Stuck in a hole
Dear reader, I don’t know whether you’ve ever been there, but the threat of redundancy makes you feel like you're disposable and frankly crap at your job.
Scene opens: Heather’s kitchen, mid 2000s. Heather puts on her headphones, plugs them into her iPod and starts dancing around her kitchen. The track ends and she puts it on repeat before shutting the door and driving to work. She needs the words to bury into her psyche, because
She’s stuck in a hole.
Trying to get out.
She’s doesn’t know what there is to see
But she knows it’s time for her to leave. Her job. Or be made redundant.
The song is Shine by Take That.
Mark Owen needed to tell me that I was ‘such a big star’ several times a day, every day, because I didn’t believe in myself. I’d been demoted because I’d not applied for the job that replaced mine and had been placed on protected salary. I was still caring for my parents with dementia and alcoholism and that came first.
Initially, I’d been sent on secondment to the local authority as a project director. But it hadn’t gone well. I’d disagreed with the council director’s approach and, egged on by my CEO who I think wanted to give his oppo a bloody nose-had resigned. I still had balls, at least. Well, you know what I mean-I was still the same Bolshi student nurse.
Now, the CEO said, what WILL you do? I shrugged.
I was put in charge of service redesign. My first task was to enact a national edict to introduce the community matron service a la Kaiser Permenante health maintenance organisation. This isn’t the same as the current modern matron thing-it was an American import aimed at saving money in their insurance - based system.
We would have to find the money for 3 matrons who would stratify those at high risk of hospital admission. The matrons would case manage them, follow them into hospital if necessary and prevent readmission. Not a bad idea, but we weren’t in America, we were in a northern English town served by a nationalised NHS, not an insurance company. Spending here and saving there sounds sensible but ignores local politics. And when NHS England tells us what to do, what to spend, and by when, it’s a recipe for disaster for a change agent like me.
Hospitals at that time didn’t like their boundaries being spanned. And as for the district nurses, who I thought would be supportive, they were FURIOUS, telling me that this what what they USED to do and COULDN’T DO ANYMORE. Being district nurses’ number 1 fan, I empathised at their anger, but what could I do?
With the data analyst and finance officer, I wrote a very detailed cost benefit analysis for the board. I explained the breakeven point where the savings in readmissions would pay for the new roles. I even impressed myself, as I don’t normally like detail.
The board junked it all and told me to rebadge and retrain the 3 existing health visitors for the elderly as community matrons.
Well you can guess what happened. It didn’t exactly go to plan and somehow it was my fault. I was clearly taking these 3 horses to water and if they didn’t drink soon they'd be on a drip.
These days we have an NHS Change Model which starts with creating a shared purpose that is discussed and co-created with staff. It isn’t about telling people what to do. My love for the NHS was total, but my love for my NHS career started to diminish. It seemed to me that there was a clear tension between localism and nationalism when it came to NHS policy. I’m all for devolution and integration but that hadn’t been invented yet.
A year or so later, the organisation hired an external consultant to help with some work. He came across my community matron business case with all the cost-benefits stuff. He whistled ‘great work!’ Thanks, I said. I’d started to notice that external opinions seem to be valued more than internal ones. I could see it going though his head to dust this business case off and use it.
Then came a new head of nursing. I’d met her at the local hospital. She had all the hallmarks of authority: presence, appearance, management speak.. and none of the ability. When my boss told me that she’d got the job I opened my mouth, then closed it again. This was my boss’s decision and who was I to query it? What I came to realise was that our new head of nursing relied on others to maintain her position, including me. I helped her as best I could. After all, that’s what nurses do. But I began to see cruelty in her operations. My colleagues' lives were being made miserable. But she couldn’t break me, as I reported to the same person that she did. We were equals.
What I know about leadership is that it’s your duty to enable your team to do the best job that they can-not to criticise or micromanage, which was what I was witnessing.
One day, she called a meeting to solve a problem. She explained the situation, but she’d alienated everyone around her and there was no reply. She prompted us-and especially me because I’d helped her many times- what should we do? I opened my arms ‘I don’t know’. This was tough because my nature is to help. Everyone knew what was happening. She started to panic.
Dear reader, was I wrong to stay silent? This was a hard decision to make. Power can be built in many ways. Those who trade on their position in the hierarchy and their ability to reward or punish people are all about control. This doesn’t develop people or build team relationships and trust.
Our head of nursing continued to struggle and, metaphorically kicking and screaming, she was eventually managed out of the organisation. At no point did I see the veneer of authority break. If she’d reached out and said ‘I need help’ I would gladly have given it. Admitting that you get stuff wrong and asking for help are acts of strength, not admissions of weakness.
Not only was I stuck in a hole with an arrogant head of nursing, my boss had his moments too.
I’d been instructed to close a local clinic because it was basically becoming unsafe (more of that debacle later). Adjacent to the old clinic was a vacant former library, a youth centre and a secondary school. My boss decided that it would be a good thing if we turned the whole area into a youth campus, because it was rife with young people causing trouble. He thought we should invest in supporting them. In a display of ‘this is how you do it, Heather’ he called the local press and as I watched on, slightly agog at his bravado, he briefed a local journalist on his ideas.
Next moment I was facing an angry mob at a public meeting, who were protesting about the area becoming a magnet for more and more troublesome youths from across the borough. I’m not sure how I managed to get out of that meeting. There were no plans, just my bosses' ideas, that he hadn’t discussed or agreed with any of our strategic partners. One thing it taught me however was how to think on your feet.
We did not end up with a youth campus, quelle surprise! But I did end up with a huge headache of a clinic that took a whole six years to cure. And it wasn’t the NHS that cured my headache in the end, but the community itself. This was the start of my journey into asset based community development work, but it would take 8 years to discover this as my true path.
Meantime there I was, in my hole. Next to me, holding a flickering candle, was my union rep and my boss, waving papers about my impending redundancy. Dear reader, I don’t know whether you’ve ever been there, but the threat of redundancy makes you feel like you are disposable and frankly crap at your job. Yet the tiny part that still believed in me reached for my iPod and listened to every word that Mark Owen sang to me, over and over.
Towards the end of my notice period, I found a job. I decided that I would try NHS commissioning. And, with a big sigh, I climbed up a ladder and left my hole.
The early 2000s for me were characterised by a type of autocratic leadership that ran through the NHS like lettering in Blackpool rock. It reminded me of the poem that my mum used to recite:
‘Big fleas have little fleas
Open their backs to bit ‘em.
And little fleas have lesser fleas
And so ad infinitum.’
Many (but not all) managers in the 2000s took the pressure put on them to do what was required and then passed it down the chain. When things didn’t happen fast enough we felt this huge three line whip making us comply. Here's an example: I inherited my bosses' problem when she too was managed out of the organisation. New equipment sterilisation standards were being introduced and our organisation didn't like the cost of it, so I had to sort it. But a) I didn't have any experience in the area and b) it was an impossible task. The director of finance (why, why?) made it her job to kick me into shape. I went home and ended up in an anxiety state. My husband called a work colleague who was actually a doctor that night, as he was so shocked at what was happening to me. She explained that the chemicals in my body had shifted me into anxiety. It was an upsetting time. I remember calling my CEO to report sick. Something in my voice must have clicked with her, because she was the softest and warmest that I'd ever experienced. I like to think that so knew that she'd pushed me too far.
Today we have ‘ The People Plan’ urging us to move towards a culture of compassionate and inclusive leadership. I nearly cried when I read it-hands down the best publication I’ve seen from the NHS for years, not just because of the description of the leadership we need post pandemic but because it clearly identifies the 3rd sector as an equal partner. I’ve been 11 years in the social enterprise and charity sector, so have little idea of how much the People Plan is changing leadership and culture. I do know how emotional it was to be vaccinated, as a volunteer for a local charity, alongside NHS Staff. I felt valued as an equal. My fervent hope is that The People Plan is enacted and we care for and support each other as a system, rather than divide and rule.
* I've been vague about which boss and when things happened, to preserve anonymity
charity, alongside NHS staff, and felt for the first time, equally valued. My fervent hope for the future is that the People Plan prevails.