22nd June 2015

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News and Comment from Roy Lilley

There are two NHS jobs no one wants. They should be the most fought for and high end, desirable jobs you could strive for. But, no one wants them.


Across the divide of health care, they are poles apart. They are as different as chalk and cheese. Both are crushed by regulation, short-termism, exposure, pressures and have become 'undoable'.


The jobs? One, chief executive of a Trust. The other, a GP. Both jobs can be hugely rewarding but these days neither are worth a carrot.


The average tenure of a Trust boss is just over two years. Faced with ludicrous regulatory demands, overwhelming pressure on services, a crisis in recruitment, more targets than a fair ground and trying to run on money vapour, not the high-octane needed, it's become a job for a carpetbagger-interim.


GPs? They are cursed with the same problems; not enough of them, unfathomable demand, impossible regulations and all the rest. It's become a job for a drive-by locum.


Both jobs are targets for the press, vulnerable to the latest potty idea from the politicians and the focus for anyone who thinks they know best.


Two reports emerged last week, each, in their own way, trying to tackle the issues. The first from Bob the Builder & Co at UCLH; The Future of Leadership. In the early pages it is beautifully crafted, excellently presented and a masterpiece in the summation of history and analysis of the problem of getting top managers into the top jobs.


However, by about page five (of 12) it meanders off into an undergrowth of social media, collaborative behaviours, 5YFV, St David Dalton and the rejection of the notion of a 'chief patient officer' (?).


By page 7 they get around to the predictable; bonfire of the regulations, a shake-up in inspection and Trust takeovers, chains and what-not. I guess if you have a big desk and run a Trust the temptation is to get a bigger desk and run two Trusts. They forget; big is the enemy of good.  Nevertheless, Naylor is circling his prey


There are 11 recommendations that I can't see being implemented.  It's the usual case of; they came, they saw, they wrote and nothing happened.


There is a final observation on page 11 that I must be too thick to understand. See what you make of it. There is nothing in the report that would inspire me to run a Trust.


The other report is more of an announcement; The New Deal for GPs. A 10m 'turnaround programme'. That's about 1,100 per practice, or if you wanted to be really sniffy; 30p a patient. In exchange LaLite says he will be; "...increasing the primary care workforce by 10,000, golden hellos to attract GPs to areas of 'greatest need' and a national marketing campaign to promote general practice..."


Oh, and more regulation, a GP 'outcomes score-card'... to be developed by the Health Foundation and the CQC. The link being the Fragrant Jennifer who is the boss of the HF and on the Board of the CQC. Mmmm..... not sure I saw the contract go out to tender? 


None of the above will solve anything. They are just two wonderful jobs made hell by meddling.


LaLite's problem; he has only 2 levers to pull.

  • Bungs; there is precious little money.
  • Bashing; new regulations, score cards and measurements.

Pulling the levers makes it look like he is on-top of problems. However, he creates expectations that cannot be met, the problems stay with him and he is obliged to pull the levers again... and again... and again.  Ending up with derisory money, more regulation... everyone groans and learns to ignore him.


Jennifer should know better than to get involved in more bashing, she does quite enough of it at the CQC.


This is old fashioned management. Peter Drucker pointed out, as far back as the mid-80's, it doesn't work. Mechanistic paradigms, hierarchical command and control mind-set, bureaucratic processes and standardisation. Ugh!


LaLite needs to learn a new trick; 'management by letting go'. Building an environment of trust, transparency, motivation, responsibility, cultural diversity, fairness, customer orientation, and collaboration.


He needs to say; we all share the same ambition, we all want what's right and we know there's no money. So, go away and do your best. I'll dump regulation. Let's talk once a month. You can show me how you're getting on and tell me what I can do to help.


This'll take courage but it will be rewarded with innovation, engagement, passion, autonomy and he will get power back because he becomes the facilitator, not the puller of levers. 


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