It’s still raining

I often say that complaining about regulation is like complaining about the rain. We all complain about the rain, whilst unconsciously recognising the essential nature of what it brings to our green and pleasant land. Until recently, I felt much the same about regulation. Like the weather, it had begun to get out of hand and there was a lot of it – but was still a fundamental good. This remains the case – but a lot will need to be done to restore confidence.

In my weekly blog for staff, I have reinforced that the events at the Care Quality Commission this week are shocking and should be a surprise. Some people fall into the trap of allowing themselves a disappointed shrug and a shake of the head, not pushing back on the commentators and cynics who take as a default that leaders have the wrong values and that we shouldn’t be surprised. My view is that we need a system where we should be shocked, be surprised and demand that this isn’t how it should be.

So, for my staff I have used this as another reminder to us all about the importance of culture and values based leadership. The report into what happened at Morecambe Bay Trust has been widely reported in the media – you can read the CQC statement and access the report here via the CQC website

Two quotes to highlight from the CQC statement  on the day –

  • Firstly: “the example of how an internal report was dealt with is evidence of a failure of leadership within CQC and a dysfunctional relationship between the executive and the board. There is evidence of a defensive, reactive and insular culture that resulted in behaviour that should never have happened”. 

The new Chair of the CQC was on Radio 5 Live talking openly and plainly about the culture and the way that the Board had set the tone previously. He stated that “the fish rots from the head” in describing the allegations of how the deletion of a critical report occurred. This is something that we are very aware of in LCH. Our Board sets the tone for the organisation and our focus on Values Based Leadership is essential.

  • Secondly:We are changing the culture of the organisation. The commissioning and publication of this report symbolises the approach we are taking and will continue to take. We are determined CQC will be an open and transparent organisation.  

The new leadership of CQC have faced huge criticism and challenge. I hope they are successful and meet their ambitions. They will need recognition and support that good people who have inherited a bad situation are not bad people. They are the ones who do some of the toughest jobs around. People like David Behan deserve our support.

This news has dominated the headlines. It reinforces one of the things highlighted in the Francis report and something that I believe passionately – we in our organisations are accountable for quality and must not rely on external assurance. It is for us to lead the culture of the organisation – one that lives its values.

The consequences of not doing so are real. My heart goes out to James Titcombe and the other families affected. As does my admiration for their resilience and dignity.

So, my exhortation to my staff in our weekly message has been another call to remember our values –

  • we are open and honest and do what we say we will;
  • we treat everyone as an individual;
  • we are always listening learning and improving.

I hope these values feel real to my people – they do to me. New Year’s Resolution was that 2013 would be tough and I would stick to my values. Nothing’s changed – patients still need good, safe care….and as I look out of the window, it’s still raining.”

The smallest thing, the biggest difference

I walked into the meeting room, a number of city partners with me, waiting for the arrival of some leading figures from the national voluntary sector movement. Two colleagues were still in the room. I smiled at them and motioned for them to leave so we could prepare for the next meeting. I had just triggered an event that reminded me of the importance of my impact as a Chief Executive, as well as providing the biggest cultural signifier in a big week for leadership…..I didn’t have a clue (all is revealed at the end of this blog)

In many ways, last week was an exemplary week for leadership in the NHS. It was also a week that provided a number of pieces of evidence that leadership in my trust and the city is changing.

Much of the national debate has centred around the statements made at the NHS Confederation Conference. One of the prevailing themes of the conference was the importance of effective leadership in driving service change. Another was the role of leaders in driving effective cultural change in the wake of the Francis Inquiry. Uniting both was a strong message about values based leadership. For those who know me, or who have read this blog, these messages are music to my ears. The development of a prevailing culture of leadership that empowers and values staff to benefit patients is a dream of mine.

Watch key speakers and sessions from our conference again

Mike Farrar at annual conference 2013Jeremy Hunt

This will be essential if we are to tackle the issues set out in key note speeches by Mike Farrar, Jeremy Hunt and David Nicholson. Points included a very real future of hospital closures and radical service reconfiguration and the need to balance this with optimism and confidence. Delivering A&E improvents across a system that delivers better care for older people with new strategies. A ten year strategy that prevents managed decline for services through a big conversation and self care as the norm. Technology as an enabler and tool, underpinned bytransparency and information.

The latter point was exemplified by the launch of #NHSEngage – a guide for Chief Executives. This is something I personally want to see adopted at scale  and am delighted to champion. Share it with your CEO!

NHS Leaders with #NHSEngage sign, launching social media briefing

Back in the trust and across Leeds, there were other examples of a change in Leadership and mood. Some requiring more work, others signalling movements in the right direction. On Tuesday, I spoke at an event set up by the managerial and clinical leads in our Health Visiting service to celebrate the brillinat work they have been doing on “A Call to Action”.  This includes a strong partnership with Leeds City Council on integrated Early Start teams and services as part of our Child Friendly City initiative. This hasn’t always been an easy ride. The best things about the meeting were the honesty of the debate and the response to the question – “Are you a leader”. I wasn’t expecting the response – nearly every card held up was Green for “yes”. As an organisation that promotes “leading from every seat”, this felt a shift.
Leadership- sea of green 4.6.13
That afternoon, I received my 360 degree feedback from staff and partners. I had responses from over 40 people across the system and at all levels in my organisation. The feedback from them matched my self assessment – I know my faults! – which is my first test of these things “Am I self Aware?”. The feedback gave me further impetus to improve where I am strong and address my weaknesses too.
The following day, the system leaders in Leeds met to discuss how we work together and how we plan for the future, building on our strnegths in partnership and recognising new faces and actors around the table. There was a degree of openness and honesty about the changes we still need to make that gives me some hope as well as an understanding of what needed to be done. Even better was the following meeting on transformation,with an emphasis on the good work we have done on integrating health and social care  
At the NHS Confederation Conference, I was fortunate to be asked to speak at the session on a Whole System Response to FrancisMy main themes focused on culture, values based leadership and great governance, allied to a new role for members. My opening point? How did Francis make you feel? “Angry”, “Upset”. “Disappointed”, “Ashamed”, “Guilty” were the responses.  Me too. And I have never been there, know no-one affected or involved….what power the NHS has over us all. Other industries would do almost anything to
strive for such a connection. Let’s use it….The response to the session and feedback was very positive. More affirmation for values based leadership.
On Friday, following a very good Board meeting, I shared a stage with the senior team as part of our team brief session. One of the slots was for our District Nursing Clinical and Managerial Leadership Team to talk through how they have begun to improve services, following issues around delivery. It was a proud moment to watch them articulate leadership that has seen them drive the capacity and demand plans, seen them innovate around how we use patient feedback to drive change in clinical behaviour, seen them explain how they had challenged poor leadership behaviours from “Mood Hoovers” leading teams.
My last meeting of the week, late on Friday.  One of the colleagues I had smiled at on the Monday and gestured to leave the meeting room asked to see me. As I basked in the glow of a brilliant week she told me about how I had made her feel worthless. 
She had experienced a bad morning, things had not been going well and I had turned up with a bunch of “important people”, gestured at the two of them to leave the room, “without even a smile, a word or a hello, how are you?” and made them feel worthless. Wow! It reminded me that the impact we intend does not matter. It is the impact felt that does. I apologised. I then thanked her for feeding back to my face and raising it with me. It stayed with me since. As a reflective person I have thought hard about what it means.
Clearly, it was the best bit of my week. Being reminded that leadership behaviours never stop. And the power of being in an organisation where a member of staff can confront the Chief Executive with negative feedback, safely and honestly.