Monday, 28 December 2015

Impact and reflections inspired by A Bridge Over You

This is going to be an untidy and meandering blog. I know this before I start. I’ve tried drawing and I’ve tried mind mapping, but my thoughts are still not neat. I have so much whirling around in my head from what I’ve read in the national news over the last few days, that I just have to go with it.

What started me off was ‘A Bridge Over You’, the NHS Lewisham and Greenwich NHS Choir’s sublime merging of two beautiful and deeply meaningful songs. I downloaded and streamed this, as I feel so very strongly about the importance of this song on so many levels, as discussed on Twitter with @PaulDuxbury. This hospital has more recently been in the news due to financial issues (it went into administration in 2012) and the campaign to keep A&E open, which was won in the High Court and the Court of Appeal, in 2013. Yet, a choir including staff from ALL kinds of roles (not just doctors and nurses – who are the only ones some parts of the media seem to value) has put together something so harmonious and deep, that the hairs still stand up on my arms and I feel quite emotional whenever I listen to it. This kind of connection is born of passion, dedication, respect for the part everyone plays in the whole team, and bags of goodwill. Boy, wouldn’t some of those modern ‘staff engagement’ programmes with bells and whistles like to generate even a fraction of that? More of that later…

Anyway, one of the reasons this song made such an impact is that, as people who know me will appreciate, the NHS has been one of my life’s great passions. As a child, I loved going to the parties for the children of staff at Christmas put on by the Obstetrics and Gynaecology Hospital my mum worked at, as a Medical Secretary. I can even remember the name of the obscure Crossroads actor who attended one year to give out the presents… There were also summer fetes etc. Then I got voluntary then paid student summer jobs in medical records and clinical coding (in the days before IT – well not strictly speaking – the Medical Records Manager did have to go to see to the computer occasionally – a massive mainframe taking up much of the hospital’s roof space…) 

In 1989, I got a great career boost, that really set me up. Stafford District General Hospital (fondly called the DGH) set up a local, rotational management training scheme, thanks mainly to the far sighted Unit Personnel Manager, who had come from retail. Yes, this is the same hospital as the major, very distressing and serious Mid Staffs Hospital scandal. It was a very different place then. In one of my roles, I was called a GMSO (General Management Services Officer – got to love the NHS’s addiction to acronyms) which I suppose would now be called an Executive Assistant or Staff Officer post to the Deputy UGM (Unit General Manager). Every morning at 9.00a.m. sharp he met with his senior nurse leaders, his PA and I to make sure he knew exactly what was going on and could address any urgent business or issues there and then. The senior nurses had already done the rounds of all of the wards for their clinical speciality that morning. I remain convinced to this day that like a spider (a nice one) in the middle of an intricate web, he was completely up to speed, could, and did use his professional, and not inconsiderably strong personal influence, to maintain a high standard of care for patients at that time. (That’s one of my messy tangents now done….)

Starting with a Diploma in Health Services Management gained in that role, the NHS, over the course of a further 22 years, gave me some wonderful opportunities and experiences, which included a Master’s Degree, and roles that enabled me to become a Chartered Fellow of the CIPD. The major changes in NHS commissioning that started as soon as the Coalition Government got into power in 2010, indirectly led to me leaving the NHS to take up a post as an HR Director in a Probation Trust in 2011. And so, I thought, I spent the first half of my career in the NHS and now I will spend the second half in probation services or the wider criminal justice sector...

Wrong! As part of the government’s political commitment (OK…… unshakable ideological stance) to reduce the state as much as possible, the partial privatisation of probation was already on its way. One of the many wonderful things that happened to me during this time, however, was working for @CEOLewis, who made me start to use Twitter. From that seed, I started to write some blogs and also gained a fantastic personal learning network, which helps my professional thinking more than I can say. (That’s another mini tangent ticked off.) What I meant to illustrate by this was how very influential the NHS has been on my life, although my roles have always been in corporate support – never the “back office” see Basic needs, security needs and the back office and She's at it again.  

This kind of segues messily into the other themes that have really been bothering me in recent national news. One is the devastating floods in the North of England. I am horrified, but not surprised to note that the government were told in very robust terms only a couple of months ago, by its own committee of experts, of the much heightened risks of flooding and of the need to do something, and that they have slashed spending on flood protection despite the lessons learnt in 2007 and the investment that followed. (The government, or rather specifically the Secretary of State for Justice at the time, did not listen either to overwhelming academic, specialist and practical evidence of what works to reduce crime, and of the criticality of joined up working across the whole criminal justice sector, local authorities, housing agencies, the NHS, specialist charities, etc.)

Another theme is tax dodging (legally) by major corporations, whose defence is that it is legal and that to change the rules might make them relocate to a more tax friendly country. Oh, and it’s OK, because their staff pay income tax and NI. Staff who earn enough to be over the NI threshold that is (there’s a problem being stored up for years to come) and whose jobs and pay are quite secure… But we hear that more people are in work than before the credit crunch – yet economics isn’t working as expected – the Chancellor’s tax revenues are lower than forecast. Does it take a genius to work out what low pay and badly used zero or minimum hours contracts lead to for the economy? As a mother to a 21-year-old and an 18-year-old, the prospects for young people worry me a lot. And another thing, even their education is commodified. I read a blog, (or was it in a Guardian article) the other day by a university lecturer who is harangued by students who don’t agree with the grade she gives to their work, or who think course work extensions should be given for the flimsiest of reasons, because they ‘have paid £9000 a year for this, you know, and the customer is always right…’ (Another ranty tangent!)

Then there is the article in the Independent article shared by @DrGrumble that the Chancellor is on course to privatise more public assets that any Chancellor since 1979. It will come as no surprise for you to read about my intense dislike of Thatcher’s ideology – I see many crises now as the direct consequence of initiatives that she put into train such as the housing crisis (selling council houses to long term occupants at major discounts – but with no reinvestment), railway and utility privatisation – which only seems to have pushed prices up… I could go on another rant. Back to that article, the sums of money involved in current privatisation are simply eye watering. And I bet most people aren’t really aware or don’t care enough – but they will when a tipping point is reached with the privatisation of parts of the NHS and, suddenly, what they took for granted has gone… As we said, when playing cards over Christmas, you can only play your trump or picture cards once.

For the record, I am not against change and I love innovation. Although when I, and others, expressed views against change for ideological reasons only (recent probation service privatisation) I think we were seen by some as change haters, or at the very least as irritating distractors / detractors? We had already done a lot of work to rationalise the estate and streamline support functions (two favourite ways of saving money without affecting the front line or cutting jobs) and we were winning awards that any self-respecting private sector company would shout about from the rooftops (e.g. 2011, British Quality Foundation Gold Medal for Excellence – all of the probation service), and gaining accreditations (e.g. EFQM level 4 on first attempt, ISO 14001, and OHSAS 18001 – locally awarded, but no longer live when the organisation was abolished and reformed*)

Some of our inefficiencies were down to national contracts we were contractually required to use as a commissioned public service. It gives me no pleasure to see news items now appearing indicating that some of the new probation contracts are at risk of failing, or of potential large scale job cuts. I still have former colleagues working in the service, who I know are full of integrity and care passionately about public safety, reducing the number of victims of crime and believe that people (service users) are capable of desistance from crime. So for them, potential victims of crime, and for service users who want to change, I do hope this does not become the train crash that it might. (Please forgive this tangent in particular – it’s still quite close to home.)
(*The other thing I could wax lyrical on is the number of babies that have been thrown out with bathwater and the waste of public money and effort that represents.)

Another way of saving money, I haven’t mentioned in this blog, that is becoming a missive, is outsourcing and shared services. I’m not a huge fan where this is done to excess. As I blogged in my first proper blog, The Man in the Sorting Office, some outsourcing of certain functions where processes could be mapped, and easily standardised then replicated, was possibly a good thing, but even in an exam question I answered in about 1990, I wondered what was in it for private sector providers, who have to make a profit in order to continue to function. One answer that sprung to mind then was that in public services where typically 70% or more of the budget is spent on wages, reducing staff pay, terms and conditions is the main way to reduce costs and make a profit. I am also musing on how efficient large shared service centres really are. From many anecdotal conversations with friends who work in the private sector (for companies you will have heard of) see The tail wagging the dog? and the public sector, my view is that these can actually reduce efficiency and push back lots of administrative work to operational professionals or managers (whose time probably costs more than that of the adviser in the former local support service.) A false economy in many cases, and in more cases, so remote that they can lack in any practical understanding of the business they support. I suspect that many of the staff who work in these large service centres are not fully fulfilled or challenged professionally, and that they know that the limited service they offer (after lots of process mapping, standardisation and removal of the use of discretion and local decision making) can often really piss off the customer.

I really need to find a conclusion, before I go on yet more ranty tangents about the biased media, vested interests to make the rich richer, extending the FOI etc. etc. so I will return to the NHS. During my time there, and certainly in the earlier years I experienced or knew of the following:

·       Ward entrances decorated like Quality Street scenes at Christmas, all vying to win ‘best decorated ward’ when my boss at the time did the rounds on Christmas Eve afternoon
·       Summer fetes and fun runs every year
·       Hospital cricket, football and even croquet teams
·       Quiz nights between teams from neighbouring hospitals
·       Plays and comedy sketches written by and performed by junior doctors
·       Numerous organised social events including a charity ball (featuring an honoured guest of a well-known Coronation Street Actress)

I could add more, but I think these are all examples of wonderful staff organised events and traditions – a bit like the social and community life that former mining communities experienced, but on a looser scale, obviously. I sensed that everyone was working for the NHS for the same reasons, no matter what role they held (and there were many more then, before outsourcing, such as carpentry, engineering, catering). As I said earlier, there was BAGS of goodwill; BUCKET LOADS in fact, and no need for hand wringing about the lack of staff engagement. Staff were engaged with their vocational profession, with their team, with their hospital or community service, with a tangible desire to make a difference. See What happened to vocation? So, to see evidence of this shared sense of purpose and vocation from the NHS Choir has, as I hope you can see, if you have been kind enough to bear with me so far, had a profound effect on me. I hope it has made people think, and not just those in the NHS and wider public service (past and present), who will get its meaning, and no doubt have a unique and personal response to it as I have. Wouldn’t it be great to see this incentivise a renewed appetite for collaborations such as choirs, sports teams and all sorts of other group efforts – no matter what further adverse polices or events come along to challenge us?
I have to end with a link to A Bridge Over You on YouTube.

Thank you for reading to the end. I warned you at the start that it was messy. I wish you a very fulfilling and energising 2016, full of learning, working together and positive opportunities.