HEADS UP
leadingedge Jon Restell, chief executive, MiP
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n the last two years I’ve spoken to hundreds of managers about Mid Staffs. They were united in shock, disgust and anger at the treatment of patients at Stafford Hospital. Few believed it was the tip of an iceberg, rather the worst example of the poorest performing hospitals. There was, however, little complacency. Most managers had gnawing anxieties about their own organisations, their ability to prevent a descent in standards under intense financial and operational pressure, their ability to challenge and change the system. This is why MiP welcomes the second Francis report. The detail needs debating, but Francis gives us a unique opportunity to develop a systemic culture of patient safety, care and dignity. MiP has argued strongly that three factors must be at the heart of the response to Francis: the culture of care (not its structure or even its regulation), staff engagement (clinicians, support staff and managers working well in teams) and patient voice (listening and responding to suggestions, complaints and representative bodies). Even if the government and other players get the response right, it will take excellent leadership and
“A profession means much more than having disciplinary sanctions after failure, but includes a spectrum of activity from education, registration, training, revalidation, and CPD.” management to deliver change. Ignore leadership, or reverse recent improvements in support for leaders, and the response will fail. One of Francis’s challenges is for us to value leadership and attend to its development and accountability much more than we have done. We should take on this challenge robustly. Francis sets out to support leadership and its importance. His thoughts in headlines are: Articulate the qualities of healthcare leadership. Acknowledge the complexity of management jobs. Bring some stability to leadership development, especially given the new and fragmented landscape. Start to control the quality of management, starting at board level, through a ‘fit and proper person test’. Consider the process of ac-
countability for managers. Keep regulation in the locker. Francis pulls back from regulation of managers, but he clearly approves of greater professionalisation. For him a profession means much more than having disciplinary sanctions after failure, but includes a spectrum of activity from education, registration, training, revalidation, and CPD. We need more professionalisation if we are to tackle the problem of talented managers being reluctant to take top leadership jobs in the NHS, which are surely among the best-paid and most interesting jobs in the public sector. Francis talks of the paucity of applicants (none at all for some director posts) and describes the tenure of chief executives as ‘shockingly short’. This is the result of a lack of respect for the role, a devalued package with patchy support, and poor tenure caused by weakly defined personal responsibility and the near absence of open and fair process. Sack first and then ask no questions often sums it up. We’ve got to do something about that. Francis does not provide all the answers but he sets out a leadership agenda which, if pursued properly, will help to change the culture.
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healthcare manager | issue 17 | spring 2013
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