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1st Septembert 2016
3

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HealthChat
Ed Smith
Chair of Not-Monitor, or whatever it's called.  In conversation with Roy L
Good conversation, networking and a glass of wine.  Lots to talk about now the STP s are ding their thing.
This will be a full house.  
If you are intending to come, get your tickets organised!.  A few left.
Learning into action 
News and Comment from Roy Lilley
The final steps in the dance macabre at Southern Health were played out on Tuesday; the chief executive stepped down.
 
For the relatives, who have lost loved ones, it won't have come a moment too soon.  The fact that the executive is being moved, sideways, into another highly paid NHS job, will add insult to injury.  The relatives are unlikely, ever, to be satisfied.
 
The events at Southern, one of the biggest Trusts of its kind, have been well rehearsed and mulled over elsewhere.  There is no closure and an institutional sorry will never be enough.
 
There is, however, a wider issue.  An issue that occupies the thoughts of senior NHS management.  An issue few people are prepared to address.
 
When things go badly wrong in an organisation the Chief Executive is responsible, of course but are they culpable?
 
The distance between the Board and the ward... is it a conduit of conversation and communication or is it a fog of competing messages, confusion and complexity.
 
Running a big organisation is simple enough.  Divide the patient facing services into clinical directorates, find enthusiastic, capable clinicians to run them, make them autonomous, with clear lines plugged into the bosses office.
 
Make reporting easy, commentary informal and face to face contact through open doors.  Make it clear there is no sin in getting something wrong; the sin is not knowing something is wrong, or covering up what is wrong.
 
It's all very easy until a rogue manager makes a foul up and for fear of the regulator, doesn't tell.  Or, an incident on a ward goes unreported.  Until a complaint is fobbed off or left to fester.  Until reporting mechanisms fail, are not followed or are inadequate.
 
At what point is the chief executive culpable?
 
The chief executive is answerable for the performance of the organisation, accountable both legally and politically.  Is the chief executive also culpable in the sense of meriting blame or censure, especially for, say, a serious incident that might have taken place on the other side of the campus, on a day the chief executive was not even present?
 
A parent is responsible for its child but is it culpable if the child steals from a shop, or stabs a school-mate?
 
What of the Board, whose role it is to hold the chief executive to account.  Commonly, when an incident occurs the Board will try to summon resilience and stability to see the organisation through the crisis.  The next step might be to protect the organisation through, if not denial, mealy mouthed statements.
 
If the Board shares a set of common values that are focused on the best interests of the public... an altogether different response might be expected.  However, they will still be working in the shadow of lawyers and journalists.
 
If a front-line employee makes a mistake, responsibility for redress lies with the employer, who is not culpable.  If you drive your car and skid on ice, into my car, you are responsible but not culpable, unless you were reckless.
 
If a hospital has tried its honest best to recruit adequate staff, they are responsible for rota gaps but not culpable for the fact there are too few nurses or doctors in the workforce or training places are underfunded.  Therefore it is facile for the CQC to describe an understaffed facility as badly run or lacking leadership.
 
On the other hand, if the absence of staff is known to make the unit unsafe the chief executive and the Board may be morally culpable if the service is left running and an incident occurs.  They could have understood the implications of their actions.

Which is why Stafford made the right decision to close and understaffed paediatric A&E.
 
The pressures of leadership, the regulatory environment, a prurient press combine to move the role of the boss towards making it a crime to be in charge.
 
When things go wrong is it enough for the Chef Executive to say this is terrible, we are sorry and I'm going to make, for certain, it can never happen again on my watch.  Or, do they say, 'this happened on my watch, I'm leaving'.
 
If Boards have faith in their senior management they have to trust them in a time of crisis.  Chasing culprits doesn't help the organisation or the victims.
 
We can't stop running hospitals because we can't foresee everything.  All we can promise is to share our learning and support the people who will turn the learning into action.
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Know something I don't - email me in confidence.
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The Vanguard Method
Beyond Budgeting
One day learning conference that will be worth every penny, from the only consultancy that has fans!
Details 
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HealthChat
26th Sept Kings Fund  5.30pm.
Ed Smith 
Chair of Not-Monitor 
(I must find out what they are called!)
Great evening in prospect.  He has a huge experience and a raconteur 
Plus the usual wine and networking. 
Tickets here
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Obsession with Activity must end
Report of conference speech from 
Hamish Dibley
Interesting take 
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Gossip
shh
This is what I'm hearing;
if you know different,
tell me here
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>>  I'm hearing - that some local authorities are less than enthusiastic about their STP plans.  There is very little money in any of it for them and a big row with their electorates.
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