Flowers for my Mother

Everyone is talking about leadership…. There are courses, books (one of the best have found is one called Intelligent Kindness by Ballatt and Campling which I really like) and conferences everywhere I turn. It is apparently the answer to IT all. Although I am not quite sure what the IT is. When is leadership something different from management? Is there really a difference between clinical and managerial leadership? It seems that clinical leadership is now the in thing…and I am glad about that because it has given me the chance to take on this role rather than be left to sit on the side-lines as I have done in various PCT roles in the past and people actually listen to what I have to say now which is novel! but what do we really mean by leadership anyway…



My mother was admitted to hospital three times in the last three weeks. She is 93 years old and has dementia. Up to this point she has lived quite successfully in a small flat with a day time warden and a life line service but clearly things are getting more difficult. As a family we experienced the wonders that are the fragmented, patchy, variable services for older people. I am sure our experiences will not be that different from everyone else’s across the country. Where my mother lives is an average sort of place with an average sort of trust and an average GP. Nothing extraordinary but okay. As we navigated through out of hours services, acute medical wards, wards for older people, community hospitals, social service teams , care homes, what became obvious to me is the huge variability of attitude, approach and energy within one small location. The worst experience by far was trying to get help initially and the tortuous map of repeat questioning( does the system have dementia?) and changing personnel that is NHS111….. 50 minutes to get to speak to someone who could maybe do something… To the best… a small community hospital with the attitude that it will make the right thing happen and that each person is important and valuable..



What made the difference? Dare I use the word? Leadership…. visible leadership… in the community hospital the matron is brilliant, she leads by example. She cares, she bothers, nothing is too much trouble… and everyone in that hospital is infected with a sense of purpose and achievement. It feels good to be there. The staff smile, they stop and greet you when you walk in. They don’t rush by with their eyes to the floor.. looking busy and hassled….My Mum was happy there, I was relieved and happy she was there. She made progress. But why the variation? It cant be right can it that each little building block of the NHS is so dependent on the individual in charge. It makes it far too fragile… So within a huge organisation made up of so many tiny parts how do we drive up quality everywhere? It feels like an impossible task. How do we get 100% excellent CCGS doing great commissioning and all trusts and All GPS caring for patients to the highest of standards? Because that is what we want for our mothers, our children, ourselves.. what is acceptable variation? We know that 50% of anything is below average, just by the definition of the word , but we have to reduce the distance from worst to best so that the variation isn’t big enough to feel from a patient perspective. The only answer I can come up with is something about the leadership of the whole system, not of each hospital or CCG but of the whole NHS. It needs to be different, palpable, with core values that are lived by everyone in the work they do every day.. Where leading can be kind. Not soft or sloppy, but intelligent, and caring. So each part of the NHS, each layer each organisation can look up and se those values everywhere. No bullying, no intimidation, no weasel words to avoid answers. AS NHS staff, managers, clinicians, support - senior or junior we have to treat each other with the same values we expect and value as patients. WE must never forget that we are all potential patients in the system we design…. my guiding principle as a GP has always been ..would this be good enough for me.. my family… if not then it isn’t acceptable for anyone….



The new NHS is an experiment… it allows a whole garden of flowers to bloom…it is a risky plan especially in such a cold and cloudy time…as a new flower ourselves I applaud that but it relies on a gardener who understands how to get the best from each variety, and how the species interact with each other. She needs to be present, visible, dealing decisively with the weeds and with those bits that overgrow, or aren’t healthy… watering, feeding, nurturing, and providing the environment that will support healthy development whilst being clear about the overall direction and shape… gardening a system requires patience , vision, permissive bravery and the wisdom to act decisively but kindly when necessary.



My mother was bewildered by the labyrinth of services she encountered….. do we have the collective will and the imagination between us and together to work with the system we have and make it work for her?