Sunday, 2 December 2018

Christmas, the NHS - a time of Great Expectations


I don’t know where the year has gone. The days have flown by and it’s hard to believe there are just 23 days left until Christmas Day 2018. And in the words of the famous song ‘Christmas is all around us’. Which is a problem when out and about with grandchildren. They of an age now and have cottoned on to the need to write a list to Father Christmas setting out what they want for Christmas. Television advertisements don’t help – ‘I want one of those, and those, and that’.  

They haven’t yet got to understand the joy of giving, and it’s all about what they might receive now. So, Christmas is a season of managing expectations. And it’s not just the grandchildren’s expectations that need managing. Due to the gales last week, I was able to catch up with some of my reading. One of the things I read was a blog on the fabulous ‘The Conservative Woman (the philosophy not the party!)’ website. There was much I recognised in the author’s view of the world, and it’s a good read. You can read it too here.   

I won’t spoil your read, but I was really struck by the expectations articulated by the blogger’s fellow patients, their friends and family and my own parents’ experiences and expectations of health care. They are of a generation which is still very deferential to the medical profession, although these days, they do complain (loudly) of the difficulties in getting to see their GP, or specialist consultants. And I am sure I can’t be the only person frustrated by what appears to be a lack of assertiveness when it comes to asking their doctors questions. Time and time again when they have been to see a health care professional and I ask them what was said, they have nothing to report – or more often than not when I ask what it was they asked, they say they didn’t ask anything – if the doctor wanted them to know something, they are sure they would be told. My parents have high expectations of the NHS and how those who work in it should operate.

They are not alone in this. Last week, the Secretary of State for Health and Social Care, Matt Handcock, spoke to an audience of health care professionals at the Kings Fund, setting out his expectations for NHS leaders and managers. You can read the text of his speech here. He compared the NHS to the US Department of Defence, McDonalds, Walmart and the Chinese’s People’s Liberation Army – all great British institutions – in fairness, he was trying to make the point about organisations comparable in size to the NHS and highlighting their approach to management and leadership development. 

One of the organisations, which Matt Hancock wants to take a larger role in achieving similar leadership development programmes for the NHS, is the well-respected charity - Staff College. You can read more about their work here. Refreshingly, they describe themselves as being agnostic about styles of leadership and leadership theory, focusing more on the leadership context. Likewise, they also believe in the importance of people, and the quality of relationships leaders have with those around them. An absolute expectation of the students who attend the Staff College development programmes, is that they explore more deeply and reflectively their sense of self and their sense of self in relation to others. 

This is an approach I have championed for many years. Partly, I think, because it reflects my clinical background and my love of psycho-dynamic approaches to therapy. Indeed, over the last 25 years my CV has stated:  My professional background is in mental health care. The focus for my research interest is on inter-personal, intra-personal and extra-personal relationships and how individuals are prepared to use such relationships. My research has centred around exploring the impact of such relationships on nursing practice, policy, organisation and education using psychodynamic and managerialist analytical discourses

35 years ago there was another chap, whose expectations of managers and leaders in the NHS had a profound impact on how the NHS has developed since that time. He was Roy Griffiths, who when he was alive was the Chairman of Sainsbury’s. Spookily, the first job I had on leaving school was as a management trainee for Sainsbury’s. The Griffiths report, published in 1983, introduced the concept of general management to the NHS. This was something I was to benefit from, gaining my first senior management position some seven years later. It was also the first role in the NHS where I wasn’t employed primarily as a nurse. 

I set out on that journey with great expectations of the contribution I would be able to make to the NHS. Many of those things I dreamt about doing I’ve realised. And there were many other career achievements that have happened that were completely unexpected, such as becoming Dean of School at a university and a Professor in mental health care and travelling all over the world to present my research. Not bad for a former management trainee at your local supermarket – maybe Matt Hancock has a germ of a good idea after all!

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