A piece of cake

primary_care_training_piece of cake

News and Comment from Roy Lilley.

They were dainty, set out on a china plate with decorations around the edge and coloured napkins, cups with saucers… and a table cloth!

Homemade cakes.  Flavoured ice, glitter-spray, sprinkles… wow! 

Mid-afternoon, on a ward for elderly people.  Nurses take turns to bring in home-made cake.  Sponges, walnut cake, carrot cake, chocolate cake.  The bed-pan bake-off!

Once a week the austerity of mugs, paper plates and plastic cups is forgotten.  Civilisation returns, along with recollections, stories, photographs and smiles.

An oasis where NHS means neighbourly, homely and something to smile about.

Nurses and healthcare assistants make a dozen patients feel very special and give them back their lives, memories and dignity. 

Elsewhere in the NHS there will be people looking at spreadsheets struggling to think how they can make the columns add-up and what they have to take-away to make the bottom line work.

NHS organisations are big, sprawling and the distance between the board to ward needs a telescope to see and a megaphone to speak. 

The disconnect between management and the people who are managed.  A disconnect between the planners and the deliverers.  All big organisations suffer this detachment and the NHS is no different.  


Before we come to work we think… what do I have to do today.  At work we focus on our roles and tasks… work through the ‘Do List’.  We do the best job we can, where we can, with what we’ve got.  We do the job through our own personal lens.  We interpret, in our own context.

We can’t see the bigger picture if no one has shown it to us. 

For a manager tasked with cutting a million pounds from their budget and; “I don’t care how you do it, just get on with it...’ ringing in their ears, afternoon tea on a ward, someplace, doesn’t cross their mind.

For the patients it’s a big part of their day, for the relatives, it’s astonishing and will be talked about for weeks.  The small things are always big things to someone.  

Meaningful day-times, therapeutic, valuable that no business plan can account for.

  • It is the purpose of the organisation to deliver compassionate care.  
  • It is the purpose of the organisation to deliver its services on-time and within budget.  
  • It is the purpose of the organisation to deliver a strategy for caring for people and a strategy for caring about the resources to do it.

The Bermuda Triangle of the Board’s mission, manager’s task to make it happen, the front-line’s role… doing it.  

It’s a problem that’s been around a long time.

How do you deal with it?

Organisations that do well build on their strengths.  NHS; the strength comes not from the board room…. it comes from the wards and the clinics where the tea-parties happen.

When someone is gripped by grief and a nurse quietly produces her pack of tissues.  

Strength comes for the personal relationships that are created and people feel safe, even if they are on a trolley, in a corridor, for hours. 

It’s the place where wise managers go to get to the bottom of their bottom-line problems.

Saving a million pounds might be do-able if you ask people doing the job.  When ideas run dry and solutions seem impossible, sharing the problem, making everyone part of the narrative of solving it… is better than leaving them trying to understand half the story.

Decision makers are not who you think they are.  

Every day people delivering the services will make decisions that will either reflect well on the organisation, or badly.  Help deliver its mission, or not.  The difference comes when they are part of the solution and know it.

Transparency, talking, sharing the problem, contributing to the answers… a piece of cake.

Have a good weekend.


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