What price enlightened leadership and excellent management?

Apart from the coverage of the first man to set foot on the moon, brilliantly celebrated by the many TV programmes during the past week, there have been other news headlines of equally hard to believe occurrences. There was Freckles, the 3m manta ray who approached divers to remove fishing hooks embedded in its eyelids; the most played song on UK radio and TV was Snow Patrol’s ‘Chasing Cars’; Alexa is set to replace your GP; the Guinness Book of Records declared that Ffordd Pen Llech, in North Wales to be the steepest street in the world; and that former directors of NHS Improvement (NHSI) and NHS England (NHSE) received exit pay-outs of £300,000 each as the two organisations came together to form a new regulatory body in April this year. 

NHSI additionally reported that they had made four other exit pay-outs worth over £100,000 each, with NHSE admitting to 32 pay-outs worth more than £100,000. The total cost of exit payments at NHSI/E totalled around £10 million in 2018/19. The cynic in me notes that the long-awaited (since 2015) Government consultation on limiting public service exit pay-outs to £95,000 has just closed. Now don’t get me wrong, I’m sure these pay-outs were all in line with the individuals’ contracts of employment. However, to be reading about them in the week that NHSI/E announced the start of their third phase of restructuring the merged organisation was not good. It is a phase that will impact on nearly 1,000 members of staff, none of whom I imagine will receive anywhere near such a good exit pay-out as those above. 

I have been on both sides of the table and usually it is not a great experience for anyone. The one exception that I was personally involved in was a cost reduction programme at the University many years ago. It was euphemistically called ‘Transformation’ and was a programme aimed at creating some ‘headroom’ for investment and change. The ‘transformation’ was to reduce the headcount of academics and centralise all the administrative processes by taking them out of the individual Schools. I was responsible for achieving the headcount reduction in my School. Now many of the academics who worked in the School were people who had come into academia in later life after a long career in the NHS. So, these folk had great NHS pensions to look forward to PLUS a hefty exit pay-out agreed by the University. This happy state of affairs meant I had a queue of interested colleagues that went from my office all the way around the building and out the front door. Many of them were due to receive six figure lump sums. It wasn’t without a little glee that I presented the names to my bosses, who couldn’t do much except shout and rave and then acquiesce – it was after all their master plan. 

And therein lies the rub. As Dean of School and usually a good corporate player, I was not on this occasion committed to the programme, on the basis that I didn’t understand why we were doing it. It wasn’t that I was against change and certainly didn’t belong to the ‘if it ain’t broke, don’t change it’ school of management, I just didn’t understand the rationale for doing what we were doing. I wasn’t the only one; overall, it was a very destructive process. Like the NHSI/E programme, many people had to re-apply for a job similar to the one they had been doing or face redundancy. The outcomes were in the main negative and left a legacy of a poor organisational culture with a heavily demotivated workforce that the University had to contend with for many years afterwards. Ironically, the programme’s chief architect left the University a couple of years later, and left under a cloud, although it’s believed he too received a hefty exit pay-out.

Like the rationale used in the University transformation programme, the NHSI/E changes appear to be predicated on once more engaging with the ‘centralisation versus decentralisation’ tug of war. The current system, put in place by Andrew Lansley, viewed centralisation and lean organisational forms as a good thing, whereas the NHSI/E merger and the [re]creation of Regional Offices is about decentralisation and ensuring decision-making is closer to those delivering the services. Have a look at what is espoused in the consultation document:  “This model will be adaptive, changing over time to adjust to developments in the health system environment. For example, as local systems improve and transform, the balance of activities that take place in the regions and in the local health system may shift to ensure that services, support, regulation and improvement are all located where they best deliver improved care and health for patients.” As a piece of rhetoric, it is hard to argue with. It’s what we would all like to see happen. Likewise, the document also goes on to say: “At its heart, our new operating model will be built on the development of a new shared culture, set of values, behaviours and capabilities to support compassionate system leadership throughout the NHS”.

I guess there will always be some folk who will forever view the new NHSI/E as being made up of millennial apparatchiks pouring bureaucratic sand into the engine of the operational NHS. However, and in fairness, having personally met the new Regional Office Director for the North on three occasions recently, I do think it might be possible to turn this rhetoric into an effective reality. That said, it will need both enlightened leadership and excellent management to achieve this. And that comes at a cost. Whilst the UK media might focus on the number of nurses and doctors ‘missing’ from our NHS, equally there is a paucity of effective managers. Like hens’ teeth, good managers can be hard to come by. They need to be rewarded appropriately, even when this means paying them more than the Prime Minister gets paid (£150,000). Sadly, the old adage that’s goes something like ‘if you pay peanuts, you get monkeys’ is still relevant today.