do not then you will lose your job, this is what is supposed to happen, this is not unduly harsh. One of the things that staff find really hard to accept is the blind eye being turned on under performance / poor performers. I am sure morale would increase if this group were managed. Let’s face it, the impact of poor performers on capable staff can be quite significant.
There are some inspirational, hugely capable people at every level working in the NHS. Some give way, way over and above what is needed and I don’t know that it’s right to say that their work would increase if we dealt appropriately with those who do not perform. If you think about it, dealing with the impact of underperformance takes a lot more effort from potentially a lot of people than dealing with the underperformance in the first place.
The purpose of the NHS is to provide care to people; be that preventative care, treatment or rehabilitation. Rather than focusing on frontline job cuts which are the jobs that really matter and rather than looking at prohibiting treatment options or rationing certain health treatments, why can’t we focus on what we can remove from the system with little or no impact. I was interested to read about high performing organisations having a higher predominance of (well performing middle) managers, I am sure this is right. I am not talking about removing the good managers; this is about removing people from jobs who are not delivering.
I have spent the last year working alongside many organisations and teams; it has been an absolute privilege and one which I will be eternally grateful for. It has enabled me to see well led organisations performing highly and organisations that appear to be less well led struggling to get even the basics right. Leadership is needed at every level; this is not solely about the CEO and exec team. There is an absolute parallel between improved quality of care and leadership. It’s really very straightforward. I am about to move on from the Institute and I will take with me the experience of the last year to reinforce what I always believed in but didn’t have wide enough experience: that good management (clinical and managerial) improves quality of care often at no additional or minimum cost, and weaker management does not improve quality of care and not only that but it sometimes quashes those that want to improve it. Plain and simple, not rocket science, and unless I see things that no one else sees I suspect my view is shared.
This is my own personal view, I am not representing any organisation. The NHS is about people’s health and wellbeing; now is not the time to extend the purpose to letting people keep their jobs because we’re a nice and caring organisation. As Rebecca Evans said in a recent HSJ edition ‘effective talent must be nurtured….. and it may be about learning to let go’. Letting go should not only apply to managers needing to delegate more but also to the approach needed if the managers are weak and not performing.
I am not an ogre, I am not particularly harsh, I do not consider myself to be radical and I am not trying to be deliberately provocative but I do think that saying there will be no reduction in jobs is at best short sighted and at worst a lie.
As Homer Simpson said to Lisa: ‘No, no, no, Lisa. If adults don’t like their jobs they don’t go on strike, they go in and do it really half-assed.’