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Steve Smith

By Roy Lilley Re-blogged with permission. Click here to see the original version


I'm guessing you won't be able to tell me, who is Arthur B. Sleigh? He was a colonel in the British Army and his big claim to fame, in 1855, he started publishing the Daily Telegraph. He couldn't pay the printing bill so he was forced to sell the banner to his publisher Joseph Levy.

Levy re-launched the Telegraph, at one penny, the cheapest newspaper in London. By January 1856 the Telegraph circulation was the biggest; 27,000. Today, the Telegraph's circulation is 544, 000 and is 5th on the ABC list.   The paper was dubbed, by Private Eye, the Torygraph.

The Torygraph NHS coverage is at the tender mercy of the energetic Laura Donnelly who writes, relentlessly, of NHS failures, foibles and misfortunes. I hope she will forgive me but I'm afraid I've stopped reading her as the incessant diet of failure is too much for my delicate constitution. :-) 

However, I happened across a non-Donnelly, Telegraph story that probably, inadvertently takes the lid off one of the most crucial policy failings the NHS is facing; how cack-handed policy can create a fault-line across the fortunes and futures of hospitals. The story, by Steven Swinford and Olivia Rudgard is about staff shortages:

"(A Telegraph survey has found) ... Hospitals at the centre of patient-care scandals are facing significant shortages of senior doctors and nurses... up to a fifth of posts for senior doctors and one in 10 positions for nurses is going unfilled at three NHS trusts that have been investigated over high death rates."

The report continues; FoI requests ... across 63 NHS trusts... found that average vacancy rates for doctors are 4.5 per cent and for nurses 6.3 per cent. Taken across the NHS, the figures suggest it is facing a shortage of 15,000 nurses and 4,000 doctors.

Significantly the Torygraph singles out a number of familiar, 'troubled' Trusts: Mid Staffs, a shortage of 66 nurses - equivalent to around one in 10 posts... it also has the highest levels of vacancies among consultants, with nearly a fifth of posts unfilled by permanent staff; Basildon and Thurrock is facing a shortage of 162 nurses, equivalent to a vacancy rate of 11 per cent... the trust was put into special measures last year after being investigated over high death rates; United Lincolnshire, which was also investigated by the Keogh review over high death rates, had 10 per cent of its consultant positions left vacant; Havering and Redbridge... 13% vacancies among consultants.

What does this tell us? Give a dog a bad name and hang him... so the saying goes. The sticking power of labels.

We could label people as heroic and organisations as busting a gut. We could call hospitals successful or we could say challenged, faced with difficulties, working through problems, confronted, risk managing, taking on challenges, withstanding pressures, suffering from a melting local health economy, defying overwhelming demographic pressure, dealing with history, managing a legacy... or we could just label them 'failing'.

Swinford and Rudgard have put 2 and 2 together, done the maths and realised, if a hospital is in trouble and gets the wrong label, given the option, the evidence is; talent won't want to work there.

With ease, the ham-handed, careless use of language reduces Trusts in the maelstrom of financial woes (not of their making), demographic pressures (not of their making) from difficult to recover to well-nigh impossible.

Clod-hopping inspection regimes, designed to find fault, will create fault lines as the pressure of employing people (who can transport their talent to pretty well anywhere else in the UK and the English speaking world) crushes an organisation, reduces efficiency and threatens quality. The whole process sucks troubled organisations from difficult to run into a vicious vortex of decline, ending in dysfunctional.

Dr Shirt-Off, health minister said; "... if poor staffing levels compromise the care of patients, the chief inspector of hospitals will step in."

'Step in' and do what, exactly? More reputational damage; 'step in' with another label; 'step in' and make it even more difficult to employ career grade staff. 'Step in', put the boot in and trample all hopes of a recovery?

If studying the work of the great management gurus, who tell us inspection and criticising struggling organisations and exhausted people doesn't work, then ignore Deming, Porter, Peters, Kano, Chowdrey, Haque, Christiensen, Moss-Kanter, Amabile and the like.

Let's make it Bozo simple; just read Swinford and Rudgard in the Torygraph.


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