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The joy of governance


Blog headlines

  • Crunch time for patient involvement
    7 August 2020

    There are new challenges for primary care, which could really do with patient input. Mike Etkind, chair of a PPG and founding member of his PCN’s patient group, recognises the size of the task clinical directors have managed over the last few months but identifies two particular issues where patients have a necessary and valuable contribution, that need to be addressed now – the 2020 vaccination programme and primary care from a distance- total triage, remote consultations, and the use of telemedicine.

  • Link of the week - Visionbridge
    31 July 2020

    The link we are sharing this week was submitted by Julian Jackson, Visionbridge.

  • Links of the week
    23 July 2020

    This week we are sharing two articles with you.

  • Link of the week
    21 July 2020

    The blog is from the perspective of the Company Chemist Association's Chief Executive Malcolm Harrison.

  • Link of the week
    9 July 2020

    This week we are sharing a blog from the NHS Confederation’s “NHS Reset” looking at the work of Healthwatch, the role of volunteers in supporting patients being discharged from hospital and the importance of the community.

  • Virtual education sessions on spinal cord injury from Spinal Injuries Association
    2 July 2020

    This week Karen Mikalsen from the Spinal Injuries Association shares some information on their work and events for healthcare professionals.

  • Guest blog:Karen Chumley
    25 June 2020

    Thank you to Karen Chumley for a second blog –this time on the local use of an Electronic Palliative Care Coordination system during the Covid-19 pandemic. Karen is the Clinical Director and Deputy CEO at St Helena.

  • Link of the week
    19 June 2020

    This week's link of the week is article by Yasmin Khanagha published in Nursing Times – Why we need to open the conversation about racism.

  • Guest blog: Dr Karen Chumbley
    12 June 2020

    This week we have a guest blog submitted by Dr Karen Chumbley, clinical director and deputy chief executive at St Helena (https://www.sthelena.org.uk/)

  • Social care to become lifestyle brand
    16 April 2020

    Social care is to get a new brand identity as the government seeks to reverse the perception that it is the poor relation of the NHS.

  • Blithering Covid-19 bulletin plays vital role
    2 April 2020

    To fill a gap in the market for timely and relevant Covid-19 information, Martin Plackard, director of global crisis communications at NHS Blithering introduces his latest initiative to reach out to stakeholders during the outbreak.

  • Social distancing the Longstay way
    27 March 2020

    We asked Sir Trevor Longstay, chief executive of the NHS Blithering University Hospitals Foundation Trust and commander-in-chief of the Blithering Covid-19 Taskforce to give us some practical tips on social distancing. Here he shares some of the lessons learned over four decades of leadership – not all of them relevant or epidemiologically sound

  • Nothing left to shift: fears grow over NHS paradigm supply
    12 March 2020

    The government has issued a stark warning that stocks of paradigms and other basic supplies could soon run out if NHS managers continue panic-buying.

  • Matt Hancock’s diary – a week of levelling up
    27 February 2020

    Taking personal charge of global pandemics is one of the perks of this job. I’m referring to coronavirus, of course, and I’m booked to appear on Sky News to talk about it.

  • Exceeding your expectations: the Blithering staff survey
    20 February 2020

    Staff at NHS Blithering feel listened to “at least once a year” and report that their expectations of taking part in surveys have been “met” or “exceeded” in the past 12 months.

  • Martin Plackard’s week: Tuesday
    7 February 2020

    The second in our series of privileged insights to the working life of Martin Plackard, the NHS’s most gifted communicator

  • Martin Plackard’s week: Monday
    30 January 2020

    First in an occasional series of glimpses into a typical week in the life of Martin Plackard, the NHS's most influential strategic communicator

  • A quick guide to quick guides
    24 January 2020

    Few of us have time for long documents that take ages to read or a lot of expertise to put together. That’s where quick guides come in.

  • Towards people and impact
    17 January 2020

    This week the Royal Pharmaceutical Society advertised for a head of engagement and belonging. Such titles can be controversial – but not for Martin Plackard, whose CV features a number of leadership roles in the fields of impact, euphemism management and talent delivery.

  • National log-in reset will change everything
    9 January 2020

    This week the Department of Health and Social Care announced a £40m investment to make it easier to log-in to NHS computers. It’s a laudable aim, akin to fitting a keyless entry system to a Ford Anglia to make it go faster.

Friday, 23 May 2014

The joy of governance

Fifty years ago, as the sexual revolution got under way, the main beneficiaries were the publishers of books and articles providing advice and guidance on sexual practice and technique.

The newly liberated generation had no more sex than their inhibited, guilt-ridden parents, they just had more to read.

Mick Jagger, a leading researcher, was among the first to declare that the revolution was not all it was cracked up to be. After a global study tour during which he explored, among other things, the correlation between manliness and cigarette brand preference, Jagger turned to song to express the illusory nature of satisfaction.

All of which explains the NHS obsession with manuals, briefings and learned papers about leadership. These also give the impression that everyone else is “doing it”, when in reality almost no one is.

This week’s bumper crop includes two reports from the King’s Fund and one from Monitor. The King’s Fund claims, like Mick Jagger, to have been ridin’ round the world in search of satisfaction, but unlike the Rolling Stone, the King's Fund also claims to have found it.

The secret of a “caring culture”, it says, is to abandon command and control, top down management in favour of “collective leadership”, a kind of management free-sex in which everyone takes part.

The report puts it a bit differently: collective leadership means “distributing and allocating leadership power to wherever expertise, capability and motivation sit within organisations”.

To do this, you must have a clear vision and shared values, shift mindsets, engage fully, make sure everyone is respected and valued while you set them challenging, measurable goals and encourage them to learn continually.

If that all sounds disappointingly familiar and not terribly sexy, the King’s Fund has plenty of examples in the form of case studies that promise to show you how it’s done.

While some of these will be a source of vicarious pleasure, they are of dubious value as instruction. Rather like the sex manual, with its illustrations of positions you never would have thought possible, the case studies show what can be done only in a technical sense. They describe the configuration of limbs, but don’t answer more fundamental questions about how to start the relationship or inject the passion necessary for a satisfactory outcome for all concerned.

Monitor’s document is even less stimulating. The Well-led Framework for Governance is apparently the product of a threesome with the NHS Trust Development Authority and Care Quality Commission. They have made a commitment to "an aligned framework" for judging the quality of leadership in NHS organisations, which will provide a consistent view of "what good looks like" and remove "unnecessary duplication".

The process of alignment involves elaborate foreplay which is expected to take the regulators until October and smacks a little - though it may be unkind to say so - of the unnecessary duplication the partners claim to be removing.

While the King’s Fund concentrates mainly on the pleasure leaders can give to others, Monitor prefers a more cerebral approach, identifying "ten key questions" that boards must be able to answer.

Monitor appears to think leadership is the same as governance, which is like saying that love-making is nothing more than birth-control. As a result, its questions focus too much on pre-flight checks and hardly at all on the rest of the journey.

Try this one at home. Before entering into sexual relations, ask your partner for evidence of capability and skills, find out if they have a credible strategy and make sure they are sufficiently aware of the potential risks. Efficient? Possibly. Alluring? Not so much.

Anything that comes in the form of a model, a framework or a step-by-step guide is unlikely to be of much use in either bedroom or boardroom.

The timid post-coital “How was it for you?” is a question that good leaders and well-led organisations never need to ask.

Editor: Julian Patterson

Mark Aitken
Mark Aitken says:
May 23, 2014 04:28 PM
The problem, as ever, is that of coitus interruptus whereby managers (leaders) move on to a new post without delivering the intended outcome. Alternatively it is a game of Vatican Roulette whereby the leader has a 1:6 chance of fertilizing a worthwhile project or being caught in fragrante delicto.
Anonymous says:
May 23, 2014 04:38 PM
Wow, love this!
Anonymous says:
May 23, 2014 04:44 PM
Julian, you are on FIRE today. Great read, thank you very much.
Anonymous says:
May 23, 2014 04:46 PM
Ha! Ha! Great article and comments.
Reminds me of the old saying:

'Those that can...do it!
Those that can't.....teach!'
Anonymous says:
May 23, 2014 05:42 PM
not to mention the NHS's current practice of promiscuity with unsuitable bed-partners who only want to get the goodies and then screw you over....
John A Ward
John A Ward says:
May 23, 2014 06:15 PM
As I am now within several months of retirement, I feel totally safe to say this is brilliant!!
Vicky Price
Vicky Price says:
May 24, 2014 08:01 AM
As ever, this blog continues to give satisfaction...
Anonymous says:
May 24, 2014 08:06 AM
Julian back to his best..brilliant!
Anonymous says:
May 24, 2014 08:15 AM
A wonderful analogy. I expect many of the staff in the NHS are tired of incessant projects, ideas, initiatives, programmes. The way forward is already known, organisational defragmentation, direction, common protocols, interdisciplinary team working at all levels.A simple UK wide model for delivery of service to high standards of clinical effectiveness ( not often mentioned). Drs and nurses doing their jobs right first time, on time to a high standard, accountability. The NHS is suffering from organisational frigidity - elation remains a distant prospect
Mark Aitken
Mark Aitken says:
May 24, 2014 01:29 PM
This endocrinology goldmine of a blog hasn’t yet touched on Contraception and HRT (Hospital Reconfiguration Theory).
Uninhibited sex, and the joy of experiencing that psychological orgasm when your first and last clinically appropriate suggestion was implemented by the Board, had to be curtailed. When the eating of forbidden fruit becomes free at the point of delivery the enjoyment had to be eliminated. Balancing the testosterone related component of the Pill is tricky. Not enough causes loss of libido; too much can make you physically unattractive (associated hirsutism). All this is compounded by Management relocating your erogenous zones to parts of the body that can’t be aroused.
HRT was introduced to deal with age related dyspareunia and impotence. In fact it compounded dyspareunia and made us impotent to do anything about it or all the other devious political nuances.
Richard Paul Croft
Richard Paul Croft says:
May 26, 2014 08:08 AM
Absolutely brilliant. Sex from a book versus.., well, just sex. I think we all know what we should be doing but what is lacking so often is charismatic leadership that will inspire.
Anonymous says:
May 26, 2014 08:19 AM
Who needs sex when they have this to read!
Vivian Wood
Vivian Wood says:
May 27, 2014 10:40 AM
The content of this email was too much for our web police and it got blocked with eh following mesage;

MailMarshal Rule: Spam & Junk Mail : Block Pornographic Language
Julian Patterson
Julian Patterson says:
May 27, 2014 04:36 PM
It must have been repetition of the word "leader". Apologies for any offence that may have been blocked.