Xmas with the Duchess; this year, as always, included the ratings-topping Queen's speech. 'Yes, she is wonderful for her age' (the Queen), 'Yes that is a good colour for her' and yes 'She talks a lot of sense'.

I usually reach for the Penderyn but this year the images of The Queen, walking through the field of ceramic poppies at the Tower of London got me. A powerful picture, made more impactful by Her Maj' telling us her reaction was 'silence'. I know exactly what she means.

As the sun dropped out of a November evening sky I stood and looked into the scarlet moat. She was right... silence. I looked on in silence, as did the hundreds of tourists, visitors and locals; just the buzz of London traffic busying by.

The Queen's speech moved on to 'reconciliation'. We should 'reach out to each other'.  Mmm... 

You will know I was so enraged by this stupid letter from the three-blind-mice I wrote an unplanned eletter, published Christmas Eve. The NHS was preparing to go on holiday. I thought readership would have dipped. Oh no! I now have a file of letters that in any other context would be regarded as menacing.

Yes, the NHS is under pressure as never before. No, no one really understands the upsurge in demand. No, there are not enough trained, experienced staff; safe staffing initiatives are a conspiratorial farrago to obfuscate the blindingly obvious. Yes, the system is silting up; social services can't cope and yes the ambulance service is redefining urgent.

The problems are beyond the power of money to fix, or the DH press office to polish-up, bright-side out.

These pressures are exposing a very ugly side of the Service. I think there is corrosive, institutionalised bullying that comes right from the top and I am not alone in that view.

Moreover, I have now had first-hand testimony of confrontations: managers dragged before panels at a day or two's notice to account for 'failures' to meet waiting targets; hectored, bullied, abused and reduced to tears. There was a time when Chief Executives were treated with respect. Now, they are treated like criminals.

Bullies are usually managed by bullies; desperate to deliver the undeliverable they become overwhelmed by their tasks, resort to strangulating, line-by-line bureaucracy, become shrill and turn to bullying for results.  When managers don't allow failures the result is people hide them and that can turn danger signs into real-time disasters.

I'm hearing system resilience meetings; the 3 Blind Mice, (again) and ADASS are little more than Star-Chambers. The whole tone, captured on page 5 (3rd Para); "There can be no trade-off between finance and performance". Oh really! Then explain the �700m bung to keep A&E 'performing'. Read the rest of the 29 pages and weep.  

The NHS sits on a compost of targets, templates, deadlines and goals; putrescing into intimidation and harassment.

Bullies become bullies because they get away with it; because they have no other techniques. Lack of skills, insight, insecurity and incompetence turns bad bosses into bully-bosses. They think Attila-the-Hun got things done, Ghengis Khan went places and the geezer on the telly, who humiliates and fires people, is the way to run a business. It's not. It's entertainment for dummies who will never get near a boardroom.

Invariably a bully boss has a bully of a boss. When political targets and policies, invented in Whitehall, become undeliverable at the coalface, it all kicks off. The bust-a-gut managers step in and bust a few guts.

We have to reconcile ourselves to the fact that management-by-intimidation has got us deeper into debt, behind on targets with most Trusts tanged up with the Flat-Earthers or the 3 Blind-Mice... delivering a system that is grinding to a halt.

We have to find a better way to work together; listen, learn, share what works and get everyone doing it, urgently.

There are ugly tensions that need reconciliation; a fresh start, a new style of management. The 5 Year Forward View won't last five minutes without enthusiastic people working together, unafraid of risk or failure, in the pursuit of something better... shared struggle and united in achievement.

Conversations that start with; 'I know you have a problem and that gives me a problem, so how can we help each other...'  Conversations that end with; 'I know you are under pressure to deliver this but intimidating me isn't going to help, we need to do this together'.

I agree with the Queen and the Duchess; in 2015 reaching out to each other makes a lot of sense.

Enjoy the New Year celebrations; if you are working, thank you and take care of each other.

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What's the future for primary care?

If you want to know, too, join me, the NHSE Primary care Tsar and Deputy Medical Director Mike Bewick, leading GP Dr Clare Gerada and the president of the NAPC and former policy advisor Dr James Kingsland, at the Kings Fund for a night of

 The Big Conversation about Primary Care. 

  Details here. 

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