Mike Attwood has spent 26 years as an NHS Leader and is an accredited coach and editorial advisor for the Journals of Integrated Care and International Leadership in Public Services. He is also a member of the LeaderShape NHS specialist faculty.
He responds to the latest Care Quality Commission (CQC) report here:
The CQC report shows safety is still a major concern with 13% of hospitals, 10% of adult social care services and 6% of GP services rated as inadequate.
Importantly, the body identifies a need for creative, selfless leadership (rather than more technical expertise and knowledge-based solutions) and outlines three key factors that play a critical role in shaping quality services:-
1) Engaged leaders building a shared ownership of quality and safety
2) Staff planning that goes beyond simple numbers
3) Working together to address cross-sector priorities
The report places a major focus on the culture of engagement that leaders need to create far more than it stresses the formal governance processes to underpin systemic, high quality care – vital though those are, of course. This aligns with LeaderShape’s long held belief that great leaders reach out selflessly beyond their own expertise and egos to acknowledge fears and uncertainty (particularly facing today’s public services.) Leaders act as catalysts to harness the creativity and new ideas that intractable environments desperately need, to break out of the old controlling, failure-based action plans.
NHS “turnaround” regimes have been alive – but not well – since at least 2000, under many different guises. The response to CQC inadequate ratings needs a new, engaging, collaborative approach – local organisations must work together locally and the “centre” itself should seek to move beyond its critical role of judge and jury towards something more empowering.
All too often as leaders we can come from a place where we confuse true engagement with sharing our own expert message and communicating what teams need to do to improve. We can fall into the trap of merely broadcasting rather than “listening to hear” the real concerns of patients, front-line teams and partner organisations. Only by striving to listen will we unlock the new creativity and ideas that undoubtedly exist beyond ourselves.
For too long we also have tended to appoint NHS leaders to run their own institutions, leaving them to struggle and fall when the challenges they face are really whole system issues.
Perhaps now we are seeing a new wave of bravery in places like Cornwall and Greater Manchester where leaders have gained a new emotional and psychological understanding, beyond their undoubted intellectual prowess. They see that collaboration between organisations and citizens requires them to value deeply the very fact that they don’t have a monopoly on expertise; a world of ideas is out there for them to draw on.
Professor Keith Grint’s work on Tame and Wicked problems is illuminating. Wicked problems are intractable, multi faceted, riven with disagreement and not amenable to linear problem solving.
A clear example of a wicked problem is safety of care. Should we publish clear standards manuals and audit compliance? Should we accept that we will simply overspend and ramp up staffing levels? How can we expand staffing if not enough nurses are being trained? How can we openly acknowledge that safety is a problem whilst persuading the press we need proportionate, challenging journalism, not universal doom and gloom?
As the NHS Leadership Academy takes its new place within Health Education England, it too needs to consider deeply how more time, space and focus on creating selfless leadership can be built into its commissioned leadership programmes. Is it prepared to work ” out there” with real health and care systems like Cornwall on culture and collaboration?
Critically too work is needed at the centre to mirror selfless leadership beyond ego. What are the Civil Service College and others doing to support and challenge national leaders in the Department of Health, the CQC itself, NHS Improvement and NHS England? Will these institutions be brave enough to challenge their own cultures? Local NHS organisations and local authorities can helpfully resist an understandable temptation to criticise “up” and instead reach out to help the centre shift its perspective.
We sometimes do see signs of a desire for a more collaborative approach from the core but all too often we still see turnaround and “success” regimes imposed. In September 14% of NHS CEO jobs were either vacant or soon to become vacant.
The CQC lays down a considered leadership challenge. It is now time for them – and the NHS at national and local level – to find the selflessness to lead differently – and by example.
See LeaderShape Director, Duncan Enright’s original thought leadership commentary on the CQC report here