News and Comments This Week

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News and Comment from Roy Lilley

Where we go to find it...

If you glance at your calendar, 2025 looks like a long way off.  Seven years.  One, maybe two elections away.  Time for children to be born and start school.  Time for others to retire and start a new life.  

Three hundred and sixty four weeks.  Just over two and a half thousand days.  Not long when you say it quick.  

That's how long we've got before adult social care tell us the funding gap, just to maintain existing standards, will be £3.5bn.

Reasons; 1.5m more +75ys coming down the track in the next ten years.  

With that fact under your belt, you may well ask why it is 400,000 fewer people are receiving care than they did in 2010.  Did they all win the Lanzarottery and move to the sun?

The answer is no.  Local Authorities ran out of money, changed their eligibility criteria and stopped providing care.  All in the name of austerity.

Apparently, English Councils plan £700m of social care cuts in 2018-19, that's about 5% of the budget.  Social care providers say they need about £1bn to relieve present pressures.

It is against this background that No18's announcement that he is 'injecting' £240m into the social care system to relieve the pressure on the NHS will be good news.

Well, good news, where he made the announcement, to the people in the audience, at the Tory Conference... to the party faithful.  Cue-the-applause.

Let's think about it.  

The money; it will, maybe, buy 150-odd thousand care packages of one sort or another.  But, it's October.  Plans have been made for the winter.  There's been almost no respite between spring, summer, autumn or winter.  The system is at full stretch.

The people; advertising, recruiting staff, training them, getting DBS checks and references, disengaging them from whatever they are doing now... might take three months.

Social care has trouble recruiting.  The adult social care sector in England faces a gap of 200,000 care workers by the end of this Parliament because of restrictions on immigration and a failure to attract British workers. 

Let's think about it.  The announcement; 'to help the NHS'.  Nothing about sorting out the crisis that underpins the actual problem... social care is broke.

Note the carefully crafted announcement; 'supporting the NHS'.  Not 'supporting social care', crippled by austerity.  

Money going late into the system will fuel wage-costs... providers have to find staff and fuel care-costs... providers will up-their-rates as councils get desperate to cope.

Nevertheless, the announcement got exactly what it is designed to do; a round of applause at the Tory Conference.

The announcement has come too late to really help winter planning, but just in time for the Tory Conference.

The announcement is a spit in the bucket but will be met with a wave of enthusiasm at the Tory Conference.

The announcement ignores the plight of a key public service but the Tory Conference won't know that.

I don't know about you but I'm growing tired of the politics.  

Tired of ambition ripping the government apart at this time, of all times, when we need cohesive leadership.  

Tired of internal rows, factions and discriminations we should have left behind with the second world war.

Government's duties are;

  • to keep the country safe, 
  • the people well and 
  • the economy working for everyone.  

We might remember Churchill's advice;

 'The duty of an MP is first to the Country, second to Constituents and third to the Party.' 

We seem to have lost all that and I'm not sure where we go to find it. 

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Absorbed...

The summer's over.  I'm back on a train.

I'm wondering if there has been a tiny shift in public behaviour?  This is not scientific, but go with me.  Are more people reading books?  It looks like it.

A stick-thin girl with paper-white skin is sitting, crossed legged, hunched over a paperback.  It's a battered book, thick and dog-eared.  It's a book that has been passed from reader to reader.  I wonder what it is?  Annoyingly, I can't see the cover.

In the corner a plump boy with a wispy stubble.  Is he too lazy to shave or does he think his pubic-fluff adds a few years?  He is engrossed in a book.  An unlikely reader?  More of a phone-gamer person?  

Opposite, a mid-twenty something with a beard like an Orangutang's armpit.  I can see pages, full of equations and complexity.  I'm guessing algorithms, software, text book.

Why does everyone have a beard?

Across the diagonal a grey-haired woman is knitting.  Perched on her lap is a handbag, propping up a Kindle.  For me, that counts as a book.

I'm reading a book.  Perhaps that's why I'm more aware of other readers.  Like owning a dog.  Once you join the international fraternity of dog ownership you see a different world from the end of a lead.

My book is a slender volume, only 89 pages.  It's a friendly looking book.  A cover in baby-blue and yellow, the colour of a custard tart.  Two hands join to form a heart shape... clever.

In fact that's a good word to sum up this book.  It's clever.  Engaging and deceptively simple.

It starts with the story of a hole in an office carpet.  That sets the tone and style of the book.  

 The anecdote of the carpet unfolds into a human story and the writer tells us what he learned from the experience.   

By implication, there is a lesson and questions for all of us.

There are 40 questions in the book, ranging from 'having a realistic view of human nature' to 'are you true to yourself'.... that's a tough one to answer truthfully.  

The writer is NHS icon, Ken Jarrold a manager for nearly 40 years, twenty of them as a chief executive and three as Director of Human Resources.  He knows a thing or two does Ken and in his book, he passes on his experiences, good and bad... for us to learn from.

He tells of a time when hospitals were run by superintendents and pre-op patients were shaved by a drunken barber!

Ken learned his listening and people skills when beer was warm and vicars still had bicycles.  

However, here's the point; 

...we may drink ice cold lager and vicars drive cars, but every message in this book, every idea, every full-stop and comma is as relevant today as it was when Argentina invaded the Falklands, Jimmy Connors won Wimbledon and the NHS was trying to figure out what to do about AIDS.

The book shops have shelves of management books.  Amazon must have a million.  There is no shortage of people impressing us how they changed this, did that and turned nothing into something.  Self publicists telling us how stupid we are.

This book and Ken are not like that.  He asks;

'What are your definitions of leadership and management and do your definitions help you to grow as a leader and manager?'

That is such a tough question.  Fortunately, Ken is on hand to help us find the answer.  Get that bit; 'help us find the answer'.  Not tell us the answer.

This book is no management bugle.  Ken reveals himself and the personal and professional pressures that boiled over in the stress of his own life.  How he dealt with them and how we can avoid them.

He tells us; 

'... listening can transform lives.'  

 How true that is.

Leadership and management is about getting the best out of people, helping them to fulfil their potential.  You can't do that unless you can walk in other people's shoes.

That's the clever title of the book; Other People's Shoes.

The woman is still knitting.  Wispy, beardy and pale have gone.  I never noticed them leaving.  That's what happens when you read a good book.  

You get absorbed... 

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See what he says...

There are some things you are entitled to take for granted.  Except, you're not.

You're entitled to expect if you buy a ticket on a train, you'll get a seat and end up wherever you're going.   Except you're not.  You might have to stand-up or worse, be marooned on a round-the-world bus-replacement service.

You might think, if you buy an airline ticket, you're going places,  Err, no.

Whatever you buy, wherever you go, whatever you do, on-line or in a shop, the odds and the small print, are stacked against you.

You would think, the last place you would be messed around, injured or damaged would be a hospital.  Think again.

There are a million people a day passing through the hands of the caring/uncaring, professional/amateur, on-the-ball/off-the-ball NHS every 24 hrs.

People collected by ambulances... waiting for ambulances.  Arriving for an operation... sent home.  Sick, injured and ill waiting for treatment in a corridor.  People whose lives or the lives of their family or children are changed, trashed and ruined forever.

There are always corporate, plastic-apologies.  There will be a 'sorry', that amounts to little more than 'woops'. Delays and people dragged through the courts.

At the Birmingham Children's hospital where, if reports are correct, the Coroner says; a child died for the lack of nurses.  

For heaven's sake, how many more words have to be written, warnings warned, red-lines crossed, to underline in crimson, there are not enough nurses... to save families from the travesty of death in our care.

We know we don't have enough staff for safe care but we manage, rub-along, pretend that we can intellectualise demand, predict and fudge our way into believing the NHS is safe.

If it is safe for nine hundred and ninety-nine people, for the one in a thousand we fail... the NHS is not safe.  

The family standing at the grave of their child.  Not for them the birthdays, the successes, the schools, the university, the loves and marriages, the grandchildren, birthdays and celebrations... can we claim to be safe? 

Basic, things like running organisations without enough staff, are page one in the manager's handbook of bog-standard.

When it gets to the more complicated stuff... where are we?

It appears; after seventy years, people still get distracted in their work...  make mistakes.  We can't agree on 'site marking'.  In English; which is the left leg and which is the right... hence we cut the wrong one, off.

  • We copy stuff, long hand, from one piece of paper to another and guess what; make mistakes.  
  • The bits that go into us, during an operation, are counted but counting policies vary from Trust to Trust.  
  • Some equipment has covers or caps that get dropped into our innards.
  • Poor training on different types of implants
  • Poor labelling.  

Surely not in our world leading NHS.  I have news... we can't even figure out matching size and compatibility of components, systems and procedures that are implanted, sewn or left inside us.  

We could have the wrong bit cut-off, the wrong bit put-in or bits left behind... and it keeps happening.

Don't believe me?  Have a look at NHSI's latest into 'never events'.

For some, the NHS is a dangerous place.

Why?  Because we are busy, not enough staff.  Wrong skill-mix.  Tired, exhausted.  People frightened to speak up.  Scared of Regulators, anxious not to see a career trashed.  Bullying management and fear.

We are looking to the airline industry for solutions.  Airlines are open and discuss their errors.  That's because pilots want to get home as much as you do.  If a surgeon cuts off the wrong-bit, or a baby dies, we still go home.

Kieth Condradi was the boss of the Air Accident Branch and now heads the NHS Investigation Branch, aimed at making the NHS safer.  

He is my guest for the upcoming HealthChat... let's see what he says.

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Bring back Carter...

It looks to me; the RCN is in a right old mess.

Does it matter?

Less than 4% of members bothered to vote in last Friday's EGM.  The upshot; their Council have been turfed out.  The RCN is leaderless, rudderless.

What happens next?  Who cares?

I care.  I don't know why!  The members don't appear to.

I well remember, in 1995; Christine Hancock, the then boss of the RCN, shell-shocked, at an EGM, when she announced the result of a ballot.  History was made; the RCN voted 9 to one, to tear-up the no-strike clause in its constitution. 

That was the moment the RCN shifted the tectonic plates that had underpinned the history of the profession and shaped the question; is the RCN a trade's union or is it a Royal College?  Can it be both?

If it's a Union it's made a mess of it.  

To be fair it's been a complex negotiation over the new pay deal and the bullies in the Treasury, confident the RCN wouldn't strike, said... 'take it or leave it'.

The RCN took it... but didn't look at it.  

The detail of the deal fell down the inevitable gap between RCN-the-Union and RCN-the-College.  

The report into what happened is here.  Highly paid officials don't come out covered in glory.  Members were urged to accept a confusing package and in a low-turn-out-poll, they did.

When members realised they'd been sold a pup... the dogs barked, rightly.

There is little argument, the RCN took its collective eye off the ball.  The Council failed.  They've been shown the door.

What's next?  I can guess.  Activists will populate key rolls and the RCN will move further away from being a Royal College.  

You can only say; good luck to the people who put in the time, the effort.  The future belongs to them.  They're motivated... set on change.

I'm left wondering; if less than 4% of members can be bothered about taking part in a crucial vote, should any of us be bothered about the RCN?

Nursing, with its pivotal role in healthcare, our daily lives... looks banjaxed. 

Nurse training has been disrupted, the bursary finished, influence sidelined, the organisation in chaos, the profession facing being de-skilled... no time for the RCN to be in a mess.

Other trades unions fair no better.  Since Mrs Thatcher came to power the so-called 'union density', the number of members as a proportion of the working population, has dropped by half and of the unions involved in collective bargaining, 2/3rds.

Recent figures; a tiny uplift in membership in 2017 but the density, still dropping off.  Representation, where it is needed most, in the low-pay private sector, just 14%.

Strong unions are good for the workplace.  They educate, train and support members.  They form the kind of partnerships we see across the EU.  They have a place on the board, partners in pointing the direction for the organisation and its workers who will make it happen.

Fragmented unions are frustrated and fractious.  The decline of the unions has coincided with the slowest period of wage growth in over a hundred years.   

Changes to the gig economy and the emergence of the Uber worker will inevitably encroach into the NHS.  The Uber-style nurse App is here.  I'm told, so too are zero hours contracts.

At a time of austerity and little security in the wider workplace it is easy to understand that nurses might reason; 

'It's pressured but fundamentally it's what I wanted to do.  All I can do and I'll keep doing it because, I have a job'.

Nurses don't need to join the RCN, they do for continuing professional development, keeping up-to-date.  For the collegiate-camaraderie.  There, if the need arises.

My guess; they don't join the RCN as they might a trade's union.

Whoever the new leaders of the RCN turn out to be, they must define their   purpose, clarify their mission and understand the organisation should be member led, not member managed.

Success will equal more than 4% of members making crucial decisions.

Something has gone very wrong at the RCN.  It is important that it is put right.  Someone needs to steady the ship.  

Bring back Carter.

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roy.lilley@nhsmanagers.net 

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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.