Leadership – My “No Excuses” Role Model

Adam Bojelian was a remarkable person. That was clear for everyone who attended the celebration of his life in Tadcaster yesterday. The celebration was a perfect reminder of the beauty of his poetry – cousin Lara reading The Green Fish was a personal highlight – and the tributes came from across the globe for someone who touched the hearts of many with his can do attitude. A fifteen year old boy who wrote poetry by blinking and captured the imagination of anyone he came across.

Celebration

Adam was a “No Excuses” role model. The photographer Paul Clarke read “My Creation Myth” and prefaced it with this statement – so simple and true. Adam had every reason to not do his homework, be bitter about life or let his challenges get him down. Instead he approached life with glee, never making excuses. For him “every colour was perfectly placed”. And a duff joke or two was always at hand.

Alongside people like Lara and Paul, I was privileged to be asked to be one of the 15 people to read one of Adam’s poems and say a few words. The poem was Leadership – something I commissioned for the NHS Confederation Conference in 2014. I needed something to set the tone for the whole of the leadership in the NHS and Adam responded brilliantly. He gave us something that defined good leadership and challenged our perceptions about the potential of people.

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I read the poem and new that it was right, it was wise and it was clever. A challenge to the reader to be a better leader. It was exactly what was needed and I shared it on Twitter. It was read and retweeted widely. Some time later, someone pointed out that the poem’s puzzle had been solved. It was not just a challenge to the reader but also spelled my name down its spine. I had missed this completely and it was something I won’t forget – one of those moments that catches you inside and is truly humbling and a personal challenge to me to be a good leader too.

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Subsequently the poem has had a life of its own. It was a wow at the Confederation Conference receiving spontaneous applause from around 1,000 delegates. The Leadership Academy have used it in their work. NHS Employers have used it in their Equality and Diversity work. It is shared widely. It is a gift that keeps on giving.

Maybe one day I will be as good as the leader it challenges me to be. What is clear is that Adam was a leader and a role model. And I wanted to give a gift to Adsthepoet and his family in return. So here it is – the poem I wrote for Adsthepoet to celebrate his leadership – my no excuses role model:

Leadership (For Adam Bojelian) 

I

This rhyme solves a puzzle, as you will see

This rhyme confirms what a good leader should be

 

A good leader aspires to be the best

A good leader debates and challenges the rest

A good leader speaks up against poor care and injustice

A good leader teaches us to cast off our prejudice

A good leader helps us to see the funny side

A good leader engages and shares what’s inside

A good leader puns (I know it’s not quite a requirement)

A good leader is open to risk and excitement

A good leader energises all that they touch

A good leader transmits our dreams back to us

 

Now, this poetic trick has been played before

Look closely and you’ll know whose name is worn

At the heart of this poem

 

II

No surprises this time

No poetic reveal

Yet the power of art

Weaves a subtler knife through our hearts

The echoes of good leadership last forever

They beat its rhythm for a lifetime

Listen carefully to yours

What do you hear now in its pulse?

Adam, Adam, Adam, Adam

 

If you think this is sad and solemn, it’s not meant to be. Kirstie Stott ended the celebration with the poem happiness. Perfect. As was her wordle of the three words Adams’ twitter friends had provided her with. Her choice was for her boys to “be like him”.

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5 Minutes to slay a dragon

It took me 10 years to write about the suicide of my brother  – the piece I wrote in 2013 is here and is called Saying Yes to Life Despite Everything. Writing the piece was cathartic for me and the response has been humbling. The blog has been re-blogged, read and shared widely. Friends, colleagues and strangers have shared their stories about suicide publicly in response to it. Comfort has been found in shared experience and perhaps a little hope.

I wrote the piece as part of my pledge to the Time to Change campaign. Approached at the NHS Values summit in 2012, I said I would talk more about how mental health issues had affected my family. It is a pledge I have stuck to personally and professionally since.

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Except…..I have never felt able to tell my kids how their uncle died. The stigma, shame and the stain of suicide felt like something I couldn’t put on their tender shoulders. If the subject came up, vague talk of “an accident” sufficed. The tragedy of Phil’s death remained hidden.

In medieval times cartographers denoted dangerous or unexplored territories by putting sea serpents and other mythological creatures on uncharted areas of maps. Over the years, the omission of how Phil died has gnawed away at me and the prospective conversation with my children has appeared on the map of my life with the phrase “Here be dragons” firmly painted over it.  The low heft of dread has dragged through the years and the conversation has reached epic proportions in my mind.

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I don’t believe in dragons or mythology or fate. I do understand fear. Fear of the unknown and fear of consequences. The irrational white noise that prepares your fight or flight responses and subjugates logic. And just as I have learned suicide is often a consequence of a loss of hope and of feeling helpless, I now know stigma is driven by fear. To end stigma we need to face our fears.

The “Take 5” minutes to talk about mental health campaign is a small positive step in ending the discrimination and stigma around mental health. It provides the permission and support to enter unchartered territory. It will be written off by the cyber-cynics as a fad, a #hashtag badge for the worthy or a promotional campaign. It will also save lives and continue a conversation that we must have if we are to map the world we live in for the 21st Century.

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I had signed up to support the campaign on twitter a couple of days ago. I added a twibbon – something i have never done before – and promised myself I would have a chat. I didn’t plan it but left it to emerge.

“How did uncle Phil die” asked my son George today. “Was it cancer? A heart attack?”. We were sitting in a wake and I said I would talk to him about it later. I resolved to use my 5 minutes wisely. Over dinner the subject of Clarke Carlisle came up. Lauren, 12, had heard the story on the radio. We talked about what happens when people become depressed. We talked about losing hope. We talked about mental health. We talked about Phil.

George, 14, looked me in the eye, reached over, squeezed my hand and smiled at me. Questions and answers flowed. The dread sank to the bottom of the ocean. The fear evaporated. The dragon slipped away.

I want to thank Time To Change. It works one person at a time and one conversation at a time. Today it gave me the tools I needed to slay a dragon. It only took 5 minutes. The impact will last a lifetime.

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It’s a Wonderful Life

Every year at Christmas, the beautiful, 100 year old Hyde Park Picture House shows Frank Capra’s It’s a Wonderful Life. It’s a Christmas staple that many of us will watch on TV too. The film stars James Stewart  as George Bailey , a man who sacrifices his own needs in order to help others and whose imminent suicide on Christmas Eve  brings about the intervention of his Guardian Angel, Clarence. Clarence shows George all the lives he has touched and how different life in his community of Bedford Falls would be had he never been born. Its life affirming conclusion where the townspeople rally around George to keep him from prison is so powerful it should be available on prescription.

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It would be easy for people in the NHS to feel like George in 2014. In bleaker moments, we can point to a bleak environment. There has been a constant stream of negative press – it is now open season on what the Commonwealth Fund decided was the best healthcare system in the world. So much so, that the real issues can get crowded out. Recent press activity now includes saying the opposite of what is true – this week’s example 4 out of 5 new nurses are from overseas [wrong! Facts here…]. Industrial dispute puts people who work in the NHS against the people who pay for it. We are facing the biggest activity surge and the biggest pressure on services in my career, with staff working tirelessly to deliver great care being kicked about like a political football. On some days, my social media feed often looks less like a conversation and more like a mob, with attacks on “NHS managers”, unpleasant trolling, doctored pictures that show me as Hitler and people behaving in pretty despicable ways to each other. Most NHS leaders and the people who work in the service are pretty resilient. But there have been moments when many of us will have wondered what it was all for….

Fortunately, the NHS’ Guardian Angel came to the NHS Confederation/NHS Employers last week to remind us how the NHS touches all of our lives. The occasion was #AdsParty . It was one of those days – the special days that touch us deeply and we never forget.

Adam Bojelian is a 14 year old poet, Brit Award winner and long term patient at Leeds teaching Hospitals Trust. He communicates his wisdom and wit through blinking. The party was a tweetmeet and celebration of Adam, inspired by Kirtie Stott and Vanessa Garrity from New Healthcare Voices and put together by the fantastic team at NHS Employers of Danni, Sam, Johnno and Andrew. The idea was simple, get Adam and his family together with all of the people he inspires through social media, throw in a bit of food and celebrate Christmas. The execution of the idea showed me why we must never take for granted that the NHS is made of people – give them the headroom and they will always exceed what you expect.

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In dark moments, I will always be able to conjure up the scene, with my own version of the guardian angel Clarence whispering in my ear about….

A set of elves doling out mulled apple juice as they greet us, the Horizons team setting the tone and supported by Ronnie the Rhino – reminding us of the great work the Leeds Rugby Foundation does in healthcare and how communities matter, place matters.

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The ward and nursing team supporting Adam talking about how tough things are and also how much they love what they do. They have a renewed sense of connection between them and the Trust Board under Julian Hartley’s leadership. I was reminded of Dean Royles’ work and the piece on HSJ about the Trust’s focus on the personal, fuelled by technology.

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New leaders emerging in the shape of New HC Voices, with Kirstie and Vanessa’s amazing group augmented by award winners and front-line heroes Sarah Searz, Joan Laplanas, Thomas Shahanan, John Walsh – “real people” doing “real” jobs epitomising a value based approach and wanting to change the world.

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Kate Granger, taking time out from being a new consultant to come and meet Adam. She has already changed the world through #Hellomynameis, demonstrating the power of an idea and a personal story that connect us all.

Films like these and these from Twitter pals who could not be there demonstrating the impact that Adam has had on them, from Chief Executives to graduate trainees, international improvement icons to nurses to OTs – and everyone in between.  Our very own Paul Deemer, was inspired to verse and NHS Employers’ staff duly obliged with their rendition of “Would You Adam and Eve It”

While the virtual log fire flickered, Kay Mellor the actress, director and author recited Christmas Gibbons and we all laughed at the reality that it isn’t the reindeer but the gibbons that do the deliveries at Christmas.

The Quarry House Choir from the Department of Health, NHS England and DWP singing “Walking in the Air”, one of Adam’s favourites. The assembled crowd look on, connected in the moment.

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And above all, the inspiration for the whole thing – Adam and his parents, Paul and Zoe and their family and friends. The team starts here in the service. The patient who always has assets to share. The parents who have expertise. The families who support each and every day.

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So next time things get bleak and things get tough, I will remind myself that we have a good set of strategies in the NHS with 5 Year Forward View and its ilk. We have a commitment to more resources. And above all, we have the people who can always exceed your expectations. Forget the HSJ100, Debrett’s and Who’s Who. The NHS is made of people – just like me and you and Adam.

It’s a wonderful life. Happy Christmas!

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It’s not all Cardigans and Charity Shops Y’Know!

I was in Oldham recently. I was really taken by the experiences of the system in Oldham and Ashton when I visited Pennine Care and Michael McCourt’s team. Their Living Well Academy and work on Carers and coproduction around long term conditions is right in line with the future needs of the NHS – building capacity by aligning the efforts of the “team” that is already in place. With over 6 million people designated as “carers” and almost a million carers aged 65 plus, this has huge potential.

Pennine

Oldham’s experiences of recent commissioning decisions is also indicative of the future. They were successful in bidding for new models of care for all of their community services in a partnership with all of the local GPs, the local authority and the local AgeUK team. True collaboration, aiming to bring integrated services through working together – not structural reform.

Both of these developments are good, but I wanted to share a story from the excellent CEO of Oldham Age UK Yvonne Lee.

Yvonne

Yvonne told me of their impressive array of services – from equipment and adaptations to befriending and direct patient care. She then told how 3 prospective partners had come to visit her. After 20 minutes they explained that they needed to go and put more change in the car parking meter. They had only paid for half an hour and two of them disappeared to sort this out. Their colleague leaned over and said

“They got you wrong love. They thought they wouldn’t be here long and were coming to see an old woman in a cardigan in a charity shop”.

Our understanding of the role of the not for profit sector in the NHS is improving – if not quite there yet . We need to exploit the potential fully. Because the sector is clearly part of the integrated team that sits around the families that we work with, the ones who will never be discharged from our care.

That has been my experience in my life as a carer – and it probably is in many of yours too. When George was born with Down Syndrome and we had a thousand questions about the future.

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The wise consultant at the hospital said – “just wait, Marjorie from Leeds Mencap is coming in to see you tomorrow. She will help answer anything you want to know.” They were right. A partnership was born that saw us supported in George’s physical, emotional, educational and social needs across his whole lifetime. From using Makaton as his first language skill, through portage, peer support, speech therapy, school inclusion and right through to dancing at the West Yorkshire Playhouse and beyond. Alongside many others – Bradford Down Sydrome Support Service, SNAPs, Down Syndrome Association, Me2, Down Syndrome Education International -they have played a critical part in making him who he is today.

They have done so with great kindness, skill and in line with an array of rules and regulations; a changing policy context and the toughest financial challenge for a generation. If this sounds familiar to NHS organisations, then it is. And what an opprtunity to embrace the contribution of carers and this sector in dealing with a shared endeavour and the biggest challenge for a generation.

 

All means all – now prove it!

“All”. It is such a small word. Three characters, only two different letters. Yet it carries an immense power and sits at the heart of the first of the Bevan principles from 1948.

ConstitutionThe NHS “meets the needs of everyone”. This has subsequently been updated as one of the seven principles of the NHS Constitution. The first principle there is “The NHS Provides a Comprehensive Service Available to All”. In fact, the NHS constitution has a subtitle.

I was asked to attend the NHS Leadership Academy’s recent Top Leaders programme semester on Equality and Diversity in the NHS to talk about my experiences as a Chief Executive in the NHS. As a former commissioning CEO and a provider trust CEO I wanted to give a perspective on a topic that is very dear to me. Because any serious look at the experiences of people and the profile of staff at senior levels shows that in many places we are making progress, but we are not succeeding in dealing with issues that can still shock as well as surprise.

My presentation is available here. I won’t use this blog to repeat the issues that I set out or the key points in the slides. As ever with me, a blend of values based leadership, visible system leadership, engagement, partnership, structure and systematic approaches to tackle issues hopefully comes through.

 

I will focus on two quick things.

Firstly, this agenda is fundamental to every organisation and person involved in healthcare. I could make the ethical case. Or talk about the effectiveness case. Both are etched in my soul and my brain respectively. Others on the day did this brilliantly (Michael West and Roger Kline for example). Oddly for me, I will stick to the rules that frame us. There are only four common fixed points for every NHS organisation – regulator, commissioner, provider, department – they are:

  • The NHS Constitution, Values and Principles
  • The Quality Frameworks
  • The Equality Duty
  • The Finances

If this isn’t an agenda of Equality and Diversity, then what is? I could couch this as:

“Deliver a comprehensive service available to all; that achieves the quality standards expected; in ways that reflect equality and diversity in your services and workforce; hence securing best value for the finances available.”

We are not there yet and have a long way to go. Avoidable deaths for people with a learning disability? BME staff experiences of development and career progression? Access to early diagnosis and treatment of CVD for people in deprived areas? All negative indicators of a need to better design services with people to overcome barriers to care. Let’s ban the idea that people are “hard to reach” while we are at it. We have just not designed services in ways they can access.

Secondly, the need for visible leadership. You will see I have a picture of the very senior NHS Leadership team in my presentation. This has changed recently, Mike Farrar has been replaced by me. David Nicholson by Simon Stevens. The question I pose is “What’s wrong with this picture”. The answer is obvious isn’t it? What I said instead was that there was a lot right because the motives and explicit intentions of the white, male, senior leaders were to focus on this agenda.

“Yes, but how would I know?” Came a question from a participant.

I have thought a lot about the answer to this question since.

We will all only really know when visible leadership of this agenda begins to make a genuine difference. When Roger Kline’s “snowy white peaks” begin to melt and when shocking figures relating to inequalities become a genuine surprise.

There is reason for hope. There are great examples of fantastic work across the NHS. Ally this to a resurgence in commissioning for inequalities and quality; and a provider regime that is accountable to its public through membership that is representative; then we may get there. With future leaders that are more diverse being championed by the very people who they will replace, we have a great chance to ensure that all really does mean all in a 21st Century NHS.

Reblogged from a post for TheNHS leadership Academy – Thanks

Good leadership is all about giving power away

One of my friends died last week. He was a truly unique individual. The Crematorium had to rig up speakers outside for the mourners who could not fit inside the building. It seemed everyone in the town new him and had turned out to celebrate his life. They all said the same thing – he would do anyone a favour, was always positive and was constantly giving. Nothing flashy just lifts for friends, a slab of millionaire’s shortbread or tray of cakes miraculously appearing as he dropped in to say hello, food for the homeless, chat (he could talk), musical tips, DVD box sets to borrow. Mostly what he gave people was his time and attention – all day, every day that he lived.

He seemed to me to embody something I learned when I visited the South Pacific almost twenty years ago. A real lesson about giving. I was in Rarotonga in the Cook Islands. One of the islanders was describing his wedding with great pride.

“It was the best wedding ever. We gave so much away!”.

Because in some island nations being rich is about how much you give to others, not what you keep for yourself.

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This came to mind as the Top 50 NHS CEOs was published on the same day as the funeral. This was part of a series of leadership pieces put on by the HSJ and sparked some debate about the nature of leadership. You can see what I think about leadership in blogs on this site – particularly “Some Things are Just Too Heavy for Superman to Lift”,Forget theJanitor at  NASA, Andy Makes People Better” and “The Smallest Thing, the Biggest Difference”

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At the heart of what I think about my leadership is a genuine sense that to be effective, I have to give away as much authority as I can, whilst retaining the accountability I hold. As an NHS CEO, that meant remaining personally accountable for the safety of every patient and the value of every penny, whilst giving staff authority to act and creating the right system of values so that we could be successful. This is not risk free. It takes time, trust, courage, resilience, a focus on purpose and a value based approach that engages all staff. [Yet another plug for Michael West’s work here]. The results are always surprising and unexpected – people tend to go further than you imagine and the impact can be spectacular.

Alongside the the list were pieces each day from some of our best Chief Executives. Reading the HSJ pieces by people like Dame Julie Moore, you can see that giving works. “Trust your staff”.

Compare this with people who retain tight hold of any power and authority they have. Leaders who hold positional power will lose it if their position changes. If they tell people what to do, that will be the best they ever get and few will ever achieve even that.

Some people fear that giving power and authority away denudes their personal store. My experience is the opposite. Some things are infinite or able to be self replicating – Dean Royles wrote powerfully about this last week. Compassion, he argued, is like love – you can’t give away every ounce of love you hold as it is inexhaustible.I think the same is also partly true for power and authority. Your influence and impact can grow the more you give away, enhancing your power and authority.

As I write this, I am reflecting that the one word that I would use to describe my friend now was that he was “good” in its truest sense.

I will be championing a style of leadership that is also “good”. One that is based on giving and is essential in a complex system like the NHS – one of delegated leadership that unlocks the potential of NHS staff by giving them authority to act, safe in the knowledge of where the accountability ultimately lies.

 

 

Larry the Downing St cat and “Keeping it real” for NHS Change Day

I walked down the familiar street, past the terraced houses towards a black front door. Armed police patrolled the area and onlookers gawped from their huddle behind a black iron railing. The familiar number 10 swung inward and away from me as I approached. I was greeted and ushered past Larry the cat – rescued from very different streets – and into the waiting room. I was back in Number 10 Downing Street for the second time in a week. As Chief Executive of the NHS Confederation, along with a group of others, I was here to discuss the mechanics of healthcare with policy advisors. As I walked up the stairs, past the portraits of every Prime Minister, I took in the surroundings of this world famous place.

Larry

Later, I sat thinking and promised myself two things…..

Firstly, that I will never take for granted the privilege of events like this. Larry was happy sleeping away his time but I know access to people with real power is a thing to be used well and for the benefit of everyone. In my new role this is as important as ever.

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Secondly, that my entry through this front door and the route into these meetings are for one purpose only. To ensure that the NHS can succeed and keep delivering care to people behind different doors, on different streets – the streets of your village, town, city or hamlet. The NHS needs to make changes at pace to keep up with societal change, demography, financial challenges and to retain trust around quality of care. How easy it would become to engage in an intellectual debate about structures, incentives, legal instruments, markets and economics and forget the purpose of the conversation – to ensure we deliver the best possible care.

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Two weeks from leaving my former role as Chief Executive of Leeds Community Healthcare NHS Trust, the memories of the patients I have seen, the homes I have visited is fresh. From proud dads of newborn babes to exhausted carers of dying people – birth to death, head to toe, mental and physical health of everyone, whether prisoners, the homeless, shelf stackers or millionaires. It doesn’t take much for me to recall the palpable joy or sadness, frustration or relief.

To ensure that it stays that way, I have made a pledge for NHS Change Day. My new job is a representative one that has the NHS at its heart. That requires ongoing visits to organisations across the country. But I will also repeat what I did as a front line Chief Executive and go “back to the floor” once a month with staff and patients at the front line of the NHS. I have always said if you want to understand something you should try to see for yourself.

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Getting out of my middle class bubble and into the real lives of staff and patients to see the impact we have is the most powerful incentive for success I know….and if you have the opportunity to be trusted to go behind the closed doors of other people’s lives, take it. You will be humbled, surprised, shocked and amazed by what you find the NHS achieves every day as well as seeing where things truly need to change.

Change day is on 3 March. You can pledge here.

The last post

I left my role as CEO of Leeds Community Healthcare NHS Trust today. This was my final message to Staff. Thanks to each and every one of them.

“This will be my last piece for Community Talk as I leave the Trust tomorrow (7 February) to take up my role as Chief Executive Officer (CEO) of the NHS Confederation. In that role it will be a real privilege to represent all NHS organisations – and particularly this one – on the national stage.

I was tidying up this week and I found the bullet points I wrote for my interview for this job in January 2011. As the trust was about to be created, I said there were four things to do:

  • Establish LCH as an organisation with a sustainable future and the right culture
  • Establish LCH as a credible and equal partner
  • Shaping the context we work in during tough times – influencing others to understand how important we are
  • Delivering high quality services every day

The first three were all essential to deliver the most important of those points – the last one, the reason why we exist.

I would love to write one of those triumphant pieces that said this was all delivered and everything is great. It would be very easy to talk only about the brilliant things we have achieved. That wouldn’t be a completely true reflection, and as someone who lives our values I know it is always important to be “open and honest and do what I say I will”.

So how are we doing? We are not an FT yet – but we do have a sustainable future and support across the city. A national integration pioneer and one of the pathfinders for children’s services. Award winning services and tenders and business won – through innovations like Traded Services in Speech and Language Therapy, the Musculo-Skeletal service winning the Any Qualified Provider bid and the new West Yorks Custody Suites. We have a good reputation too.

A culture that is built on values is essential. Our values are clear and in many places guiding every decision we take.  Our work on engagement is lauded nationally and internationally – and now that we have children on interview panels for paediatricians and old ladies interviewing nurses we will never go back. We have a good culture in the trust in many services. There is still work to do if we are to be truly led by staff who feel empowered to speak out safely, innovate and change in every service. This will be a critical piece of work in the coming months as the new Operations structure beds in. We have great staff and a real commitment to quality and change that drives improvement. Innovation is rife in many parts of the organisation and needs more support in others.

We are an equal partner in the City and have helped lead much of the system change – from vulnerable people to innovation to integrated care. The Council CEO describes our relationship as one that shows others how it is done. We have been very influential on national issues and locally too –through chairing national networks to showcasing our work to national figures. This work never stops as we work in the most difficult context for the NHS.

Most importantly, we have delivered services each and every day. Often this has transformed the lives and often it has simply made things a little better for people facing unimaginable issues. We have protected the health of people for the future and helped others in their last moments. Two million contacts a year, seven days a week, 24 hours a day – always aiming to deliver the best possible care. In some services this has been a test of capacity and resilience – where demand has been too high or the weather has conspired against us. In others it has been a period of change and transformation. All services have delivered efficiencies.

What has seen us through? All of this has been possible through you – only through you. I have been impressed and grateful for the daily examples of the passion, commitment, professionalism and guts that our staff show. On my back to the floor sessions I have witnessed the little miracles of kindness, compassion and care that take place behind closed doors every day in Leeds. All evidence that what we do matters and contrary to so much that has been written about the “culture of the NHS”. I have also seen the mistakes we have made and the impact when things go wrong for staff and for patients. Sitting with families who we have failed is a humbling experience and, thankfully, an infrequent one. We will always make mistakes – things go wrong – but we must continue to learn from them and minimise the risks. I have also seen corporate, admin and support staff working to external deadlines that can be punishing – making sure tenders go in, that plans are approved or that regulators are satisfied. Each of you is an important cog and every one of us plays a role in making a difference to people and the care they receive.

So, I know my successor will be lucky to be your Chief Executive. It has been my privilege and one I will carry with me always. Thank you for your support, hard work and the difference you make every day.

Rob”

The safety of every patient, the value of every penny

When I graduated in 1990, I went to work for the Department of Health as a professional statistician. One of my friends asked me:

 “What do you actually do all day? Do they give you some ‘rock-hard sums’ to do in the morning and you get to leave when you have finished them?”

I politely told him that it was a bit different than that (in the usual robust and Anglo-Saxon way that young men do). The job did entail doing a lot of “rock-hard sums” as I was arguing about multi-dimensional scaling and logarithmic regression models with the British Dental Association’s advisor. He was the president of the Royal Statistical Society and very kindly tolerated dealing with a young upstart 22-year-old me. I am sure he could have demolished me quickly in any debate – yet we agreed on a lot and he was supportive. Looking back, this was an early lesson for me in power and how to use it.

I was reminded of that this week. I have been asked about the day-to-day role of a Trust Chief Executive by Alex, a graduate trainee who was shadowing me, and a front-line colleague at the curry club. “So what do you actually do each day?”.

Here is what the rules say the role of the Chief Executive is in my Trust [adapted from national guidance and agreed by our Board]

As Chief Executive I will…
  • Be accountable to the chair and  to the board of directors directly.
  • All members of the management structure report either directly or indirectly, to the Chief Executive.
  • Run the trust’s business.
  • Be responsible for proposing  and developing the trust’s strategy and overall objectives.
  • Implement the decisions of the board of directors and its committees.
  • Provide information and support  to the board of directors and council of governors and ensure that board of directors’ decisions are implemented.
  • Facilitate and support effective joint working between the board of directors and council of governors.
  • Provide input to the board of  directors’ agenda from themselves and other members of the executive team.
  • Ensure the chair is aware of the important issues facing the trust and propose agendas which reflect these.
  • Ensure that the executive team provides reports to the board of directors which contain accurate, timely and clear information.
  • Ensure that they and the  executive team comply with the board of directors’ approved governance procedures.
  • Ensure that the chair is  alerted to forthcoming complex, contentious or sensitive issues affecting the trust.
  • Provide input on appropriate  changes to the schedule of matters reserved to the board of directors and committee terms of reference.
  • Support the chair in their tasks of facilitating effective contributions and sustaining constructive  relations between executive and non-executive members of the board of directors, elected and appointed members of the council of  governors and between the board of directors and the council of        governors.
  • Provide information and advice on succession planning to the chair, the nominations and remuneration  committee, and other members of the board of directors, particularly in        respect of executive directors.
  • If so appointed by the board of  directors, serve on any committee.
  • Lead the communication  programme with members and stakeholders.
  • Contribute to induction programmes for new directors and ensure that appropriate management time is made available for the process.
  • Ensure that the development needs of the executive directors and other senior management reporting  to him/her are identified and met.
  • Ensure the provision of appropriate development, training and information.
  • Ensure that performance reviews  are carried out at least once a year for each of the executive directors. Provide input to the wider board of directors and council of governors evaluation process.
  • Promote and conduct the affairs  of the trust with the highest standards of integrity, probity and corporate governance.
  • Ensure the provision of effective information and communication systems.
  • Lead the delivery of good and effective partnerships, agreeing with the Chair the appropriate lead on key stakeholders.

This is a big list – and each of them covers a broad scope. For example – “Run the Trust’s business”, “lead the delivery of good and effective partnerships” and “promote and conduct the affairs of the trust with the highest standards of integrity, probity and corporate governance” each have depth and breadth.

In practice you can get a good sense of what this means through looking at the CEO Diary Blogs of people like Jonathan Fagge of NHS Norwich Clinical Commissioning Group and Dr Mark Newbold of Heart of England NHS Foundation Trust.

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Difficult choices, public accountability and a focus on leadership, strategy and delivery are highlighted in every one of these. It is clear that, whether you run a commissioning or a provider organisation, these are system and organisation roles….and both Mark and Jonathan present examples of excellent leadership in both. So this is helpful at explaining about what a CEO does in the NHS. And as a former statistician, I would say it is all “necessary but not sufficient”. I would add two really important additions for emphasis.

When describing my role, I say that I am here to:

1. Be accountable – for two things only. The safety of every patient we care for and the value of every penny we spend. By “Value” I mean impact, quality, effectiveness and value for money. As the Chief Executive I carry this accountability 24 hours a day, seven days a week. It is like a coat that I never take off and one I wear gladly when the culture and systems are right and one that can feel incredibly heavy if they are not.

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2. Create the culture where others can succeed. This is one where people feel able to take responsibility and use the authority that they have been given to act. I have written about this elsewhere (“Some things are just too heavy for Superman to lift”) and will not repeat myself here.

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So what does a Chief Executive do all day? Everything required in the list of bullets above and, more importantly, balances keeping the accountability while ceding authority to others. It is never easy – I often get it wrong – but it is an essential part of everything we do, each and every day.

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Seeing the wood for the trees

Sometimes you look at something so often, the obvious becomes “hidden in plain sight” and we cannot see the wood for the trees.

The Internet  is a wonderful thing. I was perusing twitter recently when I came across this brilliant little clip of Richard Feynman via Brainpicker.

In it, Feynman explains how we all think trees grow out of the ground and then goes  on to explain how they are really made out of the air (the carbon that makes the wood comes from Carbon Dioxide in the atmosphere). He then goes on to explain how fire from burning wood is “stored sun” – the energy from the sun as it finally finds a way of escaping. It is magical and once I understood it, obvious. (I did have to rely a bit on my A Level Chemistry)

Richard Feynman was an amazing individual on many levels. A Nobel prize winning physicist, safecracker, calligrapher, musician, author , joker, polymath. [Read “Surely you are joking Mr Feynman” to learn more]. His biggest gift was teaching and a love of equipping people with the tools to make them think.

This little film made me think very hard about the NHS and how we talk about it, debate it and consider its power.

The usual debate goes that the NHS grows out of a national system of commissioning and provision, with regulation of the market and regulation of the quality of care that is provided.  Funds flow from the Treasury and care comes out of the other end. The NHS is delivered in homes, hospitals, GP surgeries, pharmacies, dentists, schools and health centres paid for by the money that nourishes it and makes it grow. That is clear for all to see……isn’t it?

But just as trees don’t grow out of the ground then the NHS is made not from the system or the buildings or the money it costs. It is made of the people who work in it and from the values we share. Over 1 million people, most of whom work incredibly hard and deliver great care as Professor Michael West concluded in the biggest ever rersearch study into the culture of the NHS:

“Many NHS staff – from the blunt end to the sharp end – demonstrate every single day the values of safety, civility, and compassion, providing the highest quality of care to patients even in challenging circumstances. Their excellent work must be celebrated. More than that, their values must be continually reinforced through the commitment and actions of leaders”

So obvious yet never the first frame of reference in the debate. And you don’t need a degree in chemistry, or a polymath
genius to explain how to see our wood from our trees. It is our staff, us that make the NHS….and the care that comes out is the “stored values” escaping as compassion,kindness, empathy, dignity and respect. Or, as we know to our cost when things go wrong, not.

Over to my team…..

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Happy New Year! See you all in 2014.