Relationships and reorganisation in the NHS

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“When wealth is lost, nothing is lost; when health is lost, something is lost; when character is lost, all is lost.” Billy Graham

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Far reaching reforms to the English National Health Service (NHS) were implemented this week, as responsibility for health care spending was passed down to over 200 local commissioning groups.   At the same time, deep problems in the NHS were brought to light in a damning report into poor care in North Staffs, which led to 1200 unnecessary deaths and a culture of neglect.

NHS reorganisations are hugely expensive.  A senior NHS executive admitted that during the last restructuring, the service lost its focus on patients and was preoccupied with managing the changes and merging organisations. 

The effectiveness of any reforms depends on accurate diagnosis and appropriate prescription.  The fundamental issue is an absence of values around care and respect; managers pursue financial targets rather than patient care.  But the prescription proposed is more of the same: setting new targets around values, holding people accountable for care and punishing staff who fail to deliver.

Such remedies view the healthcare service as a giant machine, which can be micro-managed to improve performance.  But what if the NHS is essentially a vast network of relationships?  Changing organisational values and culture then becomes an organic, relational challenge, involving leadership by example, cultivation of trust and responsibility, and a focus on patients’ experiences as much as clinical outcomes.

These softer goals are less amenable to target setting from a centralised bureaucracy; but they are more human, more caring, and more likely to deliver positive outcomes – not only to patients, but to anxious, overworked staff too.  

Read on…

A much more thorough analysis of relationships in the NHS was made by John Ashcroft and Geoff Meads in 1999.  Although the context of the NHS has changed, much of the underlying thinking and analysis is still pertinent.  Read the book online here.

Walk the talk

Is there an organisational problem you are trying to solve by tightening up the rules?   Might a focus on cultivating more healthy relationships of trust and respect produce a better result in the long run?

The last word

From the Bible, Proverbs 11, verse 17: “Those who are kind benefit themselves, but the cruel bring ruin on themselves.”

A tale of two leaders

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“Humility, that low, sweet root, from which all heavenly virtues shoot” Thomas More (1477-1535)

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Last week Jorge Mario Bergoglio became Pope Francis, head of 1.2 billion Roman Catholics; the following day, Xi Jinping assumed the presidency of China, a nation of 1.3 billion people.  Two new leaders have stepped onto the world stage, one spiritual, one political. 

Xi is a ‘princeling’, born into a political elite and groomed for leadership; his authority is based on being head of the Communist party and commander-in-chief of China’s armed forces.  Francis came from a working class, immigrant family and rose through the ranks of the church; his authority is expressed mainly through his example and teaching. 

Both men want to show they are in touch with ordinary people.  President Xi recently visited a poor village, chatting to peasant farmers and tasting their food.  The new Pope has a long track record of solidarity with the poor; consistent with this, he will celebrate mass on Maundy Thursday in a juvenile prison in Rome, where he will wash the feet of 12 young offenders.

Xi Jinping seeks to reform China’s economy, making growth more green and more equitable, and clamping down on corruption.  Pope Francis likewise needs to reform the Catholic Church, which is still weakened by its handling of sex abuse charges and revelations of corruption inside the Vatican. 

The Chinese president has a transactional leadership style in an authoritarian political system, so change will be imposed from the top down, and compliance achieved through rewards and punishments.  In contrast, the new Pope leads relationally, and his radical humility quietly challenges attitudes, and inspires people to relate differently towards others.    

Who has more power, the President or the Pope?  And whose reforms will bring the deeper, more lasting change?  Might it all hinge on their approach to leadership and relational skills?

Read on…

Read Jim Collins’ classic article in Harvard Business Review about ‘Level 5 leaders’ – those rare people who combine deep humility and fierce resolve in order to lead an organisation from good to great  – here.   

Walk the talk

Humility and a firm resolve are valuable for every kind of leader; which of these two do you need to cultivate more?

The last word

From the Bible, 1 Peter chapter 5, verse 3: “Don't lord it over the people assigned to your care, but lead them by your own good example.”

Abusing abuse?

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“Nearly all men can stand adversity, but if you want to test a man's character, give him power.”  Abraham Lincoln

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The flood of sex abuse allegations in the news media since the Jimmy Savile case broke last year shows little sign of abating.  Does it suggest society is getting more depraved, or are more victims finding the courage to speak up about it?  Or is it the press which is giving it more emphasis?

It would not be surprising if inappropriate sexual behaviour is increasing, on the same trajectory as the sexualisation of society.  We cannot expect men (especially) to be bombarded with erotic images in a culture preoccupied with sex, and then not struggle at times with finding a legitimate expression for what that produces.

At the same time, for the last 50 years our society has been empowering women (especially) not to accept sexual harassment.  It is quite right to insist that women and girls (as well as men and boys) are treated with respect as persons and never exploited as objects of someone else’s desires.   So it would not be surprising if victims of sexual abuse are also finding a stronger voice.

But a third current is compounding the issue: accusations of sexual abuse are becoming weapons in the media against whole institutions.  The BBC, the Roman Catholic church, and the Liberal Democratic party have all received such treatment recently.  All too quickly the wrongdoing of an individual subtly shifts to an implication that there may be a whole culture of abuse, which can taint an entire institution – and indirectly all the other people who work there.

Sexual abuse is always wrong, and managing it is also sensitive and difficult.  Just because we are overcoming our reluctance to talk about it openly, let’s be sure not to damage even more relationships through careless accusations and extrapolated guilt.

Read on

Journalist Brendan O’Neill argues that accusations of sexual impropriety have become the key currency of political and moral infighting; read his article here.   

Walk the talk

Most cases of abuse (of any kind) take place because there is a misuse of power in the relationship.  Are you vulnerable to someone taking advantage of you because they have power over you – or vice versa?  If so what might you do to bring more parity to the relationship? 

The last word

From the Bible, Mark chapter 10, verses 42-43: “Jesus called them together and said, “You know that the rulers in this world lord it over their people, and officials flaunt their authority over those under them. But among you it will be different. Whoever wants to be a leader among you must be your servant…”

House prices and relational capital

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“Property is intended to serve life, and no matter how much we surround it with rights and respect, it has no personal being.  It is part of the earth man walks on.”   Martin Luther King

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Research findings from housing charity Shelter state that nearly two million couples in Britain started cohabiting primarily to make housing more affordable, rather than because their relationship was ready for such a transition.  Furthermore, an estimated 1.8 million couples whose relationship has collapsed are still living together because they cannot afford to split up.

Since 2004 average house prices in England have remained at over 6 times median salary levels, nearly twice the ratio prevailing in the late 1990s.  A long-term, sustainable ratio is less than 4 if young families are to get on the housing ladder.  Consequently, first time buyers in London now have to save for 24 years for a deposit on a house, unless they have help from their parents.

For many couples, expensive housing combined with the high cost of weddings puts off the decision to get married, with the result that they slide into cohabitation and parenting without making the solid commitment of marriage to help them manage the risks and the tough times in their relationship. 

Alleviating these pressures on couples is right for their own sakes, but it’s even more important when it comes to their children.  Weak or broken relationships between parents tend to be magnified in the lives of their children, who literally embody the relationship between mum and dad. This is why divorce often leads to children feeling torn apart inside.

Whether they own their own home or not, the next generation will inherit the relational capital of their parents. Pressures that bear on the stability of marriage and family life now will make that generation either richer or poorer; which will it be?

Read on…

For practical insights into strengthening a marriage, especially with the pressures that a new baby can bring, read about a very effective couple education programme called Let’s Stick Together here.

Walk the talk

Where is the relational capital in your family under threat?  What might you do to build it up in that place?

The last word

From the Bible, Proverbs chapter 13, verse 22: "A good man leaves an inheritance for his children's children"

Motorway and marital misdeeds

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"Heaven has no rage like love to hatred turned,
Nor hell a fury like a woman scorned." William Congreave, 1697

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A year ago Chris Huhne was a senior politician in the UK government, minister for energy and climate change, and one of the leading Liberal Democrats in Parliament.  But on Monday he pleaded guilty to perverting the course of justice, resigned as an MP, and is waiting to be sentenced for his crime – and his reputation, family and career lie around him in tatters. 

It started with a motorway speeding ticket Huhne picked up in 2003, and to avoid being banned for driving for six months, he persuaded his wife to admit she was the driver.  Seven years later, just after Huhne was appointed a minister in the new coalition government, his affair with a media adviser was exposed, leading to the breakdown of his 25 year marriage to Vicky Price.

At what point did all this trouble really begin? Was it in 2003 with the speeding ticket?  Or was the real starting point when Chris Huhne broke his marriage vows?  Up to that point the motoring offence was a skeleton hidden in the family closet, and would have remained so had Vicky Price not been so incensed by her husband’s betrayal that she told her story to the press to take revenge on him.

This sorry tale offers two important lessons.  Firstly it underscores the reality that what happens in our key relationships will almost certainly have knock on effects in other parts of our lives.  Secondly, it illustrates that marriage is a much more profound relationship than a contract, it’s a covenant formed by vows that joins two lives into one.  When that is violated by a hidden affair and the prolonged deceit that goes with it, the betrayal of trust can have devastating consequences.

The law, both civil and moral, is there for the ultimate good of our relationships – whether on the motorway or in the bedroom. 

Read on…
This week up to February 14th is National Marriage Week in many countries, inviting everyone to consider the value of this unique institution to society.   Read the speech on ‘Modern marriage and the pursuit of happiness’ by Kevin Andrews, Australian MP and author, here. 

Walk the talk
Is there some law standing in your way to the point that you are tempted to disregard it?  Bring into your calculation what the consequences of that might be for your relationships… would it really be worth it?

The last word
From the Bible, Matthew 5, verse 25: “Settle matters quickly with your adversary who is taking you to court. Do it while you are still with him on the way, or he may hand you over to the judge, and the judge may hand you over to the officer, and you may be thrown into prison.”

Beckham’s move

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“It's not how much we give but how much love we put into giving.” Mother Teresa

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David Beckham, ‘the world’s most marketable footballer’ has announced that he has signed a five month contract for the top French club Paris St Germain (PSG), and will donate his whole salary to a children’s charity in Paris. 

Critics have dismissed it saying it’s a media stunt, and that given his age (37) and fitness he doesn’t have much to offer the club on the field – only off it.   But this news reveals something about the importance of relationships to Beckham. 

Firstly he wants his wife Victoria and their children to settle back in London again, and Paris is a commutable distance away.  Then in joining PSG he is being reunited with two friends and former colleagues from AC Milan, manager Carlo Ancelotti and director Leonardo Araujo, with whom he has a warm relationship.

Indeed his relational skills may represent the main value he brings to the Paris team.  Sports journalist Matt Spiro writes that Beckham's professionalism, experience and ability will set a clear example on the training ground to younger players, and help the disparate set of individuals work better as a team.   

Finally the decision to give away his entire football salary – perhaps £3 million – to a local children’s charity has won applause from many quarters.  The fact that he doesn’t need the money (he and his wife have an estimated wealth of £165 million) is beside the point. 

What the highly visible celebrity’s unusual gesture says to the neediest kids in Paris is that their plight has not gone unnoticed, they have been seen and actually matter to this sporting superhero, who wants them to have a better chance in life.  Would those children be entirely wrong to think that David Beckham is perhaps really playing for them?

Read on...

Thinking relationally can change the way we look at strangers – whether those are kids from rough inner city neighbourhoods or executives going to work in the financial district.  Read the chapter ‘Strangers’ in the R Option by Michael Schluter and David Lee here. 

Walk the talk

Next week take a moment each day to consider some of the people you normally take no notice of – in your neighbourhood, on your way to work or when out shopping.  Start to think about what you might have in common with them, and see if they become more ‘visible’ by the end of the week.

The last word

From the Bible, Matthew chapter 6, verse 21: “Where your treasure is there your heart will be also.”