Brilliant leadership in the NHS is music to my ears

There are many things I like about being retired. One of them is the possibility of living a life to a different drum beat. For me, this often means that everything that needs to be done, or I want to do (and sometimes happily the two things converge) gets done, but at a much less frenetic pace. I think I’m less obsessional about things these days as well. For example, whilst I still wake up at 5am every morning – no alarm clock required - I no longer feel the urge to go online, or get up straight away, and feel quite at ease enjoying a slower start. I have even found a way to tune out the mutters of ‘some of us have to go to work, again’ as J gets herself ready to leave for work.

Another thing I don’t do any more is update my CV every week. Yes, I used to be fairly obsessional about keeping it up to date. Even when there wasn’t anything to add, I would read through it and maybe tweak it a bit here and there. Academic CVs are peculiar. For a start they tend to be long. Mine runs to 28 pages and tells you nothing about me as a person other than I write and publish a lot, have spoken at countless conferences, taught, assessed and supervised the work of others, and sat on many committees, boards and even, just once, a thought leader group!

Late last year I had to rethink my CV. I had been approached by one of those pesky headhunters, who thought 28 pages was a lot of CV to get through. So, I rewrote it, and reduced it to just six pages, and this time you did get to see who I was: an academic, practitioner, manager and human being. Nevertheless, I didn’t get the job. Had I done, I would have been able to sleep at night knowing that everything on the CV was true, authentic and interesting. Unlike, it seems, Peter Knight. He was the former Chief Information and Digital Officer at the Oxford University NHS Foundation Trust. It was a Board level role, and he was paid £130,000 a year for it. Although he was said to be good at his job, he was also a fraud, claiming to have a Classics Degree on his CV when he didn’t.

Following an anonymous tip off, which sparked an investigation, he resigned from his job, and last week was sentenced to a two-year jail term and ordered to carry out 200 hours of unpaid work. I imagine he will also have to pay the trial costs and compensation for the salary he was paid. He declared that it was the recruiting firm that had added the line that said he had a degree. I doubt that very much and, in any event, it’s his CV and he must have known what was in it!

It is managers like him who frankly give managers and management a bad name in the NHS. Actually, I vehemently dislike the term ‘management’, particularly when it’s used as noun – as wonderfully illustrated by Hale and Pace here. And, I think, for too long, managers in the NHS have suffered a bad press. Who doesn’t remember the New Labour (2002) cry of turn ‘grey suits into white coats’ as a way of resolving all the problems of the NHS? In reality, there are not enough managers in the NHS. Study after study have shown this, yet the urban myth that there are too many managers persists like a blood stain on a white sheet.

Back in 2018, hospitals in England were recruiting managers at a faster rate than they were doctors and nurses. And whilst NHS Improvement claimed there were still too few managers, the Royal College of Nursing (RCN) called the increase ‘galling’ at the time. Perhaps they forgot how many of their members also had a managerial role – I know, a bit controversial, but I was once one of these folk and I think I did a fairly good job of managing those services for which I was responsible. In 2017, the NHS was ranked as the most safe, affordable and efficient service in the world by the US think-tank the ‘Commonwealth Fund’. The ‘NHS Long Term Plan’ notes that for every Great British Pound spent by the NHS, just tuppence is spent on managerial and administrative costs. That sounds like great value to me. Well, that is, if our managers and leaders are doing an effective job.

Given the ever-increasing complexity of providing contemporary healthcare, effective (and yes, efficient) managerial expertise is essential. But of course, we shouldn’t see this as an either/or situation. We need world-class nurses, doctors and allied healthcare professionals alongside world-class managers and leaders. If we can combine these roles in the future, so much the better. One of the colleagues at the University whom I most admired was a radiographer by profession, but also a wonderful researcher and a brilliant leader – hats off to you Peter! He demonstrated that it’s possible to be a healthcare practitioner and also deliver great leadership and transformational management.

In the NHS, managers make up just 3% of the total workforce. Elsewhere in the UK economy, managers make up 9.5% of the workforce. If we were able to find even just 1% of the next generation of Peters across the NHS it would cost just £500 million, which in an annual NHS budget of nearly £140 billion is rather a small cost. My belief is, unlike Tesco, Sainsbury and as of last week Morrisons, all of whom have reduced or plan to reduce the number of managers they employ, the NHS needs to invest in more, albeit infinitely better, managers.

Last word on effective management has to go to Julian Richer. He is the Founder and MD of Richer Sounds, the UK’s leading Hi-Fi music store. Last week I enjoyed listening to him on the Radio 4 programme ‘You and Yours’ where he was talking about his approach to management – which includes: no zero hours contracts, a pay gap that favours women, job perks (for everyone) that include access to holiday homes around the world, and a consistent donation of 15% of the profits to charities – which last year equated to nearly £10 million. As my friend and former colleague Umesh has said on many an occasion ‘happy staff means happy patients’.

The First World Problem of what to eat…

We are only on day 19 of the new decade and I’m afraid I am struggling with a personal dilemma over how to respond to what have been called ‘First World Problems’. It’s said that the term first gained widespread use and recognition around 2005, and was a popular #hashtag on many social media sites. Some might say that it still is. I’ve used it more than once since the turn of the year. The term is usually used in self-deprecation, or more commonly, to gently chastise those who are complaining about trivial matters, when there are so many difficult issues facing many people across the world.

Way back in 2012, UNICEF conducted a small study in New Zealand, where the most common First World Problem reported was putting up with a slow internet connection! I guess for many people, me included, Wi-Fi problems can still be a big issue. If anyone was to ask J, she would say I am like a bear with a sore head when I can’t get online for whatever reason. It’s not true of course, I have infinite patience in such situations. However, in the last few weeks I have seen very sensible, mature and worldly-wise folk complain about many things including, having to use the hair dryer in the gym to dry themselves, because the gym hadn’t received its towel delivery, mouldy fruit in their supermarket shop delivery, and how life wasn’t worth living now as the TV remote had stopped working!

My First World Problem is not being able to find Garlic and Parsley Quorn sausages. I love these tasty meat-free sausages, and always have some in the freezer as a stand by for unexpected visitors who might want something to eat. They are delicious, the sausages that is, but they can be hard to find. None of our local supermarkets stock them. I have been able to keep my supplies going by stocking up at a supermarket near to where a couple of my grandchildren live. This week was different. There was not a single sausage to be seen – just empty boxes or those plain Quorn sausages that are just frankly, simply plain and uninviting.

As I stood looking at the near empty shelves, I was bumped, elbowed and could hear the tut-tutting of others anxious to buy their meat-free goodies. It hasn’t always been like that. More often than not, I would be the only person choosing what to buy from the vegetarian selection and could take as long as I liked doing so. It’s all changing. Mintel, the market analysis organisation, published the results of their recent survey last week. The results showed that more people than ever before are becoming vegans, vegetarians, or flexitarians; the latter being those folk who just want to reduce the amount of meat they are eating.

Flexitarians! – it’s enough to make Linda McCartney turn in her grave – my mother would call such people fussy eaters. Over 14% of the population describe themselves as flexitarian – this is twice as many as pescatarians (people who don’t eat meat, but do eat fish), vegetarians and vegans combined. Research by YouGov found that only 1% of the population describe themselves as vegan. Strangely perhaps, given this, the rise in people shunning meat products has been fuelled in part by the ever-increasing meat-free products now available and partly because producers have devised ever more ‘healthy’ products for us to try. Look at the success of Greggs and their vegan sausage roll, (more of which later). Indeed, Mintel reported that just under a quarter of all new food products introduced last year were labelled vegan. My local supermarket has now devoted a whole section to such products, which I have to say, on the whole look fairly unappetising and appear very expensive too!

Overall the proportion of folk who have reduced or limited the amount of meat they eat over the last 12 months rose to 39% of the population. Women are much more likely than men to have made the decision to reduce the amount of meat they eat, but overall 45% of those aged 45 or under report they are eating less meat than in the previous 12 months. All of which is great for animals (unless you happen to be a chicken, then the news isn’t so good).  

The sale of lamb (those little white fluffy things that are starting to hop, skip and jump in the fields as of now), has fallen year on year, as has the sale of pig meat (including bacon and ham), whereas beef showed a very small rise in sales, but nothing like that of the sale of chickens, which has risen nearly 4% over the past year. In contrast, the sale of meat-free products has risen by some 40% over the past few years. Have a look here at what is around to tempt you as you shop.

Now I became a vegetarian some 50 years ago. I did it for reasons of wanting to become self-sufficient. My guru was John Seymour (now sadly no longer with us). One of the things he described was that it was possible to keep a cow all year on just two acres of land – but used differently, the same amount of land could keep a family in food for a year. Just take a look at the infographic in this article. These days, people are turning away from meat because of a variety of reasons. In the main they are split into three main areas – (1) for health reasons; (2) to save money; (3) for environmental reasons. The latter reason is the one most supported by those aged 24 years or younger. They see a reduction in meat production as a great way to reduce the adverse impact humans are having on the environment.

Whatever the reasons people are turning away from meat, it fills my heart with joy. There is enough evidence to show that a meat-free (or nearly meat-free) diet is good for your health – but please, hands off my garlic and parsley sausages!

Oh, and Greggs and their vegan sausage roll. Well I haven’t had one yet and I’m not in a hurry to try one to be honest. And it seems those sensible folk in Cornwall are with me. Greggs have closed their one and only shop in Cornwall after just a year of trading. I think ‘Greggxit’ was almost inevitable, given that supporters of traditional Cornish pasties described Greggs’ offerings as ‘junk food’ and ‘Satan’s franchise’ – just another First World Problem methinks - happy eating folks!

Neighbours and an altruistic Parrot

Like most people, we had a number of parties, family do’s and even a bit of a soiree this Christmas. It was lovely to be able to see our children, grandchildren, friends, work colleagues, and for the first time, our new neighbours. More on them later; but it was interesting that, when they came round, one of the things they all enjoyed was Billy providing some of the entertainment. Billy is our African grey parrot. I bought him way back in 1986, he was just one year old then, so that makes him at least 35 years old. He has a wonderful vocabulary, which I think (in part), is what amused our guests. He has opinions, and will express them. He loves music, particularly blues, which he will whistle along to. He will give me a kiss, and does so with a beak that can easily crack open a walnut. Billy is very much part of the family, and hopefully he will continue to be so for another 35 years. Parrots are incredibly long living, and according to researchers in the Max Planek Institute of Ornithology in Germany, they are also altruistic. 

Their experiments showed that they were intrinsically motivated to help others, even where that individual was neither known to them nor a ‘friend’. It’s a behaviour that is normally only associated with humans. They found that African Grey parrots voluntarily and spontaneously helped other parrots to achieve a goal without any obvious benefits to themselves. Dr Desiree Brucks, who led the research, tried the same experiments with other parrot species, but it was only the African Greys that behaved in this way. It’s also sometimes true that not all humans behave in this way too.

Last week, I met a group of healthcare professionals at our local hospital and we talked about transcendental leadership, something I strive to demonstrate in my organisational relationships with others. As a leader, I have always tried to recognise the importance of the interrelated elements of self, and self in relation to others and to the organisation and, in our discussion, we focused on how to inspire the transcendent motivation in colleagues. For me, this has always involved seeing the well-being and development of others as being a critical factor in unlocking this transcendent motivation. This is not the place to fully explore what this means, but here is a good paper to get you going if you are interested. However, an example of transcendent motivation would be that sense of altruism that makes people think of and/or help others in situations where there is no tangible or extrinsic reward for themselves.  

As with all such ideas, there is always a critical challenge. For example, the notion of psychological egoism suggests that all of us are ultimately motivated by self-interest and even selfishness. This would seem to apply even in what might be seen as acts of altruism. The argument is that when people choose to help others, they do so ultimately because of the personal benefits they expect to obtain, directly or indirectly, from doing so. I know it’s a slightly contentious idea. But that said, for many healthcare professionals, intrinsic rewards are likely to be just as important as the more obvious extrinsic rewards, such as their salary – although I have every sympathy for the nurses working in Northern Ireland who are seeking ‘fair pay’ parity with nurses working in the other three Home nations.

Regular readers of this blog will know that I was pretty ashamed that I had reached the advanced age of 64 and yet had never given blood until just before Christmas last year. I have no excuse for not becoming a blood donor earlier in my life. I should have done so years ago. I think that giving blood is a great example of the altruistic/psychological egoists dilemma. I gave blood without thinking anything more about it than I thought I should. But last week, I had several tweets and even an email or two from the NHS Blood and Transplant service urging me and men like me to give blood. It was an illuminating experience, and made me glad I had given blood, as I now felt good knowing what it could be used for. For every 100 women who donated their blood last year only 70 men did. As such, male blood is particularly valuable, which surprised me (and truth be told, added to my sense of guilt). Some neonatal transfusions can only be done from male donors; men can donate more often than women; men have fewer antibodies in their blood, have higher levels of iron and have a higher platelet count than women. How I didn’t know this, I simply don’t know. Now I do know, I shall give more blood on the 6th March, which is the earliest I can do so. Altruistic, I think not, I’m pleased that I can do something that can help others – ‘quod erat demonstrandum’.

Which takes me back to our neighbours. At Christmas we had been living in our little house for some 10 months. We were on nodding terms with all our immediate neighbours, and even knew some of the names. Christmas is a time to reach out to others, so I knocked on folks’ doors and said it would be very helpful if they could tell me their names, so we could send them a Christmas card. They did and we sent out the cards, which felt good, but not that good to be honest. So, we decided to send out a little note to each of our neighbours saying we were having an ‘open house’, and please feel free to come.

On the day, we had eight couples turn up around 4pm, and the last of them left at one o’clock the following morning. It was a fabulous opportunity to get to know who our neighbours were. And it was an infectious evening too. We have since been invited to a couple of our neighbours’ houses for a drink and something to eat, and I have enjoyed a lawn bowls lesson, and we have someone coming to give us a quote (mates rates) for a new kitchen. Were we altruistic, I think maybe so, but in any event, I’m pleased we could do something that helped others help others – probably still ‘quod erat demonstrandum’.

But the last words go to ‘Our Neighbours’ who last week said: ‘It’s now more important than ever that we reach out to the people around us. By doing your bit to support people in your neighbourhood, you’ll help to rekindle neighbourly spirit, reduce social isolation and even prevent illnesses such as dementia, heart disease and depression’.

Ps – I so love the reflected positivity of my blood donor card

Creating memories; but don’t look back in anger, I hear you say

Welcome to the first blog posting of the new year and indeed the new decade. I’m not going to look back at what, in many ways, has been a remarkable last 10 years. I have, for those last 10 years, nearly always used the last blog of each year to do just that. No, whilst it is sometimes good to look back to see the journey you have been on, my eyes and thoughts this year are firmly fixed on the future. It’s an immediate future that I’m especially looking forward to creating and enjoying. J has a thing on her phone called Timehop, which each day throws up photos, tweets, or Facebook posts of something she was doing or saying on that day in years gone by. It is a clever app, and over time it will become a wonderful memory store – a bit like the memory suitcase that Liverpool Museum developed for people living with dementia. When we met, J and I had many memories we could share with each other, but not many shared memories – so we have been busy each day creating memories of us, for us.

And that’s the strange paradox. Why create memories if you are not going to look back at them? Well of course, I’m sure, we will sometime in the future, occasionally sit with a glass of wine and talk about what we have done, who we have met, where we have been… Maybe, what worked and what didn’t turn out as we expected, or what we still have left to do. The older I get, the more I realise what the saying ‘One Life, Live It’ might actually mean - and there are so many things yet to be experienced.

That said, not looking backwards that is, I’ve had some very strange dreams over this Christmas period. What made these dreams strange is that they all contained people who I have met at different times during my life. Many of whom are no longer an active part of my life. They included people I have worked with, people I’ve had a relationship with, and even people who have died. In real life they couldn’t all be there together. Physically, it would be difficult, if not impossible, and there would be too many high-expressed emotions for some of these people to be in the same place at the same time. Sadly, but understandably in some cases, some of these people might not even want to be in the same place as me. Yet in my dreams, they appeared all together, and there was no rancour or anger or other negative emotion to be seen.

Now Christmas time television usually has Dickens’ ‘A Christmas Carol’ where Ebenezer Scrooge is confronted by his past, present and future self in a series of dreams. This year was no exception, with the BBC screening a new adaptation over three episodes. Whilst there is an explanation and ultimate choice to be taken with Scrooge’s dreams, I don’t pretend to know what my dreams meant, and I’m certainly not putting a description of them on here for others to dissect, and suggest any possible meanings.

Suffice it to say, I think the dreams were perhaps an overindulgence in good cheese over the Christmas break. Now you may think that it’s just old folk wisdom that suggests that eating cheese can give you nightmares. Whilst it’s difficult to find many research studies on the subject, we do know that cheese can influence brain function. Many readers will know that the brain is stimulated by a range of hormones including serotonin (which promotes relaxation and sleepiness), adrenalin (which acts as a stimulant), and testosterone (which regulates libido and strength). It is these hormones that influence how we think, and how we might behave. Some of these chemicals come from the food we eat. Cheese contains tryptophan, an amino acid that when consumed can be processed into serotonin – the essential hormone for sleepiness. Not exactly case proven, but there is, at least, a tenuous link between eating cheese and having a good night’s sleep.

And famously, back in 2005, the British Cheese Board conducted a study on cheese and dreams. I know perhaps this may not be the most independent bit of research ever undertaken, but it had some interesting results. Participants were asked to only eat a particular type of cheese 30 minutes before going to bed each night for a week. These included Stilton, Cheddar, British Brie, Lancashire, Red Leicester and so on. They would then record their dreams the moment they woke up the next day. Surprisingly, 83% of the participants who ate Red Leicester had pleasant dreams, with 60% of the dreams being about fond childhood memories. Those who ate Cheddar, dreamt about celebrities, while those who were given Cheshire cheese had no dreams. You can read about the study here – look out for the sad vegetarian crocodile, depressed because he couldn’t eat humans.

If truth be told, there is actually nothing particular about cheese. If you go to bed with a full stomach, you are more likely than not to spend most of the night in REM (rapid eye movement) sleep, which is when your most vivid dreams occur. We habitually eat late in this house, and over Christmas we may have been just a little guilty of snacking up until bedtime too. If this is the case with you, and you do dream, whether those dreams are good or bad is likely to be determined by the degree of your underlying anxiety and whether or not you get to have your fair share of the quilt during the night.

So as the new decade gets underway, let’s not look backwards, but if tempted to do so, let’s do it with love and fondness, and not with anger or regret. The future, for however long that might be, is there for the taking, it really is ‘One Life’ so live it and let’s all start creating and collecting memories. Finally, we are getting married in Spring this year, As is our wont, we want to do so differently, a mixture of elegance and edgy, traditional and contemporary. For example, my best man is actually a best woman, and we are determined not to have the familiar sit down wedding breakfast – in fact we are off to the cheese shed to order our wedding cake which will be made of many different cheeses – sweet dreams are made of this – a very Happy New Year to you all.