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Change
Somebody once advised me in my 20s that destiny is when luck meets preparation.
When I was younger, I used to think that you could prepare yourself out of any situation. But wisdom and events proved me wrong. I soon discovered that what you did yesterday though can affect today, and what can affect today can affect tomorrow. The only thing you can predict pretty comfortably, apart from death and taxes, is change. When I was younger, I used to think I could live forever. All this changed when I woke up newly physically disabled, after a six week coma on a life support machine on the Royal Free Hampstead. The National Health Service saved my life. Indeed, the on call Doctor who led the crash team the day of my admission, when I had a cardiac arrest and epileptic seizure was in fact a senior house officer with me at a different NHS trust in London.
This feeling of solidarity has never left me. I do also happen to believe that anything can happen to anybody at any time. I studied change academically in my MBA in the usual context of change management and change leadership. It’s how I came to know of Helen Bevan’s work. I’ve thought a lot about that and the highly influential Sirkin paper. But I don’t think I honestly ‘got‘ change until this year. In 2007, I was forced to change, giving up alcohol for life. I realised that if I were to have another drink ever I would never press the off switch; I would either end up in a police cell or A&E, and die. This is no time for hyperbole. It was this forced change, knowing that I had an intolerance of alcohol as serious as a serious anaphylactic shock on eating peanuts, that heralded my life in recovery. I later came to describe this to both the legal regulator and the medical regulator as the powerful driver of my abstinence and recovery, rather than a ‘fear based recovery‘ from either professional regulator.
But I feel in retrospect my interpretation of this change, as due totally to an externality, is incorrect. As I used to attend my weekly ‘after care’ sessions with other people newly in abstinence from alcohol or other toxins, or from gambling, or sex, I discovered that the only person who can overcome the addiction is THAT person; and yet it is impossible to read about this path of recovery from a book, i.e. you can’t do it on your own. So ‘command and control’ is not the answer after all. Becoming physically disabled, and a forced change of career and professional discipline, and a personal life which had become obsessed by alcohol, meant I had no other choice. I had to ‘unclutch’ myself gear-wise from the gear that I was in, and move into a different gear. But I did find my new life, living with mum, and just getting on with my academic and practitioner legal and business management training intensely rewarding.
In 2014, I attended a day in a hotel close to where I live, in Swiss Cottage. One of the speakers was Prof Terence Stephenson. After his speech, I went up to thank him. I found his talk very moving. He was later to become the Chair of the General Medical Council (GMC). I was later to become regulated once again by the GMC. Two lines of his has kept going through my mind repeatedly since then. The subject of the day was how sick doctors might get salvation despite the necessary professional regulation process. Stephenson claimed: “If you’re not happy about things, I strongly urge you to be part of the change. You being part of the change will be much more effective than hectoring on the sidelines.” This was not meant as any threat. And as I came to think more and more about this I came to think of how much distress my behaviour had caused from my illness, how I wish I had got help sooner, and how looking for someone to something to blame was no longer a useful use of my energies. I am now physically disabled. I get on with pursuing a passion of mine, which is promoting living better with dementia. But if there are any people who are worthy of retribution I later decided then their karma might see them implode with time. Not my problem anyway.
I now try to encourage others where possible if they feel that they have hit rock bottom; I strongly believe that it’s never too late for an addict to break out of the nasty cycle. If you think life is bad, it unbelievably could be much worse. I think businesses like persons get comfortable with their own existence and their own culture, but need to adapt if their environment needs it. I think no-one would wish to encourage actively social care on its knees such that NHS patients cannot be discharged to care, if necessary, in a timely fashion. I don’t think anyone designing the health and care systems would like them to be so far apart deliberately, with such bad communication between patients, persons and professionals. Above all, I feel any change has to be authentic, and driven by people who really desperately want that change. I think change is like producing a work of cuisine; you can follow the recipe religiously in the right order, but you can recognise whether the end result has had any passion put behind it. For me, I don’t need to ‘work hard’ at my recovery, any more. I haven’t hit the ‘pink cloud‘ of nirvana, but I am not complacent either. Change was about getting from A to B such that I didn’t miss A, I was in a better place, and I didn’t notice the journey. If I had super-analysed the change which was required to see my recovery hit the seven year mark this year, I doubt I would have achieved it.
Labour needs to keep scrutinising PFI and the NHS
Nigel Farage’s supporters often say that at least UKIP is forcing the main political parties onto the ‘immigration agenda’, despite the main parties not wishing to discuss immigration.
Critics have argued that UKIP have discussed moving the NHS towards a private insurance system, whereas Nigel Farage, leader of UKIP, on Question Time, argued that the matter had indeed been discussed but later rejected by their party.
It is reported that the Labour Party wishes to make the NHS its ‘number 1 electoral priority’, and that Lynton Crosby, the current strategist and tactician for the Conservative Party, is desperate not to make it so.
Labour themselves have criticised heavily how PFI represented poor value for the NHS, while most people generally concede that the NHS has suffered from lack of capital for its various necessary infrastructure projects.
“Take the PFI contracts – the private finance initiatives”, Farage mentioned on Question Time in a lengthy answer on the NHS.
Through PFI, large debts have been stored up for future taxpayers – at some stage need to be repaid. PFI debts do not form part of the deficit balance sheet.
“New hospitals were built, but rather than going to borrow money rather than going to the gilts market in that horrible City place, where they’re all crooks, Labour went to really rich people in private equity – and we borrowed £50 billion sterling to build new hospitals, which we built, but the repayments are £300 billion sterling.”
PFI deals were invented in 1992 by the Conservative government led by Sir John Major, but became widespread under Labour after 1997.
The schemes usually involved large scale buildings such as new schools and hospitals, or infrastructure projects which would previously have been publicly funded by the Treasury.
The projects are put out to tender with bids invited from building firms and developers who put in the investment, build new schools, hospitals or other schemes and then lease them back.
Love them or loathe them, the people in the City understand finance.
I suspect Nigel Farage does too.
Debt finance is a loan – an “IOU” – where you pay back the money, together with debt interest payments.
Equity finance is the bread-and-butter of the City and its lawyers.
For a pot of money, you buy a stake in a project which you can later sell at a profit. The critical thing about equity finance, which is why some people don’t like it, is that this stake buys you a slice in the management and control of projects.
Equity financiers, by buying stakes in PFI, exert from a distance a lot of control on our current NHS. This is a subject that no mainstream politician wishes to talk about; except…. bless him… Nigel Farage.
Nigel Farage may have become public enemy number 1 over their previous commments suggestive of privatising the NHS, but it is still not out of the question that Nigel Farage or Alex Salmond become Deputy Prime Minister in a formal coalition or a supply-and-confidence government led by Labour following May 8th 2015.
According to a Guardian analysis of contracts that were sanctioned by the Treasury dating from 2012, the cost of Britain’s controversial private finance initiative will continue to soar for another five years and end up costing taxpayers more than £300bn.
Andy Burnham MP continues to argue that Labour will return to the NHS to ‘people before profit’.
But Burnham has previously admitted PFI is problematic.
And all the mood music sounds as if Burnham is ‘seeing red over PFI’. Literally.
“We made mistakes. I’m not defending every pen-stroke of the PFI contracts we signed.”
Due to the costs of PFI, many NHS hospitals have found themselves struggling to pay for safe staffing in their budgets. It was recently reported that half of NHS workers would not receive a 1% pay rise.
Despite recent coalition criticism suggesting that the government was going cold on the scheme, published figures from the current Government have indicated that repayments will continue ballooning until they peak at £10.1bn a year by 2017-18.
According to the Guardian newspaper from 2012, the 717 PFI contracts currently under way across the UK are funding new schools, hospitals and other public facilities with a total capital value of £54.7bn, but the overall ultimate cost will reach £301bn by the time they have been paid off over the coming decades.
Equity investors have helped to deliver many public sector infrastructure projects via the Private Finance Initiative and have managed them in ways from which the public sector can learn.
Against a background of limited information, evidence gathered by the National Audit Office raises concern that the public sector is paying more than it should for equity investment. This report was published in February 2012.
The report still makes for interesting reading.
“Banks or bondholders provide around 90 per cent of the project funding for a PFI project on the condition that the remaining money is provided by the investors as risk capital or equity, which will be lost first if the project runs into difficulty.”
“Investors are rewarded for taking risks. The risks the investors bear are mainly the costs of bidding; that their contractors may fail to perform; or that other project costs the investors bear the risk for will be higher than envisaged. However, the investors limit their risk by passing it to their contractors. In addition, the government is a very safe credit risk and many projects such as hospitals and schools are repeat projects.”
“The Treasury and departments to date have relied on competition to secure efficient pricing of the contract but have not gathered systematic information to prove the pricing of equity is optimal. The NAO report identifies three potential inefficiencies in the pricing of equity. These are the time and costs of bidding; minimum rates set by investors, which sometimes do not reflect the actual risks the project will face; and bank requirements.”
The NAO report argued that, generally, public sector authorities have not been equipped with the skills and information required to challenge investors’ proposed returns rigorously. The NAO shows how further analysis during the bidding process would help authorities to assess the reasonableness of the investor returns. As an illustration, the NAO estimates that around 1.5 per cent to 2.2 per cent of the annual service payments in three projects it analysed were difficult to explain in terms of the main risks investors said they were bearing.
“Some investors in successful projects have gone on to sell shares in their equity to release capital and fund new projects. This has also resulted in accelerating the receipt of their returns. Analysis by the NAO has shown that investors selling shares early have typically earned annual returns of between 15 per cent and 30 per cent. The NAO recommends that the Treasury should use its current review of PFI to consider alternative investment models that limit the potential for very high investor returns in relation to risk.”
A future Labour Government will have to confront PFI, as it is an integral component of why the NHS is facing difficulties. A future Government could have the power to cancel or substantially renegotiate PFI projects where it could be proved that taxpayers were not receiving value for money.
It is also critical that the Government has the critical skills and expertise to use its huge buying power to obtain better deals, if it remains keen to pursue this policy route. It is already hardly coping with the deluge of contracts being put out to tender under section 75 Health and Social Care Act (2012), but Labour plans to repeal that Act in its first Queen’s Speech of the next parliament.
Unfortunately, total repeal of the Health and Social Care Act (2012) will have absolutely no effect on the operational or strategic management of PFI in the NHS.
Margaret Hodge has thankfully spoken out very vociferously about the problems with PFI under successive Governments.
“A rotten deal”
I agree with Margaret (full account here).
Andy needs to keep up the pressure on this.
Is the pilot always to blame if things go wrong in a safety-compliant plane in the NHS?
The “purpose” of an air plane crash investigation is apparently as set out in the tweet below:
It seems appropriate to extend the “lessons from the aviation industry” in approaching the issue of how to approach blame and patient safety in the NHS. Dr Kevin Fong, NHS consultant at UCHL NHS Foundation Trust in anaesthetics amongst many other specialties, highlighted this week in his excellent BBC Horizon programme how an abnormal cognitive reaction to failure can often make management of patient safety issues in real time more difficult. Approaches to management in the real world have long made the distinction between “managers” and “leaders” and it is useful to consider what the rôle of both types of NHS employees might be, particularly given the political drive for ‘better leadership’ in the NHS.
In corporates, reasons for ‘denial about failure’ are well established (e.g. Richard Farson and Ralph Keyes writing in the Harvard Business Review, August 2002):
“While companies are beginning to accept the value of failure in the abstract-at the level of corporate policies, processes, and practices-it’s an entirely different matter at the personal level. Everyone hates to fail. We assume, rationally or not, that we’ll suffer embarrassment and a loss of esteem and stature. And nowhere is the fear of failure more intense and debilitating than in the competitive world of business, where a mistake can mean losing a bonus, a promotion, or even a job.”
Farson and Keyes (2011) identify early-on for potential benefits of “failure-tolerant leaders”:
“Of course, there are failures and there are failures. Some mistakes are lethal-producing and marketing a dysfunctional car tire, for example. At no time can management be casual about issues of health and safety. But encouraging failure doesn’t mean abandoning supervision, quality control, or respect for sound practices, just the opposite. Managing for failure requires executives to be more engaged, not less. Although mistakes are inevitable when launching innovation initiatives, management cannot abdicate its responsibility to assess the nature of the failures. Some are excusable errors; others are simply the result of sloppiness. Those willing to take a close look at what happened and why can usually tell the difference. Failure-tolerant leaders identify excusable mistakes and approach them as outcomes to be examined, understood, and built upon. They often ask simple but illuminating questions when a project falls short of its goals:
- Was the project designed conscientiously, or was it carelessly organized?
- Could the failure have been prevented with more thorough research or consultation?
- Was the project a collaborative process, or did those involved resist useful input from colleagues or fail to inform interested parties of their progress?
- Did the project remain true to its goals, or did it appear to be driven solely by personal interests?
- Were projections of risks, costs, and timing honest or deceptive?
- Were the same mistakes made repeatedly?”
It is incredibly difficult to identify who is ‘accountable’ or ‘responsible’ for potential failures in patient safety in the NHS: is it David Nicholson, as widely discussed, or any of the Secretaries of States for health? There is a mentality in the popular media to try to find someone who is responsible for this policy, and potentially the need to attach blame can be a barrier to learning from failure. For example, Amy C Edmondson also in the Harvard Business Review writes:
“The wisdom of learning from failure is incontrovertible. Yet organizations that do it well are extraordinarily rare. This gap is not due to a lack of commitment to learning. Managers in the vast majority of enterprises that I have studied over the past 20 years—pharmaceutical, financial services, product design, telecommunications, and construction companies, hospitals, and NASA’s space shuttle program, among others—genuinely wanted to help their organizations learn from failures to improve future performance. In some cases they and their teams had devoted many hours to after-action reviews, post mortems, and the like. But time after time I saw that these painstaking efforts led to no real change. The reason: Those managers were thinking about failure the wrong way.”
Learning from failure is of course extremely important in the corporate sectors, and some of the lessons might be productively transposed to the NHS too. This is from the same article:
However, is this is a cultural issue or a leadership issue? Michael Leonard and Allan Frankel in an excellent “thought paper” from the Health Foundation begin to address this issue:
“A robust safety culture is the combination of attitudes and behaviours that best manages the inevitable dangers created when humans, who are inherently fallible, work in extraordinarily complex environments. The combination, epitomised by healthcare, is a lethal brew.
Great leaders know how to wield attitudinal and behavioural norms to best protect against these risks. These include: 1) psychological safety that ensures speaking up is not associated with being perceived as ignorant, incompetent, critical or disruptive (leaders must create an environment where no one is hesitant to voice a concern and caregivers know that they will be treated with respect when they do); 2) organisational fairness, where caregivers know that they are accountable for being capable, conscientious and not engaging in unsafe behaviour, but are not held accountable for system failures; and 3) a learning system where engaged leaders hear patients and front-line caregivers’ concerns regarding defects that interfere with the delivery of safe care, and promote improvement to increase safety and reduce waste. Leaders are the keepers and guardians of these attitudinal norms and the learning system.”
Whatever the debate about which measure accurately describes mortality in the NHS, it is clear that there is potentially an issue in some NHS trusts on a case-by-case issue (see for example this transcript of “File on 4″‘s “Dangerous hospitals”), prompting further investigation through Sir Bruce Keogh’s “hit list“) Whilst headlines stating dramatic statistics are definitely unhelpful, such as “Another nine hospital trusts with suspiciously high death rates are to be investigated, it was revealed today”, there is definitely something to investigate here.
Is this even a leadership or management thing? One of the most famous distinctions between managers and leaders was made by Warren Bennis, a professor at the University of Southern California. Bennis famously believes that, “Managers do things right but leaders do the right things”. It is argued that doing the right thing, however, is a much more philosophical concept and makes us think about the future, about vision and dreams: this is a trait of a leader. Bennis goes on to compare these thoughts in more detail, the table below is based on his work:
Differences between managers and leaders
Indeed, people are currently scrabbling around now for “A new style of leadership for the NHS” as described in this Guardian article here.
Is patient safety predominantly a question of “teamwork”?
Amalberti and colleagues (Amalberti et al., 2005) make some interesting observations about teamwork and professionalism:
“A growing movement toward educating health care professionals in teamwork and strict regulations have reduced the autonomy of health care professionals and thereby improved safety in health care. But the barrier of too much autonomy cannot be overcome completely when teamwork must extend across departments or geographic areas, such as among hospital wards or departments. For example, unforeseen personal or technical circumstances sometimes cause a surgery to start and end well beyond schedule. The operating room may be organized in teams to face such a change in plan, but the ward awaiting the patient’s return is not part of the team and may be unprepared. The surgeon and the anesthesiologist must adopt a much broader representation of the system that includes anticipation of problems for others and moderation of goals, among other factors. Systemic thinking and anticipation of the consequences of processes across depart- ments remain a major challenge.”
Weisner and colleagues (Weisner et al., 2010) have indeed observed that:
“Medical teams are generally autocratic, with even more extreme authority gradient in some developing countries, so there is little opportunity for error catching due to cross-check. A checklist is ‘a formal list used to identify, schedule, compare or verify a group of elements or… used as a visual or oral aid that enables the user to overcome the limitations of short-term human memory’. The use of checklists in health care is increasingly common. One of the first widely publicized checklists was for the insertion of central venous catheters. This checklist, in addition to other team-building exercises, helped significantly decrease the central line infection rate per 1000 catheter days from 2.7 at baseline to zero.”
M. van Beuzekom and colleagues (van Beuzekom et al., 2013) and colleagues, additionally, describe an interesting example from the Netherlands. Teams in healthcare are co-incidentally formed, similar to airline crews. The teams consist of members of several different disciplines that work together for that particular operation or the whole operating day. This task-oriented team model with high levels of specialization has historically focused on technical expertise and performance of members with little emphasis on interpersonal behaviour and teamwork. In this model, communication is informally learned and developed with experience. This places a substantial demand on the non-clinical skills of the team members, especially in high-demand situations like crises.
Bleetman and colleagues (Bleetman et al., 2011) mention that, “whenever aviation is cited as an example of effective team management to the healthcare audience, there is an almost audible sigh.” Debriefing is the final teamwork behaviour that closes the loop and facilitates both teamwork and learning. Sustaining these team behaviours depends on the ability to capture information from front-line caregivers and take action. In aviation, briefings are a ‘must-do’ are not an optional extra. They are performed before every take-off and every landing. They serve to share the plan for what should happen, what could happen, to distribute the workload efficiently and to prevent and manage unexpected problems. So how could we fit briefings into emergency medicine? Even though staff may be reluctant to leave the computer screen in a busy department, it is likely to be worth assembling the team for a few minutes to provide some order and structure to a busy department and plan the shift.
Briefing points apparently could cover:
- The current situation
- Who is present on the team and their experience level
- Who is best suited to which patients and crises so that the most effective deployment of team members occurs rathe than a haphazard arrangement
- The identification of possible traps and hazards such as staff shortages ahead of time
- Shared opinions and concerns.
The authors describe that, “at the end of the shift a short debriefing is useful to thank staff and identify what went well and what did not. Positive outcomes and initiatives can be agreed.”
Is patient safety predominantly a question of “leadership”?
The literature identifies that overall team members are important who have a good sense of “situational awareness” about the patient safety issue evolving around them. However, it is being increasingly recognised that to provide effective clinical leadership in such situations, the “team leader” needs to develop a certain set of non-clinical skills. This situation demands more than currency in advance paediatric life support or advanced trauma life support; it requires the confidence (underpinned by clinical knowledge) to guide, lead and assimilate information from multiple sources to make quick and sound decisions. The team leader is bound to encounter different personalities, seniority, expectations and behaviours from members of the team, each of whom will have their own insecurities, personality, anxieties and ego.
Amalberti and colleagues (Amalberti et al., 2005) begin to develop a complex narrative on the relationship between leadership and management (and the patients whom “they serve”):
“Systems have a definite tendency toward constraint. For example, civil aviation restricts pilots in terms of the type of plane they may fly, limits operations on the basis of traffic and weather conditions, and maintains a list of the minimum equipment required before an aircraft can fly. Line pilots are not allowed to exceed these limits even when they are trained and competent. Hence, the flight (product) offered to the client is safe, but it is also often delayed, rerouted, or cancelled. Would health care and patients be willing to follow this trend and reject a surgical procedure under circumstances in which the risks are outside the boundaries of safety? Physicians already accept individual limits on the scope of their maximum performance in the privileging process; societal demand, workforce strategies, and competing demands on leadership will undermine this goal. A hard-line policy may conflict with ethical guidelines that recommend trying all possible measures to save individual patients.”
Conclusion
Even if one decides to blame the pilot of the plane, one has to wonder the extent to which the CEO of the entire airplane organisation might to be blame. The question for the NHS has become: who exactly is the pilot of plane? Is it the CEO of the NHS Foundation Trust, the CEO of NHS England, or even someone else? And rumbling on in this debate is whether the plane has definitely crashed: some relatives of passengers are overall in absolutely no doubt that the plane has crashed, and they indeed have to live with the wreckage daily. Politicians have then to decide whether the pilot ought to resign (has he done something fundamentally wrong?) or has there been something fundamentally much more distal which has gone wrong with his cockpit crew for example? And, whichever figurehead is identified if at all for any problems in this particular flights, should the figurehead be encouraged to work in a culture where problems in flying his plane have been identified and corrected safely? And finally is this is a lone airplane which has crashed (or not crashed), and are there other reports of plane crashes or near-misses to come?
References
Learning from failure
Farson, R. and Keyes, R. (2002) The Failure Tolerant Leader, Harvard Bus Rev, 80(8):64-71, 148.
Edmondson, A. Strategies for learning from failure, Harvard Bus Rev, ;89(4):48-55, 137.
Patient safety
Amalbert, R., Auroy, Y., Berwick, D., and Barach, P. (2005) Five System Barriers to Achieving Ultrasafe Health Care, Ann Intern Med, 142, pp. 756-764.
Bleetman, A., Sanusi, S., Dale, T., and Brace, S.(2012) Human factors and error prevention in emergency medicine, Emerg Med J, 29, pp. 389e393. d
Federal Aviation Administration, Section 12: Aircraft Checklists for 14 CFR Parts 121/135 iFOFSIMSF.
Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S., Sexton, B., Hyzy, R., Welsh, R., Roth, G., Bander, J., Kepros, J., and Goeschel, C. (2006) An intervention to decrease catheter-related bloodstream infections in the ICU, N Engl J Med, 355, pp. 2725–32.
van Beuzekom, M., Boer, F., Akerboom, S., and Dahan, A. (2013) Perception of patient safety differs by clinical area and discipline, British Journal of Anaesthesia, 110 (1), pp. 107–14.
Weisner, T.G., Haynes, A.B., Lashoher, A., Dziekman, G., Moorman, D.J., Berry, W.R., and Gawande, A.A. (2010) Perspectives in quality: designing the WHO Surgical Safety Checklist, International Journal for Quality in Health Care, 22(5), pp. 365–370.
David Cameron's brand of "pragmatic politics" is not likely to be a vote winner
For some time, I have been worried about the perception of David Cameron by Prof. Vernon Bogdanor, at Brasenose College, Oxford, as a “classic Tory pragmatist”, that he is an “instinctive Conservative”. Bogdanor feels, apparently, that the closest comparison is with Harold Macmillan or Stanley Baldwin. In a way which I can understand, it is symptomatic of a Government which ‘is in office but not in power’, as Norman Lamont so famously said of a previous Conservative administration. Attempts deconstructing Cameron’s biographical roots appear to have overall drawn a blank, although Jason Cowley’s attempt in the New Statesman does not unearth evidence for a strong ideological passion. Cameron simply looks like a person who has been at the right place at the wrong time, or the wrong place at the right time, but never unfortunately the right place at the right time; although due to misfortune rather than design he seems to have attracted also the wrong people at the wrong time, such as Andy Coulson and Rebekah Brooks who through alleged activities at News International face severe allegations from the Crown Prosecution Service.
The word ‘pragmatist’ means in political circles means, to a large degree, that he is a consensus politician; it is a matter of personal preference whether you embue into that a sense of compassion. I sense that Cameron would like to be seen to make tough decisions, such as exposing the NHS to the full opportunities and challenges of operating in a regulated market, or by taking certain legal services, such as welfare benefits legal advice, out of scope simply because we cannot as a country afford it. Further, it has been observed that Cameron, in his general style of decision-making, has shown raw pragmatism in trying to minimise the negative aspects of policy, particularly in areas of immigration, Euroskepticism, and multiculturalism. However, the ultimate denouement of this nature of politics has fundamentally been exactly the same problem faced by a business wishing to take into account views of its stakeholders – what Ed Miliband calls ‘responsible capitalism’, but what the recent of the business and legal fraternity have known for ages as ‘corporate social responsibility’. That denouement is that it is actually impossible to reconcile all of the views all of the time, and, as in many multinational corporates, some views will simply be irreconcilable.
As a style of leadership, it means that David Cameron is not a leader, but a manager – given the nature of the Coalition politics, some will necessarily view him, in fact, as a ‘caretaker manager’. It’s what the late great Prof. Peter Drucker would call ‘doing things right’ typical of managers, rather than ‘doing the right things’, typical of leaders. David Cameron cannot unfortunately rely on natural charisma necessarily, though few of us have met him. The media have been effective in painting a view, and the public have been keen to accept the depiction, of Cameron as a Bullingdon Flashman-type figure, completely at odds with Cameron wishing to present himself as a one-nation Tory, certainly very far away from Benjamin Disraeli’s character or performance. The ‘come on Dear’ putdowns to Angela Eagle may have been a flashman-in-the-pan, but it is fact that he can call Nadine Dorries ‘frustrated’ to roars of public which attracts concern from the spin-doctors of the Conservatives. As a leader, possibly Cameron is a ‘transformational’ leader, but he has in fact, with the help of George Osborne, transformed the country from a deficit to an even bigger deficit; whatever deficit he has paid off, the benefit paid out coupled with decreased income till receipts and horrendous growth, meant that plan A has objectively failed, and the Government had to swallow their pride yesterday. The investment policy is better late than never for Keynesians, but there is a definite sense of lost time, such that most economists believe that the UK will not emerge from recession until 2018-2020.
This all puts Ed Miliband and Ed Balls in a tricky position. People will be quick to criticise any agreement with austerity at the time of the General Election, but Ed Balls has a powerful morale high-ground in being able to claim that the double-dip recession was exactly as he had predicted. Sunder Katwala in 2010 warned a meeting of ‘Next Left’ of the Fabian Society in Manchester that, even if the programme of austerity worked, the social damage to the UK would take many years to recover from. Since then, austerity has been totally discredited in Europe. All of this of course assumes that David Cameron is solely pragmatic, but lacks an ideological mantra.
I do not believe David Cameron lacks an ideological mantra, he may be pragmatic, but his policies are entirely impractical. His ‘pragmatic’ policies have seen the deficit get worse, the raison d’etre of the coalition, even if there had been an initial element of ‘crisis’ which had brought the Conservatives and the Liberal Democrats together. His economic policy was an ideological rejection of investment in the UK; it is a fact that stopping the ‘Building Schools for the Future’ starved investment in the country, leading the Q3/4 2010 construction industry growth figures to deteriorate, precipitating the overall decline of the weak recovery in the UK. This fact is a clear prediction of Keynes’ General Theory of 1948, a school of thought from meaning leading economists, wilfully rejected by Cameron.
I also believe that David Cameron’s doctrine is not simply to ‘make the state smaller’. He has a specific ambition to outsource or subcontract the state, and we have seen this policy run into clear difficulties as the general public reject the notion of unaccountable people in the private sector taking no responsibility for catastrophes in policing to security. The behaviour of private sector organisations in generating money through illegal or unlawful means has also shocked the general public, illustrated by the A4e, News International and Barclays scenarios. Whilst it is a complicated argument, this argument, best seen as mostly ideological but partly pragmatic, is not one which the public appear to support. The largest democratic movement in England, the Unions, are furthermore keen to represent the statutory duties of employers, or overzealous corporate directors, although their scope for shareholder activism is somewhat muted by the English courts at present.
David Cameron is best seen as a manager, but in meantime it is very unfortunate that George Osborne has murdered the economy in the UK, either through a mens rea of intention to kill the recovery through rejection of Keynesian economics, or through extremely recklessness (or incompetence) rather in running the economy. With Cameron through a highly ideological, but perhaps pragmatic, management procedure in outsourcing the State, the public is already noticing a clear lack of leadership in any time. It is this rejection of what the Conservatives stand for, illustrated by mismanagement of the last budget despite seeing a tax concession for the highest income citizens of the UK, will mean that this is possibly not the wrong time to demonstrate this particular style of “pragmatic politics”. A weakness of this “pragmatic stance” is that Cameron quite often has not been able to please many of the people much of the time, and this indeed has been a problem in general of the Coalition needing to appease the views of different factions, especially in the field of social welfare and justice. Another weakness of this stance has been Cameron’s apparent eagerness to show the politics of ‘divide and rule’, living a nation very unease with itself; pitting employed versus unemployed, the City against non-City, the rich against poor, the non-disabled versus the disabled, and so it goes on. This all smacks of the style of government of David Cameron, characterised by the approach of ‘whose time then is it to be unpopular?; One term governments are most unusual, but, as I suspect Cameron will find out on 8 December 2015, entirely possible.
Thanks to Ram Lakha for a comment on a previous version of this blogpost.
If I could subpoena Cameron and Clegg to do a leaders' debate now, I would
If I could subpoena Cameron and Clegg to do a leaders’ debate now, I most definitely would. As a student of a MBA course going at a very fast rate, it is easy to get a feel for a flavour of the management and leadership styles of David Cameron, and to understand why he personally, and his Tory-led government, are doing catastrophically badly. I exclude Nick Clegg and the Liberal Democrats, whose ‘once-in-a-lifetime’ opportunity to transform the nature of politics on the left-wing has been utterly wasted. Nobody sane would expect Nick Clegg to face the music in a Leaders’ debate in 2015, for example.
The issue with the Tory-led government is that they have a sole core competency, that is to reduce the deficit. However, the mechanism by which they are doing it is causing considerable damage to the recovery which had started in the first few months of their current (and probably) last term of government. By having no coherent policy for generating growth, they potentially could worsen the deficit by decreasing tax receipts and increasing benefit spending. It’s like having a credit card when you’re unemployed, but you are sanctioned from having any source of income.
David Cameron also fails as a leader in a number of textbook ways. As a potential transformational leader, he does not have the support of key followers essential for a change management to succeed, say in the public sector. Essential in this change management is not doing the change too fast, and having some symbols of success. Instead, David Cameron faces increasing waiting times and a plethora of equally disastrous metrics in NHS management, and the ultimate accolade in manufacturing output, the GDP, is deterioriating all the time. His preferred management style for running the public sector is ‘lean management’, which runs two grave dangers. Firstly, it can be extremely difficult to do a root cause analysis of problems when things go wrong, and secondly there is little functional slack. Take for example the recent riots. In an overstretched, underfunded, police service, it is difficult for the police and justice system to mount a satisfactory response. Amazingly, they have, but despite a dangerous level of cuts.
David Cameron has equally proven himself as a poor crisis leader. Over the riots, where he was accused of spending too long in Tuscany, and over the hacking crisis, where the evidence provided by Goodman, Coulson and Murdoch continues to cause problems, Cameron has been seen naked in responding way too late after the events; and again he suffers from a lack of trust by his followers, the UK general public.
Furthermore, in textbook terms, David Cameron fails as a charismatic leader. This was first identified really by Mary Liddell who wondered some time ago whether the general public could grow to embrace David Cameron. Indeed, Liddell was right. They couldn’t. The result was a hung parliament, with a completely ineffective Nick Clegg, driven by a personal dislike of Gordon Brown and ‘liberal principles’, led his party at Westminster to vote against EMA and the rise in tuition fees. No wonder his political party was slaughtered in the local elections.
So, I do come back to my basic thought: if I could subpoena Cameron and Clegg to do a leaders’ debate now, I would. Tragically, the country is stuck with them until 2015.
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Not The News Of The World
There is a concept in large professions such as law that no single person is more important than the profession. Many analyses have been written about the relationship between Tony Blair and his Party, and indeed subsequently between Gordon Brown and the same Party, and the concept has arisen that Tony Blair was more popular than Labour, making him such a formidable ‘election winning machine’. The electability of the Leader has always been cited by New Labourites as being pivotal to Labour’s ultimate electoral success, and I believe that this die-hard group of members within Labour still feel this today, with their eye on 2015.
This week was a ‘game changer’ for Ed for various complicated reasons. Having been stuck ‘on loop’ with the traditional Labour bust-up with the Unions, it seemed unlikely that Ed would be able to make a new, innovative step in Labour. A quantum leap. Thankfully, the Right seemed to resent that the group representing ‘It’s the Sun that won it’ had been caught up in such a robust scandal. Rewind – the Right seemed to resent the fact that the Left seemed to be enjoying it so much. What about Tony Blair’s transatlantic flight to court Rupert Murdoch once?
What about Ed Miliband and Douglas Alexander meeting Rupert Murdoch only the other week? Rupert Murdoch, more than the Left, is more symbolic of the corporate in US and UK life, and it is this maximization of shareholder profit which is about to come under enormous scrutiny in David Cameron’s single term of government. The NHS Health and Social Care Bill is (potentially) fundamentally flawed because it edges towards NHS institution becoming private limited companies, with legal corporate legal liability, with the function of maximizing shareholder profit, and becoming subject to the intense regulation of competition, insolvency, and employment law disciplines, but a few.
History has shown that, when corporate scandals of any description, such as ENRON, they have a lasting impact, because they force management analysts to examine how a toxic organizational culture has arisen, and how corporates must have a strong grasp on the triple bottom line ‘people, planet and profit’ (i.e. they must mean it), to survive. This is not however the same as a belief that pursuing profit is fundamentally wrong. This, so-called “corporate social responsibility”, can directly impact on their financial success, as investors can powerfully make a financial decision to go elsewhere. In the case of News International, investors can decide to shop around, but the genuine question is whether other entities are simply better at hiding their own brand of toxicity. The danger would of course be for the Left to conflate the toxicity of News of the World (“NOTW”) (evidenced, arguably, by the Management Board of News International deciding to dump NOTW in its last edition this Sunday) with any toxicity of the Conservative brand. A noteworthy success of David Cameron has been to detoxify his own brand.
You can often tell a lot about a leader by its followers in management analysis, but people are more interested in leadership than followership (reflected in fact in the relative numbers of books written on the subject on Amazon). The fact that David Cameron promoted Andy Coulson, after he had left News of the World, at a time when John Prescott had warned of there existing some ‘unfinished business’, is at best an error of judgment. A minority of people feel that he has handled the News International scandal well, and it should be of no shame to him that he personally gets well with Rebekah Wade and Andy Coulson. People are not so superficial to think that this impacts on running the country, but the corollary in business is whether a corporate should be able to make large profits at any cost. Interestingly, the Independent ran a story earlier this week suggesting that Directors could be negligent in spotting illegal phone-hacking activity through s.79 Regulation of Investigatory Powers Act [2000] (article by Andreas Whittam-Smith dated 7 July 2011, quoted by @charonqc on his blog).
In the far-from real world, the New York Times gave a glowing description of Rebekah Brooks’ leadership qualities today. In traditional MBA territory, Ed Miliband has in fact shown excellent leadership. He demonstrated risk-taking behaviour, in being the first to dare to break from the fetters of ‘It’s the Sun that Won it’. He showed emotional intelligence in agreeing to a discussion of the matter with David Cameron next Wednesday, and he also displayed cognitive intelligence in being able to analyse a case for regulation of the journalism profession this morning. He has inspired followers, but indeed books can be justifiably written about whether the followers are actually ‘susceptible’. This notion of susceptibility can arise from the view that David Cameron did not in any sense win the election, but Gordon Brown (predictably) lost it, and a lot of people (including a vast majority of English Labour supporters, but rarely social Liberal Democrat voters) feel they’re biding time until 2015. The severity of the situation has meant that people are not too concerned about whether Ed Miliband looks like Gromit the Dog, but feel that there is something toxic about the culture in some parts of the News International, from the past, if the allegations are to be believed.
However, an inquiry through the Inquiries Act [2oo5], and the various criminal cases, seem like a sensible way for the law to progress. David Cameron’s (and, now, by association, Nick Clegg’s) challenge is to try to ‘nudge’ a sentiment of members in the public being inspired enough to consider he will contribute in clearing up the mess. The ultimate challenge for Rupert Murdoch to survive through these challenges, and for Jeremy Hunt to avoid referring it to the Competition Commission which many believe he is still able to; and, of course, for the re-branding of a newspaper on Sunday to go smoothly. Whether ‘ringfencing’ will be sufficient is anyone’s guess, but we’ve actually been here before.
@legalaware is a full-time MBA student at BPP Business School, St Mary Axe, The City, London. This article is not to be taken as representative the views of the BPP Legal Awareness Society, nor of BPP University College.
