20th November 2015

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Health Chat

1st December King's Fund 5.30pm

Janet Davis - New CEO and Gen Sec of the RCN

What is the future for nursing?

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Tickets here.

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News and Comment from Roy Lilley
The overwhelming outcome of the junior doctor's ballot, for strike action, plunges the NHS into the darkest of days.
The service will plan, stretch and fathom a way around the first strike; withdrawal of docs from everything but emergency cover. The subsequent days of a complete walk-out create a potential for a disaster that neither the BMA nor Jeremy Hunt will recover from.
The dispute highlights something missing in the NHS. I have watched it erode. Imperceptibly at first but now we are watching a full-scale corrosion.
What's missing? Trust.
Good management, bad management, indifferent management, we can struggle-by with any of it but when 'trust' is gone the whole foundation of management is undermined.
Trust is a precious component. It takes years to build.
There are three key reasons why trust evaporates and the NHS has them in spades.
The first is how managers behave.
The NHS is a people centric, people powered organisation that, like no other, struggles with the basics. Bullying, whistleblowing and complaints. As pressures undermine service standards managers, facing failure, resort to strong-arm techniques; people who speak-out are still terrorised, end up losing their jobs and there is still no systematic way to analyse complaints and learn from them.
High turnover of senior managers, productivity at all costs... managers assuming they are trusted and take that belief for granted. The arrogance that said 'they'd never risk a strike'.
Is it any wonder staff don't trust management.
The second, communication.
Disingenuous, hypocritical, misleading communication. The worse culprit, the DH press office. Time and time again we see stories of services struggling and the best we get from them is 'we expect services to work within their means'... or 'the NHS has had more money, blah, blah....'  
I know how much that infuriates the NHS. I have an in-box to prove it. Ambiguity, weasel words, dissembling, economical with the truth. Negotiate without precondition or not, or what?
Is it any wonder the staff don't trust the management.
The third, the money thing.
As the NHS faces mounting pressure staff will be asked to do things to services and colleagues that they, instinctively, would rather not do. With the exception of the surgeons, no one comes to work to 'cut'. Where it is 'done-to' and not 'done-with', trust evaporates. Inclusive, 'no-surprises management' is a rare skill.  
We have to take tough decisions but when managers acquire the God and Moses syndrome and decisions are handed down, trust becomes a memory. Do the Docs get more money, less money, or the same? Even the ready reckoner didn't seem to tell us.
Is it any wonder trust in management disappears?
Preserving trust is the number one priority. If managers are not transparent, realistic in their expectations and communications, fail to support staff troubled by events and bring a reality check to work, every day; don't be surprised to see trust dissolve.
Trust is management glue, it holds relationships together, underpins communication; banked in the good times and drawn upon in the bad. To be trusted is the greatest compliment a manager can have.
To trust someone is to acknowledge our own vulnerability, we put our future in their hands. To let someone know that you trust them places on them the greatest responsibility of all. When a large portion of the day is centred on the lack of trust which, in turn, breeds rumour and gossip, the rot sets in.
You can't be careless with trust. The Doc's dispute is a collapse in trust. It's a train crash that will damage every part of the NHS; polarise it, divide it and stain its reputation for years.
A strike could mark the careers of a generation of Jnr Doctors and destroy the careers of Jeremy Hunt and Mark Porter. The pubic will never forgive an incident or, heaven forbid, a death, attributable to a row over pay and rations.
The strike will only be resolved when both sides decide to trust each other. When they say;
'I will put behind me past arguments, draw a line and I trust you to want a resolution as much as we do... let's talk',
...we will make progress.
That will take another rare characteristic... courage.
Have a good weekend. 

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1st December
King's Fund 5.30pm 
Janet Davies
New boss at the RCN
King's Fund 1st December 5.30 pm.
20 Bursary tickets for RCN members - see yellow panel at the top of the page for details.
19th November
King's Fund 5.30pm
Lord Hunt
Labour's Health Leader in the Lords.
This will be an absorbing evening of politics, policy and no few insider secrets (we hope).  In conversation with Roy Lilley; come and hear from the heart of Westminster.
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>>  I'm hearing - very little discussion on the Devolution Bill making its way through Parliament.  Given its power to redesign services I would have thought the great and the good would be making more comment.  There is a very good up-sum article here, from Mark Dayan, one of the Nuffs.
>>  I'm hearing - frenetic work going on between DH and the Carbuncle to shuffle budgets to avoid a year end overshoot of the DEL.  Primary care have a predicted 45m underspend which will be snatched to bail out secondary care. 
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