Bumper June Crop of MAC Musings

“Text cloud” for this post below, created by www.wordle.net

Ruminant Rumblings

It has been a bumper month for the public engagement debate across a wide range of participatory and management issues. We have sought inspiration for better management practice from an annual ritual in the Swiss Alps where cows battle out issues of hierarchy and succession in what we might call a ritualised ruminant rumble (to borrow the rather ancient gang fight vocab of West Side Story) complete with combat footage video. This piece brought out the worst in partner-originated puns.

Participation by Invitation Only – a discredited approach

Management issues were at the heart of Caroline’s accusation that parent power was nothing more than a piece of populist spin. The model of ‘trouble-shooting’ management embodied in an Interim Executive Board does not seek to engage parents. Instead they seem to favour the traditional ‘expert’ management style – taking the hard decisions quickly unencumbered by the burdensome baggage of external consultation. This executive pays little heed to the necessity of communicating what it is doing to parents and even as it moves to appoint a new governing body, the Board deploys the discredited practice of participation by invitation only whereby a small number chosen from the ranks of teachers and parents and a member from that most nebulous of concepts – the local community – are invited to take their place at top table. And invitations as we know can be withdrawn.

NHS Market Stimulation – new competencies needed

Andrew Craig has a different emphasis in his piece on market making in healthcare. This is a new competency for the NHS and unsurprisingly they are not yet very good at using their purchasing position within the economic framework of the NHS to get better value for patients. All are having to learn very quickly on the job as they look to managing their budgets in anticipation of them becoming subject to the new constraints on public expenditure. The debate on the positive contribution that markets may make is a theme of the current Reith lectures where Sandel tells us that there are instrinsic values in human activity where a purely economic approach does not work. The NHS will perhaps always be a battlefield between these two ideas in a context of political management.

Morality and Economics – a Reithian debate

I have touched in a previous newsletter about the deficiences in the consumerist model in those contexts where the citizen interest has to be invoked to make provision work for all sectors of societies. I wonder if this Reithian debate will form any part of Richard Thomas’s agenda as he becomes the Deputy Chairman of the Council of Management of Consumers’ Association. We marked Richard’s departure from the post of Information Commissioner and summarised the interesting debates we heard at a farewell conference in May 2009 – Jack Straw was moved to deny that the Government was using Orwell’s 1984 as a manual of statecraft. The mixture of the economic and the moral is particularly volatile in the arena of public privacy and data protection where a technology is evolving at light speed while the debate on public morality and efficiency and of course now national security and personal safety moves at its traditional pace as lots of people try and make up their minds about difficult topics.

Sarah’s Story and decency, fear and distress

An example of the controversy that can arise from sincerely held differences of opinion in the public arena came with an Advertising Standards Authority decision about five complaints received about the short film ‘Sarah’s Story’ made by the Motor Neurone Disease Association on the grounds that its violent images as Sarah is possessed by MND on the grounds that it offended against the Code clauses relating to decency, fear and distress. The ASA decided that the content was justified given the nature of the disease.

Please comment if any of the above resonates with you. We look forward in particular to hearing from Swiss dairy farmers.

Parent power – just another piece of populist spin?

And their parents?

A few weeks ago Gordon Brown declared that he wanted to make schools more accountable to parents. The National Union of Teachers spat back that this was just a bit of “populist spin”.  After all, they argued in their press release, “Schools already work with parents and governors to ensure that information is fully available to the local community”.  As my kids would say, “Yeh, sure.”

Some sorts of information, it would appear, are rather more available to parents than others however.  My daughters’ school is currently being run by one of the government’s newest beasts, the Interim Executive Board, an unelected and apparently entirely unaccountable group of “experienced educationalists” which replaced the governing body when the school went into Special Measures a year ago.  It took the Parent Forum seven months to get our lovely shiny IEB to agree to “publish” its minutes. Publish in this context means sticking them on a notice board inside the school where parents seldom tread and refusing to put them on the school website.  And funnily enough, despite massive changes taking place in the school every week, the minutes say little more than the date of the meeting and who was there and are posted approximately six weeks after the event.

Now they are setting up a “shadow governing body” for an unlimited timespan.  At last, we thought, a chance for parents to stand to be elected as governors and have some say in what it going on.  We had been promised elections a few months ago, but now we are told that the new governing body will be made up of the same old “experienced educationalists” plus three hand-picked new members: a parent, a member of staff and someone from the local community.  No elected trouble-makers here please.

But this worrying lack of stakeholder accountability extends well beyond Schools Causing Concern, such as ours where some might argue you need emergency measures to deal with emergency situations.  In her column last week in the Education Guardian, Fiona Millar describes how, despite massive protests from parents and other local people in the London Borough of Camden, the local authority has decided to go ahead with an Academy run by a “preferred sponsor” (preferred by the local authority that is).  What worries her is that the legislation around Academies means that their governing bodies can be entirely dominated by the sponsor, whether it be a creationist accountancy firm or a used car salesman with a side interest in selling cigarettes to young women in developing countries.

She writes: “Meanwhile, the academies experiment is still being rolled out with a vengeance, and is making a nonsense of local community empowerment. The wholly controlled governing bodies put in place by the sponsors are often fronts for more shadowy charitable trusts that make the real decisions – such as appointment of the head – from headquarters that are often hundreds of miles from the schools they control.”

The Conservatives have been a bit vague so far about what sort of schools they want to have in the future but they seem to be quite taken with the idea of parents running schools themselves following what is described attractively as a Swedish model.  A recent MORI poll however suggests that this is not really what most parents want.  Only 11% of parents thought parents themselves were the best people to run schools preferring local authorities (39%) or teachers (32%).  7% said they would definitely get involved in setting up a school if they could.  Another 36% said they might help.  A reality check based on our own experience and other research reminds us that the good intentions expressed in a questionnaire are not a reliable guide to who will actually turn up on the night.  But if they did build the school and the people came, how accountable would this small band be to everyone else in the local community?

The Wisdom of Cows – choosing leaders the Swiss way

The news of Andy Hornby ’s appointment to Boots was of course the cue for the digital cuttings file to be raided for lots of images of him being abused by Parliamentarians. How could this man so recently discredited, rise again so soon to head up one of our great British businesses? How can this happen to a man so fresh from being bombarded by rotten vegetables in the stocks of public opinion?

The appointment of managers is a process that more and more, takes place in public. As the process of ‘externalisation’ takes place in the NHS with lots of new social enterprise service organisations being established, how will they find their managers and agree stable management structures for all these new businesses? Read on for the Moore Adamson Craig & Millar solution to filling the need for a credible and effective process for choosing our future business leaders.

Managing in the Public Eye

How do we learn to manage in the public eye? How can we find the leaders we need and organise succession in a way that will provides solutions that stick? We give you the Swiss Queen Cow approach to succession management – an organic approach to organising succession and finding leaders, tried and tested every year.

Heirarchy and the Herd

Each spring the herd emerges from its long winter confinement in the village barns out onto the mountain meadows bright with Alpine flowers. A natural amphitheatre in the bowl set in the mountain side is our stage and it is here that the drama of the annual struggle for the right to lead the herd, takes place.

The black bull-like Herens cows stand out against the green hill and their horns while carefully tended and trimmed are kept in full working condition. These vast beasts clash – click on the clip below to see the video captured by our on the spot but rather far away cameraman.

The hours pass, the onlookers get steadily more refreshed and steadily over time, the winner emerges from the group. All can now look forward to a summer under their their Queen Cow until the autumn transhumance when crowned with flowers, top cow leads the herd back to winter quarters.

The Public Gallery

We have witnessed a management process that is fit for purpose, regularly tested and is based on the principles of wide consultation with the involvement of the key stakeholders. The process is sustained by total confidence in the result giving a period of stability to ensure maximum outputs over the critical production period.

No to Testosterone

One final point – we are just talking cows. The animals may look a lot like bulls but they are not.

Not a bull

Bulls have no part in this. No flashy parade of testosterone-fuelled fighting for the sake of it from males – au contraire, a contained process calibrated to achieve the desired outcome, agreed by all.

Put them in the field and let them fight it out, we say.

More on MND film ‘Sarah’s Story’

We have inserted as a comment on the original piece in February this year, news about the ASA judgement following complaints that the film ‘was offensive and distressing’.

Governor induction programme for Foundation Trusts

The M-A-C Partnership offers a fully-managed induction programme for your new governors (you may be calling them something different). Our induction training package has a fixed price but can be tailored to your environment and the needs and wishes of your governors.

Our focus in the last two years has been supporting and sustaining citizen and user participation in Foundation Trust Hospitals and in particular training and development of Governors and Patients’ Forum Members. We offer the benefit of our experience in the whole area of public and patient participation, working with you as partners.

It was clear to us that, whilst there are many things in common to all potential FTHs, each Trust is tackling things in a slightly different way and have reached a different point in developing your strategies and implementing your goals. So the one size fits all package will not work. Instead we propose a core programme of learning supplemented by local input.

M-A-C Aims and Approach

To enable new Foundation Trust Hospital governors early in their term of service, to develop a coherent and effective approach to their work by:

• providing Governors with a grounding for their individual and collective role and purpose
• exploring appropriate ways for Governors to contribute to the Trust’s visioning and strategic processes linked to the member election statements – with the M-A-C Values and Beliefs Enquiry tool
• identifying Governors continuing learning needs and enlisting the Governors in their own learning and evaluate their progress

M-A-C Menu

On the basis of our experience in working with communities and NHS management, we have developed a comprehensive approach to developing, managing and evaluating policy and practice in this area.

We can offer you a choice of services and support and assist you.

Start-Up

• a checklist for building and sustaining good communications with Governors
• advice and support for the Trust on the content and style of the inaugural Governors’ meeting
• help for the Trust in the production of a Governors’ Resource Pack which can be used by Governors from all constituencies and added to in the future
• the creation of common values and goals by using what they said about their own beliefs and values with an analysis of Governor election statements and intentions
• uses its M-A-C Health Service mapping question list to provide the means of Governors’ understanding of the local health environment

Ongoing

• Project planning meetings with Chair and Foundation Manager of the Trust
• plan and present an induction programme for Governors (ideally consists of two half-day sessions)
• develop and deploy self-assesssment tools showing where the governors have got to now in their learning and understanding – what are they confident about? Where do they need more support?
• Gather feedback by induction training evaluation; business meeting feedback and tracking
• Planning and content for induction course to include Trust and outside experts if needed
• Recording discussion, capturing debate and feeding points back into the process

Costs & Implementation

One M-A-C partner would be designated as the key contact for the Trust, although usually two partners would be involved in planning, development and actual events. The cost of the standard and tested package is £8,000 (exlcuding 17.5% VAT) and out-of-pocket expenses.

Additional work is charged at a consultancy rate of £800 (excluding VAT) per day.

Customer Insight – Investor Foresight: Market Making in Healthcare

A recent blog by the estimable health economist at the Kings Fund Dr John Appleby on PCTs and managing markets pointed out that in the recent World Class Commissioning external assessments, most PCTs scored poorly on competencies around stimulating the market and market management.  That rings true for my corner of South West London. I’m long enough in the tooth to remember when what we now call commissioning was just “purchasing” replete with shopping trolley analogies.  We’ve come some way since then, but still have a long way to go to get to the stage of being real market makers able to shape services (and more importantly provider behaviour) towards outcomes that do something positive about narrowing health inequalities and improving the health status of individuals.

To do that we need to move beyond commissioning in terms of how we describe what we are really seeking to achieve.  As “purchasing” was overtaken by “commissioning”, so the next iteration of the art should be  “health investing.”   After all £450m is no mean sum to have at our disposal annually. We should be able to do something creative with it to make things better for our 300k+ people who use services in our borough.

Just buying the same old, same old from the local providers won’t change things much.

As John Appleby says: “The fundamental question for PCTs is how, having identified their population’s health care needs and decided on priorities, they use their purchasing position within the economic framework of the NHS to get value for patients. “

There has been a spate of helpful “how to do it” guides for market management from perhaps not-too-disinterested management consultancies.  These are all welcome – we have to start learning somewhere -  but the best way I think is to learn market making by doing it.  Perhaps that makes me a radical empiricist in my approach to market stimulation. I’ve just finished being part of the procurement team for our GP Led Health Centre at Clapham Junction and am now part of a team getting to grips with potential providers keen to help us do something about our scary childhood obesity problem.  Everyone involved is on a rapid and time-hungry learning curve.  Without doubt, sharing this experience within the PCT and with our local authority commissioning partners is building our competency as market makers and market managers in a very practical way.

Obesity and other “lifestyle-related” services was an area identified by external consultants as ripe for market stimulation and open procurement.  Now that we are doing just that, I’ve been amazed by the number of quality providers from inside and outside the NHS who say  – at least on paper, the real test comes in eyeballing the short listed candidate providers – that  they want to work in this new way to address the outcomes we are seeking to achieve.    If we become competent health investors we can have competition for the market and also competition in the market.  That should give us much increased flexibility to address the health and well being needs of our diverse population and provide expanded choice amongst services.

PCTs must be smart health investors.   Like any successful business -  especially one looking to survive and prosper during the economic downturn - we must have good customer insight (intelligence from user experiences, learning from user and public involvement, complaints etc).  But insight is not enough. We must learn to join up this insight with investor foresight (our aspirations and expectations, market intelligence about demand, provider capabilities and potential etc).  Putting these two things together is the only way we will be clear about what journey we are taking and -  crucially –  whether our local population is with us on the same journey.  We cannot simply assume everyone is going to the same place just because we have a strategy document about it.

One way to start getting to grips with being a smart health investor is to use an excellent new tool developed by David Gilbert and colleagues at InHealth Associates for the Department of Health -  the “Engagement Cycle” The first thing I would like to use the Engagement Cycle for in our PCT is to audit what we think we know about user-focused views in our commissioning strategy.

I’d like to be assured on these points: How robust is this intelligence? How are we relying on it in our current plans reflecting the NHS operating framework?  How are we refreshing, extending and communicating our customer insight and translating it into future commissioning plans?  Where is user-focused intelligence helping us to go as a health investor? Is everyone on the same journey?

To have insight, you first have to have the right data from your customers. If you aren’t sure what customer experience information (CEI) is, how to get it and what to do with it, PriceWaterhouseCoopers have provided a helpful guide to CEI in health and social care. Then its a question of rolling up your collective sleeves and getting to grips with learning the health investing business.  I guarantee you will not be bored.