What lessons can be learnt from reviving Per Una underwear to the 14 Keogh Trusts?

The left wing does business too.

Look at Alan Sugar.

Or maybe not.

Sir Stuart Rose, who was credited with rejuvenating Marks & Spencer during a turbulent six years as chief executive, has been hired to help revive the fortunes of failing hospitals in England.

In “Back in Fashion: How We’re Reviving a British Icon”, Sir Stuart Rose establishes his thinking about turning around the fortunes of Marks and Spencer, in an article in the Harvard Business Review.

In this article, Rose explained that he was a temporary “guardian of this great business and that my job is to leave it in better condition than I found it.”

On his eventual demise, Rose wants people to say, “He could have turned left but, thank God, he turned right.”

This of course is a tongue-in cheek reference to his known sympathies for the ideology of the Conservative Party. But on closer inspection his transformational agenda is not particularly right-wing in the sense that the principles are generally widely held.

In a move dubbed in Whitehall as “M&S meets NHS“, Rose will advise the health secretary Jeremy Hunt on how to build up a new generation of managers to transform failing hospitals. There will be a particular focus on the 14 NHS trusts placed in “special measures” last year.

One of his criticisms is that major decisions were being made by people not experienced enough to make them. But it will be interesting to see how he deals with CEOs of English Trusts, who are not clinically trained, who achieve good four-hour wait targets. And yet the management plans of the patients leaving A&E in those Trusts can be an unmitigated disaster for patient safety. Often, frontline staff in such Trusts are totally disenfranchised, and even discredited by their management.

“For those outside the UK, it is difficult to understand just how powerful the M&S brand is. It is a national institution. Two prime ministers, Margaret Thatcher and John Major, both famously said they bought their underwear at Marks & Spencer, just like nearly a third of the people in the UK.”

And of course the NHS is a powerful brand.

Rose is clearly a marketing guru at heart. The brand is so powerful that even private providers are allowed to use their intellectual property to market their services.

The early events Rose experienced are very revealing.

“Clearly, the battle hinged on our ability to convince reporters, analysts, and investors that I was the one to lead M&S back to prosperity. Having such intense scrutiny of you personally, as a leader, can cause self-doubt.”

One of the issues about Sir David Nicholson’s ability to lead his organisation is the extent to which he appeared ambivalent about the events at Mid Staffs.

Mike Farrar has also had such problems with the media.

Rose has previously spoken about the the “rock star” image and PR skills needed for those at the top of the world of business and politics. One thing that Nicholson and Farrar can’t be called are ‘rockstars’.

Rose warns, “Don’t Even Consider a Plan B”.

And yet it’s this ‘there is no alternative’ narrative which is causing disquiet for people running the NHS.

People are more than aware that some McKinsey ‘efficiency savings’ have in fact led to dangerous staff cuts in certain Trusts, compromising patient safety.

In “The only thing wider than the NHS funding gap is the policy vacuum’ by Colin Leys published in the Guardian today, Leys considers a number of different proposals for the ‘funding gap’.

Leys remarks,

“As a result, there is a policy vacuum, which the private health lobby is eagerly seeking to fill with renewed calls for charging and “top-ups”; in reality, these would do little to close the funding gap, but would mean the end of free and equal care for all. In the meantime, it seems that in official circles it is left to everyone except Hunt to suggest solutions: more “efficiency savings” (Sir David Nicholson); rationalisation, with fewer hospitals offering specialist care (Sir Malcom Grant); more specialist GPs and intermediate care provision (NHS England’s Dr Martin McShane); more self-care (NHS clinical commissioners); more telemedicine (the joint government-industry 3millionlives project).”

“As it became clear that one successful line could not, in reality, fuel a sustainable revival by itself, M&S suddenly discovered the allure of consultants. But for a company that had long prided itself on home-growing talent, the heralding of consultants to bring in “fresh” ideas sent a damaging message throughout the ranks.”

It is well known that the NHS has had trouble in generating home grown talent in management, symbolically heralded by the appearance of Simon Stevens from an US healthcare provider to head up  the NHS.

“One of the most important messages I wanted to send to our staff was that they should trust their own judgment again.”

But this is the very essence of one of the toxic problems of the NHS.

Certain frontline staff, especially juniors, don’t have a say on what is going wrong with patient care, because of some seniors pursuing targets. If Rose is serious, he will need to talk to frontline staff to find out what problems there have been with patient care, and why.

He may find a lot of it does come down to the fact there is an unsafe staffing level, but they’ve had no-one to report their concerns to in a meaningful way.

Another problem comes to analysis of the ‘offering’.

“Then we made changes closer to home. The most symbolic thing we did was to have a massive housecleaning. Because there were so many different subbrands in our shops, we had lots of signage and titles and names on cardboard cluttering up our stores.”

Between NHS hospitals in the round, they need to offer a comprehensive offering, and not miss out any rare diseases. But here the acccusation for cherry-picking for profitability becomes particularly pertinent.

The difference in ethos between the NHS and M&S has parallels with the differences between UK state prisons and US private prisons.

In US private prisons, prisoners are able to pay for a better room – in other words, as US prisons are designed to make money, this creeps into other activities of prisons.

“The stores looked dated. We weren’t in the same league as trendier retailers like Zara, Next, and Topshop. It was the beginning of a major store-by-store refurbishment program, which cost us more than £500 million by the end of 2006, with an additional £800 million earmarked after that.”

Many people are indeed impressed by the brand-new spanky new hospitals funded by PFI, but find horrific the idea of hospitals looking like hotels a bit nauseating if there’s insufficient money to staff them properly.

But Rose is known to be very keen on showing visibly the hallmarks of his ‘turnout’.

Presumably Rose will want there to be external markers of turning around the Keogh Trusts.

But that’s admittedly another problem, and why Rose’s medicine is ‘too generic’. It is all too easy for clinical staff to be forced to cover up bad care because of not wishing to get into trouble with their regulators and a lack of duty of candour (not necessarily working independently.)

The danger is that the Keogh hospitals end up ‘looking nice’ but are still as dangerous/safe as previously.

“Having cut so many staff from a business as culturally embedded as ours, I had to spend probably 90% of my time over the next six months convincing people who were already pretty disillusioned that we were making progress.”

It’s well known that Rose cut thousands of staff to stem the fall in drop in profits.

The problem with the NHS, more so than with M&S possibly, is that it might be easier to find alternative employment for staff in the NHS about to be made redundant.

And the idea of the need to make staff redundant is still a problematic one for the NHS.

This is because, despite the urge for ‘efficiency savings’, the demand in the NHS has been traditionally described in rather hyperbolic terms such as “exponential”. In other words, the messaging problem for those who want to cut staff numbers in the NHS is that the demand on the NHS is huge.

And if the Government wishes to feed the demand, such as a ‘seven days a week service’, the demand is by definition going to get greater, unless you literally vary unilaterally employment contract terms for Consultants and their junior staff.

It is said, furthermore, that Rose is known for taking a personal interest in his customers’ thoughts on his products – he once arranged a meeting with Jeremy Paxman following the BBC presenter’s criticism of M&S men’s underwear.”

But the actual experience of many who have complained about the NHS is that complaints get sat on.

Rose was knighted in 2007 for services to the retail industry and corporate social responsibility, had worked his retail magic.

But corporate social responsibility in the NHS will not be achieved by green light bulbs or clever marketing.

There needs to be a genuine ‘investment in staff’. Trades unions for nurses and other clinical staff cannot be any longer totally ignored in policy decisions regarding the NHS.

The Health and Social Care Act (2012) was itself a monumental failure of the mantra, “no decision about me without me.” So were the decisions about the Lewisham decided in the second and third highest courts of the land.

“We’d also finally regained our stride in advertising and marketing. We led from the food side of the business, because it had suffered less than the clothing side and for that reason was seen as our stronger asset.”

For the NHS, Rose will have to concede that a bone marrow transplant for a rare blood disorder is as important as a hernia operation for the patient involved. But this is where a left-wing twang, regarding equity, might be significant after all.

How will Rose know when his Trusts have got better?

A cosmetic refurbishment, realigment of the product offerings, or better marketing are not the solutions.

They are too generic for retail, and not appropriate for this sector.

As someone else might say, he is hitting the target but missing the point?