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OPINION

'A politically free NHS makes more sense than gangsta rap'

Many things bemuse me. The popularity of Cheryl Cole is an obvious example. Or gangsta rap – and I know I’m not the target audience but what is that all about?

Oh and people who got overly involved in the royal wedding, camping on the streets for a week, knitting a wicker hat to send to the happy couple, crying with joy or punching a foreigner in celebration of the whole regal shebang. Please understand I am not being anti-royal-wedding-fans here, and if you are a big fan of Snoop Biggy Flim Flam, don’t write in with your aggressive rhyming feeling all “disrespected bro”. I am expressing bemusement not opposition. I just don’t get it.

Indeed there are some social trends that have been around for ages that I have completely failed to get. Soap opera for example. Or kebabs. Or, perhaps less randomly, the industry that is nurse leadership.

A recent letter responding to my column about nursing and the public service cuts asked: “What should our leaders be doing differently to withstand the economic and political onslaught?”. I hope you’ll forgive me if I give the question some attention in the next two or three weeks because it’s a good one from an honourable source.

First things first though, let me say something in defence of people who do not lead but rather just carp on the sidelines criticising the compromises, confusion and misunderstanding that is so often the preserve of some “leaders”. Being a recognised leader is – regardless of whether you like it – an act of compromise. When someone signs up to lead, they sign up to the limits, internal logic and “rules”.  Choosing not to compromise and instead being a critical voice – whether you are a nurse, healthcare assistant or anyone else – is an understandable and legitimate choice. No matter where it occurs, it creates a mechanism of random accountability and long may it continue. Because, let’s face it, most of us have seen people who, driven by ambition, self belief and a desire to change things from within, become disarmed, reshaped and ultimately transformed by the compromises they have to make as leaders or managers. Some “leaders” are guided by what or who is above them and, if you are looking upwards when you walk, you don’t notice what or who you are treading on.

Of course that may be avoiding the issue so I offer this. Nursing is bound, to its detriment, by its insistence on deferring to whatever agenda it is presented by government. Nursing does not decide what should be talked about, it joins in with what it is told to discuss; it defers, it lacks confidence, it fits in. Maybe it needs to do something transformational, politically speaking. Instead of responding to the agenda of politicians, economists or unions, it ought to lead on something important, where others would follow. As advocates, guardians and care-givers, we should start with a campaign to make the NHS independent of government, to develop a charter of independence that safeguards patients and services against the ever-changing whims of political parties – a charter that genuinely modernises the health service.

Leadership is about vision; great leadership is about transcending limits. Leading a campaign that frees the NHS from government interference while establishing its rules, responsibilities and future would not only rescue healthcare, it would put nursing at the heart of decision-making and advocacy for a generation.

 

 

Readers' comments (12)

  • Nursing leadership that charters a politically free, Nurse led NHS focused on health and patient centred care.

    We can only dream of such leadership.

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  • Agreed Mark!

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  • The other thing that struck me is the question of if we are to remain under the auspices of governmental colleagues, then should we not demand that hose colleagues are in fact fit for purpose? I mean the chancellor at present has no economics study behind him, much less a qualification, Mr Lansley..does he have any qualification for health organisation or medical ethics/philosophy...apart from a GP wife of course? Which body is regulating the politicians to make sure they are fit to practice in their positions?

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  • Anonymous | 8-Jun-2011 3:50 pm Well said!!!!!

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  • michael stone

    'we should start with a campaign to make the NHS independent of government'

    Hmnnn ? It is the very fact that voters are attached to the NHS, and that being blamed for messing the NHS up terrifies all political parties, which is a major reason why we still have a 'free' health service !

    Too much 'independence' would put that at risk, surely ?

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  • Micheal I dont see why taking politics out of the equation would lead a sudden rush to privatisation. The public would still "own" the NHS as it would still be their taxes paying for it, and the constant political games that are played with the NHS are messing it up anyway.

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  • Michael I agree with Sarah on this one. The NHS should always be state owned, but it can still be so without the constant interference and political chess games from government.

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  • michael stone

    I agree about the constant interference - but I think you will always get that, while the Health Secretary 'gets the blame for things perceived by the public as wrong'.

    You need to be careful, in this area !

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  • I don't think the health secretary generally gets the blame, (even though they should the majority of the time), that is usually placed squarely on the shoulders of those on the front line, typically Nurses; any headlines in the comic book tabloids will attest to that. Lansley has faced a lot more criticism than his predecessors to be fair, but that is slightly different as both he and the government has faced such a huge backlash for his/the governments ridiculous and ill thought out policies.

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  • I don't work for the NHS, but I have worked with them for the last fifteen years. All I have seen, from my semi-outsiders position, is a seemingly endless moving of the goalposts to align with political needs and ideals that has significantly and negatively affected both the efficiency of the NHS and its ability to care for patients. I've often preached the fact that if the NHS was just given a little stability it might be able to sort out many of its long running issues and truly deliver the service its component parts should be capable of.

    Any move to detach the running of the NHS from politics is, in my view, a positive one. Yes we need to ensure a continuity of funding and that ultimate responsibility still rests with the state (though not, perhaps, with the government). But an NHS free of it's current, politically imposed, cyclical change might just be able to shine beyond anything it is currently delivering.

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  • michael stone

    I agree with you both, about the 'goalposts being continually moved', and other things as well.
    But goverment ministers don't usually sit back and do nothing, and when they do something (or if they haven't done anything at all, and something bad happens) they are committed to it: politicians do not have the 'test it and see' attitude of scientists. They decide on a policy, then defend it - they do not, from anything like a neutral perspective, 'test things out'.
    This is a general problem, for everything paid for by goverments.
    And, this 'perspective bias' point applies to everyone - if you claim that clinicians should control NHS behaviour, that is also wrong: it should be both clinicians AND patients, who 'design and assess' the way the NHS runs. And, clinicians are not experts in finance, so you get 'managers' involved, as well.
    The answer might lie in rather more discussion between people of different types, and rather less imposition of 'hierarchies' - it is very difficult !

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  • I fully agree that it is very difficult and I am not naive enough to imagine that the unhitching of the NHS from direct political control will solve all of it's problems. However, I am still a firm believer that it is an important first step in solving those problems.

    What we need is an integrated strategy that brings together all of the varied areas of the health service. and can be relied upon to remain stable, in essence if not in detail, over the longer term. That can only be acheived by removing direct political leadership because politicians (worryingly) are not incentivised to think long term.

    I am not too concerned about individual groups in the NHS complaining that they dont like new roles (everyone will complain about change, be it for better or worse) but I do think wide consultation is required and I don't think the NHS should be clinically run (there should be clinical input).

    Clinicians are generally good at helping patients and often good at tactical organisation but I wouldnt imagine it would be sensible for them to be doing management accounts, fleet management, human resources or building maintenance as part of their day to day responsibility. Like any big organisation a skilled management group will be required. The trick will be to prevent it becoming bloated and unwieldy.

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