February 2014

But the question is asked because when we look at service failure and weakness, we reasonably ask why was nothing done?  Sometimes the answer is that something was not known – by which we usually mean that dots had not been joined up, indicators not put together to create a picture that told a story.  Even when that had happened, sometimes we find that no action was taken or action was ineffectual.  Cultural barriers are blamed.  Yet we know that leadership plays a significant role in framing a culture – permitting it, challenging it, moulding it.  And so I think the fifth dimension that the CQC are focusing upon is a crucial one, and one we have to develop and improve at our Trust.

Patients often praise what this organisation does.  We have perhaps 700 formal complaints each year from our 1.5m “contacts”, yet we have many more compliments.  We have the lowest mortality of any hospital in Birmingham.  Good things from which to build.  So the leadership we need to see and to support takes us from a position of good to an ambition of great.

As I edge towards a first anniversary as Chief Executive, we have completed in large part the changes to our senior teams.  Creating, or rather recreating thirty or so directorates – groups of services that are big enough to merit a management infrastructure but small enough to have a human scale where those seeing patients and those in accountable leadership roles would meet in the ordinary course of a week.  We have said goodbye with thanks to some senior executive colleagues, and welcomed new people onto our Board team.  This month we signed a contract to partner in an eighteen month leadership development programme, based here at the Trust.  This is not about going back to school.  But it is about developing a culture where we learn together as leaders in the Trust, using the real experiences and issues that we face to solve problems and learn about what works well.  Because to be well-led patients and staff should have confidence in the Trust’s leadership.  And part of confidence is consistency and predictability.  If I raise a concern, I know I will be listened to.  If I need help, I know I will get advice. And so on.

Eighteen months ago, the Board invested substantially in our matrons.  Creating a cadre to senior clinicians with authority to make a difference to care in clinic, in theatre and in our wards.  With the creation of the new leadership team in adult community services, we will take the opportunity over coming months to make sure that a similar tier is in place and empowered there.

Joining up these two investments is the task to make us well-led.  Because we need so-called frontline departmental leaders to shape a culture.  And we need them to know that those around, and structurally above them, share the same values and have the expertise to help and the wisdom not to hinder.  Making smart choices about when to intervene and when to leave well alone.

Leading a public service is often currently spoken of as making tough choices.  And that is and will be true at our Trust in coming months.  Despite our year-end surplus, 2014 will see difficult changes in our workforce and changes in how we provide services, to improve quality, but also to spend less, though more of each pound on patient care.  Yet in my view leading a public service is much more about communication than choice.  Because day to day leadership is not about choosing things for others, but making sure you communicate the information around you so that those best able to make choices, make informed decisions.  Leadership depends on communication and communication depends on listening.  The golden thread between the five questions posed by the CQC is listening.  All five goals we have rely upon it.

Listening – hearing what is being said but also what is meant – is a preoccupation for our Board team.  The single topic on which we have spent the most time in the last three months is how to listen well.  That’s right, more time on that than the new hospital or next year’s budget.  That will continue to be the case, as individuals (my NHS Change Day pledge refers)  and collectively (from April we start exploring in public the role of Governors, come along and have your say. Please see dates below.)

As we develop our ideas about the future of care within the Trust we know that we have to able to hear what our patients think.  Because if we truly mean that, in time we want to be renowned as the best integrated care organisation in the NHS – it will be patients who judge whether we are integrated.