Category Archives: Healthcare

Audit, Inspection and Scrutiny: the three ugly sisters?

This popped into my inbox today:

“The need to drive up the quality of care for patients, whilst delivering efficiency and productivity, is a key principle for the NHS. As pressure on NHS finances continues to build, UKAS accreditation is increasingly being used as an effective way for purchasers and commissioners to demonstrate that they can achieve ‘more for less’.”

I felt a stirring of irritation. This blog is the result……….

I know organisations have to behave commercially and tick boxes in order to thrive. I spend part of my working life encouraging and supporting charities and NFPs to do exactly that, but without losing their heart and soul to it. It is possible. But as an old nurse (registered about a century ago) and vehement supporter of the NHS original principles of free at the point of need and paid for by the entire community I am increasingly dismayed by the passionless, sterile performance of the people tasked with – and paid handsomely for – managing “public” health services. I have seen patients become the enemy, clinical standards side-lined in favour of improvement on the balance sheet, kindness become irrelevant, and buzzwords and trends take the place of clinical and compassionate behaviour. Health and social services are scrutinised, inspected, audited, governed, examined, professionalised more than ever before and we still have Winterbourne, elder abuse, Southern Health (pauses to spit), frequent reports of casual abuse and cruelty (that we know of), and we will all know those “care” homes with a good CQC rating which pong and employ people you would not want to sit next to on the bus. We will all know of supported living services that are little more than one person institutions with little or no meaningful activity and engagement – or to put it another way, that warehouse people in units of one, creating the illusion of choice and a Life but deliver isolation and fear. We have seen Southern Health reduce victims and loving families to statistics and irrelevancies, destroying people in order to prop up a system that sucks and protect the very people who allowed and encouraged the system that killed people and fixed the blame on others, with lies, obfuscation and bluster.

Some inspection agencies, several tiers of consultancy and management and many more are too often yet another layer of “approval” or box ticking to chuck at organisations. Along with services like 111 –  a dangerous irrelevance that often removes much needed funding from frontline services for the return of reduced standards and increased risk –  they also create a cash cow for canny providers without delivering any improvement in clinical outcomes, or supporting real people with the very real challenges of everyday ill health. We seem to simply carry on increasing layers of approval, fresh hoops to leap through (some with fire) rather than examine very basic factors. Often the people creating those hoops are not clinical and have little understanding of how  things actually work in the real world. I keep hearing that we need more funding for this that and the other – I keep seeing a variety of groups being blamed for an ever increasing number of failures and deficits: currently GPs are getting a hammering despite being possibly the last group of professionals who should be blamed and who, along with dedicated skilled nurses have kept things going against the odds. Commissioning services is clunky, inappropriately targeted, poorly contracted and badly managed, which is a criticism of the process –  again often created by people who do not understand the real workings – and not the people who have to work with it. The competition itself reduces the capacity to develop and really grow health and social care support services because contracts are not only badly drawn and managed but are up for renewal so frequently it is impossible to invest in services and also make that holy grail of profit. Profit is not going to be the first thing to go.

I firmly believe in a skilled and educated workforce well managed and led and supported with career choices and pathways. I also firmly believe in holding organisations and individuals to account. I believe those can be delivered without the huge self-propagating self- perpetuating roundabout of new mandatory qualifications and accreditations, incompetent inspections, and without the workshops, consultancies, projects, papers, enquiries, processes, requirements and bottom feeding organisations that have sprung up around services that are actually intended to protect, care for and nurture us.

There comes a time when the volcano erupts, the boil is lanced, the pus drains and healing can take place. We need to recognise that the privatisation experiment which was trumpeted as the way to increase choice and competition which were equally being promoted as in our interests – I am pausing for the laugh here –  is a failure, delivering little more than profits for largely incompetent organisations and draining the body of the NHS of resources and talent. Choice is not what sick people want, overall – they want skilled professional care, close to home, delivered kindly by people they trust and with their involvement in the process. And answers if something goes wrong, with a meaningful apology attached. Dividing professionals and organisations with “competition”, asking for innovation when compassion is good enough, blaming good people for systemic failures and expecting mountains of assessments, graphs, justifications, and hounding good people for honest mistakes does not result in decent health and social support.

Have a look at this: Laugh and then weep.

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Brexit. Trump. Strictly. No, don’t click me away! Bear with.

Cards on the table, I don’t much like the tellybox. I watch, occasionally, stuff like Railway Journeys with Portillo, or that wonderful Canal programme with Timothy and Prue, but on the whole most of it passes me by. Most of what I do see is caught accidentally when the rest of the family are watching and I stumble into the room on my way somewhere else. However, I have become surprisingly interested in Strictly Come Dancing this last couple of series – maybe it’s because I remember watching the original all those years ago, usually with an altered state of mind which helped.

Bear with…….

This year has been in interesting year for anyone with half an eye on politics. We have, allegedly, seen a rise in the proletariat offering a bit of a slap to the people who have seeped and dribbled into offices of power and decided they know best. Not only that they know best but that the proles know nothing and need to be kept in their place. Our place. To that end, arguably, Education and Health, and to a large extent the Criminal Justice System and Housing, have been morphing in recent decades, leaving behind much of the social construct and responsibility that most of us value and developing a profit motive that no longer has to try to hide. Priorities in socially important organisations changed of necessity – it was do or die –  and in part that has been supported passively by people still believing that someone with a lot of money and a private education knows better than them. Pair that with the desperate need of many to simply keep body and soul together leaving little time to be involved in much else and a consistent lowering of expectations and we have a perfect storm of passivity and fatigue that allows people who do have the time and money (and the networks developed at school and Uni and by family connections) to buy a pathway into power. I mention no names…….

And then came 2016. Hands up who approached 2016 thinking “Thank Goodness 2015 is over, what a year, it can only get better”…..? Yes, well that went well, didn’t it? Apart from lots of lovely people dying who had created my history and the musical and artistic backdrop to my youth, we also had Brexit and Trump. Divisions created deliberately by the powerful to conquer the masses led to the very public murder of one woman, an increase in the confidence of people with shameful attitudes, a legitimising of all kinds of isms from ageism (the older generation have spoiled things for the young/the young don’t understand the issues) through racism (go back to where you came from/who will you blow up next) and a general atmosphere of mistrust and hatred. Conversation was replaced by brick throwing and chanting, voting was seen as an act of defiance rather than an inalienable right and duty and more people voted for Brexit than at any General Election for years. Public dissatisfaction with politicians who fiddle expenses and despise their electorate was having some practical results. Trump had already hopped onto the bandwagon and shamelessly – alongside some of his opponents and supporters – traded insults and lies rather than debate and detail, whipping up his gang to hatred of others, violence, intolerance and a lack of facts. Taking mansplaining to a whole new level, and behaving publicly in a way that many parents would justifiably have slapped their children for, he set new and deeply unattractive guidelines for public debate and demeanour. In both of these events we witnessed the powerless grasping onto something over which they believed they had some control, a new experience for many. In reality the power and control remained exactly where they already were but the illusion of influence was conferred, more expertly in some areas than in others. That precious vote, hard won by ordinary people over the years, wrestled from the wealthy and powerful and certainly not given freely by them, was being manipulated to support the very people who stood to gain most. And that, Ladies and Gentlemen, is politics in the 21st Century. Ordinary people are encouraged to think they have had enough of the elite – by some of the elite – in order to get them to vote for the elite.

But something did happen. The idea of sticking it to the elite has taken hold. The concept that perhaps people can make choices, sometimes dangerous or wrong choices, and define their own reality and outcomes and live with the consequences is becoming clearer. And so we arrive at Strictly. I told you to bear with. Ed Balls joined the Strictly dancers and immediately gained the publics support for dancing badly, but with charm and warmth. The pubic enjoyed his efforts and his ineptitude, his determination to do his best and move forward – they liked it much better than some of the other dancers who danced better but were less appealingly human and had less distance to go to dance well. Someone who until recently appeared as part of the elite was shown to be Like Us. Not only Like Us, but likeable and funny. He charmed. The judges were ghastly to Ed and that just increased his popularity – they gurned when he danced, were outright discourteous, were way less encouraging to him than the other “better” dancers and generally behaved like, well, like the elite. Clearly they are the experts, clearly they are dancers, but their unpleasant behaviour rendered that immaterial – we liked Ed because he wasn’t an expert and wasn’t elite. We didn’t like the judges being smug and telling us what to like and what not to like. We Brexited them. We Trumped them. We voted in droves for the Little Man. Apparently. Well, job done. Ed is rehabilitated and the People have spoken. He has worked hard and redefined his place in the public eye.

Quite a few of The Elite are chums of mine. Quite a few of The People are chums of mine. I like them all – I think there is a little bit of fabulous about everyone, without exception. Their politics are not what I admire about them – if they charm me and make me laugh, if they have a brain and a heart, are kind, and hold a conversation well that is what I admire. What they do in the ballot box is not my business. What is my business is what happens when the votes are counted and policy decisions are being made. As someone who has worked for years in health, justice and social care and across all the sectors, and as a school governor, I have seen how public policy impacts actual people. Left and Right are almost irrelevant as long as socially important organisations and services remain at the whim of people many of whom will say and do almost anything to sit in a seat of power, many of whom have no meaningful experience of the departments they lead ( I am sure you know what I mean and who I mean……), and who potentially change direction regularly every few years. When there is actually a direction to change and not just a dogma to follow.  While we have no available Intensive Care beds for children anywhere in the country, while nearly 9,000 people slept on the streets in London alone in 2015/16 – and that is only the recorded figure – and 57,750 households were accepted as homeless and in ‘priority need’ in the same year, a six percent rise on the previous year, while mental health services are randomly delivered and under-funded and a false economy as so many people bounce around the expensive system, while almost as many people leave prison unable to read as entered it (this is changing, thank goodness, thanks to some fabbo people, but so slowly), while people with a criminal record are routinely excluded from jobs and housing denying them the opportunity to desist, while all of these things and more are happening Left and Right can argue until blue/red/green/yellow/purple in the face but it will remain a disgrace and the responsibility of all of them. And all of us.

There are some properly decent people in and around government and in and around some of the organisations that develop and deliver services, people who actually want to make a difference and not a fortune. I insist on feeling hopeful that the vote for Brexit – and Strictly – is an indication of the start of increased popular involvement in government. Whether or not I agree with outcomes upon which people vote does not matter – it is up to me to make a case for my view and debate properly. If votes go a different way to the one I would like I still rejoice that democracy has taken place. We have become a tad complacent in recent years, the freedoms and opportunities that have taken so long and so much painful sacrifice to attain are at risk. That complacency has allowed bad practices to slip under the wire – without some darn good journalism the expenses scandals would have remained unknown, for example, or at the least unremarked. Our inexplicable faith in people in positions of power, supported by the anaesthesia of media dependence, has let us take our collective eyes off the collective ball. My optimism tells me that people are perhaps willing to become more engaged and knowledgeable about the things that will affect their lives and less tribal in their allegiances. Brexit and Strictly both cut across most demographics…….

So, vote for Strictly! Vote in your local and general elections! Talk to your MP, find out what she or he actually thinks and don’t take it on face value – challenge, probe, question, scrutinise. And crucially, tell her or him what you think and what you expect of them. Own outcomes. Learn to Salsa and wear some fancy clothes. Dance and vote like no-one is watching.  And remember that T Blair is creating a global organisation to combat populism  – that’s you and me – and promote globalism – the thing that fills his pockets. We must be becoming dangerous……….

A criminal waste, a disabled society. Unlock Your Future.

Easter is a time for reflection. I have been reflecting on the many people it has been my privilege to meet over the years. Many of the people I have worked with are people that the Jesus that I like to imagine would recognize: vulnerable, damaged, disenfranchised, hostile, broken, pathetic, lost, abused. I like them.

Disability is a strange concept, and many of the people with disabilities who I know would strongly suggest that it is not them with the disability but society, culture, which is disabled or which provides the disability. We build streets fit for the able bodied, buildings that exclude all but the well and the fit, work that suits only the driven and the straight and “normal”.  We see “work” as a means for economic growth and acquisition, and ignore the very real other benefits work can bring such as purpose, esteem, quality of life, respect. We patronise the successful disabled and express astonishment at their success. We create targets and drivers that take no account of alternative talents and aspirations, that fail to value otherness, indeed in a tabloid sense disability is so often viewed simply as a problem, a drain, a fiscal error.

If you look for the word “disability” online these are some of the words you get:

handicapafflictiondisorderdefectimpairment, disablement, infirmity  incapacityweaknessinability • Disability can make extra demands on financial resources.

Transfer those words to our environment and see what happens. Our shops have defects and will not allow wheelchairs in, our streets are afflicted with high kerbs and a lack of ramps, many work environments lack the capacity to value a range of people and talents and are, as a result, weak and impaired. Recruitment is afflicted by a set of rules and processes that despite legislation and encouragement still often excludes too many and that handicaps the workforce.

I would go further and suggest that people with a criminal history have been handicapped or disabled by society. Their forensic history effectively cripples their employment potential and afflicts their family life. If we suppose that it is indeed society and our culture that creates disability, in effect cripples its citizens, it follows that society can redress that. Some legislation attempts to do that by supporting “equal opportunities”, but equal ops can only happen if we view all candidates with an equal eye and the work environment is capable of accepting all candidates equally.

If you look for the word “criminal” online these are some of the words you get:

unlawfulillicitlawlesswrongillegalcorruptcrookedviciousimmoralwicked, culpable, disgracefulridiculousfoolishsenselessscandalouspreposterousdeplorable

I notice that none of those characteristics is irreversible. They are a description of how it is at the moment, not how it will be in the future. If we continue to exclude people from employment, to ignore the many benefits a varied and experienced workforce can bring, to expect jobless hopeless futureless people to suddenly somehow behave like employed, hopeful people with aspirations on release from prison, we set ourselves up to fail, and we fail our communities.

I don’t suggest for a moment that we employ anyone and everyone into any vacancy without safeguards and safety nets. I don’t do soft and fluffy. I do however suggest that we create those safeguards and safety nets and take the trouble to include the excluded and create a properly integrated and cohered environment in which everyone is valued, has the space to grow, and has their aspirations valued. Not because it is soft and fluffy, but because it reduces the risks of offending, of disaffection, and increases the chances of people buying into their communities and making the effort to support their futures and crucially it means we reduce the risk of missing out on some serious talent. Back in the day when social and health care services were even more rigid in their outlook than they are now, I employed an ex-offender who had done time for murder. I employed him in elder care. This was not universally welcomed…….But I ran the checks, created the risk assessment, spoke to the people I needed to speak to and importantly offered him a mentor and some effective support to re-adjust. It was a success.

No-one would suggest  there is an easy answer or that it is a simple matter. But that is not a good enough reason not to try.

No Offence CiC is a social enterprise  and I am lucky enough to be on the Board. We are not driven by private profit and we facilitate open access to crime and justice information. By challenging barriers to positive change and influencing future policy, our objective is simple: to make a difference. My own organisation, Mayall Management Ltd, is proud to support the Unlock Your Future project that No Offence is driving.

http://www.no-offence.org/

Unlock your Future

‘Breaking down barriers to employment for people with convictions’

This project will focus on identifying and breaking down the barriers to employment for people with convictions, to bring employers and employees together.

A simple key discreetly placed on a job advert will indicate that this employer will consider all applications on their merit and not their past.

Many employers have a skills shortage and would benefit from an increased pool of suitable candidates from which to recruit.

Unfilled vacancies can have an economic impact on any business and increase pressure on other employees attempting to make up the resourcing short fall.

We need a network of champions to raise awareness of this project and support employers to use the key either on their own website and/or on our jobs board and spread the word to those people looking for a job and also recruit other champions. Could you help us?

Employment provides us with a significant opportunity to break the cycle of reoffending. If you are an employer please join our network and we will send you the key to use free of charge.

http://www.no-offence.org/static-page/unlock-your-future/

 

Diabetes, then…..tch!

You have probably not been wondering where I have been as you have better things to do. After regular blogging there has been a pause, a whistling  tumbleweed silence unfilled by words or thoughts. I have missed you, though.

Like many women of what used to be called “a certain age” but is now called the New Forty I have discovered that  I am not a grumpy tired old bat, but that I have diabetes with a side order of thyroid malfunction and some yummy cholesterol. Well, ok, I am also a grumpy old bat, but I now have a lovely ready made off the shelf excuse for it and I’m not afraid to use it. With a vivid memory of the PMT I used to suffer, or rather my Old Man used to suffer, pre-menopause (men, look away now) I put the  recent irritability and low moods down to being a woman. Call myself a Feminist?! I should be ashamed, bringing dishonour on the lovely bright green dungarees I used to proudly wear in the 70s, with the universal Feminist sign all over the front. In case the short hair, dungarees, free-flow pit-hair and  belligerent attitude didn’t give it away.

So, the low moods, exhaustion and annoyance are the result of diabetes. Another confession: I used to be a nurse (technically I still am, which is scary), and I still don’t understand diabetes. I tried to convince the diabetes nurse that my blood sugar was raised because I have honey for breakfast and that the dizziness, fatigue and biting the heads off small children was probably because the Old Man was annoying. Which is true. But it wasn’t the reason that getting out of bed in the mornings was becoming less of a pleasure. I am a natural early riser, every morning, around 04.00 or 05.00 at the latest, up and at ’em, starting the day with meditation, focus, honey (of course) and tea – I love the start of the day. But in the last few months my mind has continued on the same plane but my body has been dragging behind whispering ” do we have to do this….?” and generally loafing around making my mind think twice. And when I was first identified as diabetic I dived straight into denial, taking to it like an old hand: it wasn’t diabetes because I eat properly/don’t smoke/it can’t be/I haven’t time for this. I thought that I could eat my way away from diabetes. Partly true, but a little optimistic I think. I think I thought I might grow out of it, like acne………

So on the whole I made a nuisance of myself avoiding the inevitable, bobbing and weaving to miss the headlines and warning signs, finding plenty of sand in which to bury my head and making a pain of myself.

Running alongside the diabetes was a serious dip in confidence. Hitting fifty (and the rest) can be a shock to the system, especially if the usual things all happen at once – and I can almost hear the rumble of agreement from other “New Forties” out there as you anticipate what I am going to say. My parents both died within a couple of years of each other (horrible circumstances, for another blog), I became disabled enough to need a blue badge, and the kids started leaving home/having babies/getting married/being grown up. And I continued to run the business and work hard. I wasn’t about to let grief, disability and pain, and the empty nest stop me! Oh no, because I am Superwoman, hear me roar.

Except I didn’t roar, I shrieked, snapped, snarled and moaned. I lost the ability to step away and see the bigger picture, and my assertiveness began to drip out of me and stain the carpet. I am used to achieving and have high expectations of myself, not unrealistically.  I know what I am doing and that bigger picture is what informs me. I always think my work is like being the conductor of several orchestras – the job is to lead, to show the tempo and understand the destination, and to make sure all the component parts get there at the right time and that any improv enhances the show. The energy and thrust needed for the business gives me energy, feeds me, and gives me purpose. And when all of those other things, those Life Events, converged, I lost the Kerpow Whoomph. I no longer really knew if  knew what I was doing even though I thought I knew that I did, I wasn’t sure. If you see what I mean! Where once I would have known with certainty when something was actually mine and the buck stopped at my feet, and when it wasn’t and that buck needed to be re-directed, I suddenly found it harder to tell, and started to think it was indeed all my fault, that I was wrong, it was me, and that I didn’t know anything. I think it is fair to say I was confused. But confused on the inside. My Fellow New Forties,  you know what it’s like – you are the one in the middle holding it all together. You have the reins, the strings and the plug that could be pulled and let it all swirl away, so you can’t let it go. So I didn’t, and the music played on. But I did shut down for a while, which is why I haven’t been here for a few months. It took all my energy to keep the plates spinning and I didn’t have any left over for Life.

So……..now I am diabetic and proud! I remember when I first became disabled, and I kept thinking “when this gets better I will get the bike out again” until gradually (d’oh!) it dawned on me that this was as good as it got and I was disabled. Diabetes received the same treatment. I have now reached acceptance and along with it the ability to take the advice and the pills, and I am living again. Maybe next time I have a Life Event you will be kind enough to send me a copy of this blog post so that I don’t waste too much time on denial and faffing. And, a bit like the Walking Stick club that I inadvertently joined – that band of walking stickers who with a nod and a smile, and a comment about the stick, offer unity and solidarity in disability – I have found a new club of diabetics that I hadn’t known existed. The more impaired I become, the more clubs I seem to be invited to join…….Happy Days!

Food Glorious Food?

Sharing meals allows us to come together and spend quality time with each other. It increases communication and understanding.  How many of us had our first experience of another culture through food? And coming together to prepare and eat food is part of many rituals and traditions. Food plays a big part in faith and in worship. When one shares in the Eucharist, it is said to be a  sharing of Christ’s body and blood, and worshippers are reminded of their responsibility to share all our meals with others. As St John Chrysostom once said, “You have tasted the blood of the Lord, yet you do not recognise your brother…You dishonour this table when you do not judge worthy of sharing your food someone judged worthy to take part in this meal.” Most faiths and religions have food rituals, most cultures have food rituals and norms. Food is significant. Food rituals – cutlery or lack of, how the food is produced (is it Halal? Organic? Vegan? Kosher?), how it is presented, how it is eaten – matter deeply to us all. The only people for whom those things no longer matter are the hungry, and even then I have known seriously hungry people refuse non-kosher or non-vegan food. So it is quite simply that important.

So…..

How many times recently have we heard about nurses now being expected to “feed and wash” patients for a year before they train? How many times do support workers and health professionals refer to “feeding” their patients or clients? The act of eating is reduced, for some, to the passive “feeding” offered by “carers”. It is reduced, for the care-givers, to a task to be got out of the way before the serious business of training, the important job of “nursing”, can be carried out. This simple attitude reduces human and humane care giving to the status of animal welfare. Now, let us acknowledge that there are similarities between the two, and animal welfare is very important. But in offering to care for and support other human beings we need to respect and acknowledge their humanity, and one of the few things that identifies humans as distinct from other animals is the development of specific and identifiable social rituals, especially around food, and the food rituals often define what we are as people: they indicate and specify how we live, what we believe, what matters to us.

The attitude that accepts us saying we are going to “feed” people when what we should  mean is that we are going to help them to eat or support them to eat is the same attitude that allows nurses and care givers to say things like “I have done Mrs Brown” when they mean they have helped or supported Mrs Brown to wash, or dress, or change her colostomy bag, or any of the other deeply personal, uncomfortable and intimate things carers do for us.  Those words, casually used and casually accepted, reduce our collective humanity, remove our independence. They remove the respect for our humanity that we properly expect our nurses and carers to demonstrate. They allow the casual neglect – and even the active cruelty – that we have seen in Winterbourne and at Stafford, and the many other places that have not yet hit the headlines. How can we pretend to be surprised by those events when we use the words that support the attitude of neglect and cruelty?

The words we use define how we behave, demonstrate how we think.  Let us challenge the use of words that encourage patient-passivity such as “feeding”, let us encourage the words that support active care such as “supporting, or assisting, to eat”. The former gives us a picture of food being shovelled into a patients mouth as a “carers” task, the latter gives us a picture of  someone in control of their food, being helped to perform their own task.  Notice the difference between “bathing” someone and “helping someone to bathe”.

When we become vulnerable through age, illness, disability or other reasons we often lose the option of privacy or dignity only because of the attitudes of the people tasked with supporting and assisting us. There are many discussions about why care can be poor, and often the poor wages are cited. And that is a factor – pay peanuts and you get chimps, and low wages do not reflect the importance of the job – but there is never, at any price, wage or  reward any excuse for reducing another persons humanity, for dragging away another human beings respect and trampling on their dignity. Individuals are responsible for their own behaviour and we should expect people recruited to care and support to behave properly – but the modelling of those good behaviours will flow from the leadership. If the people leading the services and the organisations do not demonstrate the crucial behaviours that indicate respect, humanity and the support of autonomy and independence for all then the people following those leaders will have no incentive to do so.

If you offer someone care and support, please, feed your dog but support your patient to eat.

An old blog of mine…….strokes, death and the aftermath.

I was looking through some old postings and re-read my blog from over a year ago, written when my Mother was dying as the result of a stroke. I need to finish the blog – it was interrupted by the need to be with my Mother, and then  to repatriate her and arrange the funeral, and then to have a period of planned insanity. I will complete it soon. But I wanted to share it again, first, because it is so different from  how  I usually am, and the many responses I had to the blog when it first appeared made me realise that we are all “different selves” when confronted with death and suffering, or with neglect and idiocy. And I was made forcibly aware that it doesn’t matter who we are, what we do for a living, how much money we have, how bright or otherwise we are, or who we know – at heart we have that turbulence and pain right at our core and it is how we manage it that matters.

http://daughterofastrokepatient.wordpress.com/

Add some integrity and stir…….

I ambled around the idea of being selfish in the last blog, mainly because I had been, and I was doing a bit of self-justification. But it set me off on a canter about integrity – I was selfish, and left a project, because I wanted to maintain my integrity. It had taken considerable reflection and planning, and was not a whim or a fancy, and I had done my best to reinvigorate the role in the first place when I realised it, or maybe I, was going off the boil,  and to put in place all I could put in place to reduce the risks of me leaving, but it was still a rigorous decision making process not without its pain. And I did my usual agonising thing about it before and after, although after was easier because the decision was made, and it was a good one. But I was leaving behind some great people and had had some real fun and achievement out of it.

So…….integrity. What is it? And why is it powerful enough to make me lose sleep?!

“Steadfast adherence to a strict moral or ethical code.  The state of being wholesome; unimpaired.  The quality or condition of being complete, pure.”  That was what the dictionary said.

“Reduced risk of compromising moral or ethical ideals, a need to move on before effectiveness is crucially impaired” is what my head said.

I will not claim to be pure, wholesome, or even complete, but I do claim to have some moral integrity and a bit of an ethical code motoring around in my aura.

My company has the tag line “Henry Ford said: quality means doing it right even when no-one is looking. We agree.” When we started the company we started out with ideals which are still as fresh as the day we started: we have a sincere and genuine commitment to people, to human rights, parity of services and equality of opportunity. We believe that everyone, regardless of all the usual suspects like race, (dis)ability, religion, gender, sexuality, forensic history and so on has a right to a Normal Existence and the support to create that. We have been around a long long long time most of which has been spent in and around different kinds of  health and social services and have seen it all – as it says on our website (www.mayallmanagement.co.uk) we have seen the Good the Bad and the Ugly. And our experiences drove us to want to influence and improve – to make sure that, wherever possible, we made things better for people, with people.

S0……… we have Integrity, dammit, and sometimes that means we have to take difficult decisions.

I have made the decision, a number of times, not to take a piece of work because I am not confident that the prospective client actually wants to improve rather than just meet compliance. We are not interested in simply or solely meeting compliance targets, although that matters very much indeed. It is my belief that in order to continue to reach people who need to be reached we have to reach compliance targets as a given before moving into the work that makes a difference. But that is only the first step, the loosening of the stabilisers on the pushbike before taking off and getting the yellow jersey. If an organisation or group – or even a single service – wants to make things better and actually make a real difference to the people using and working in their services, then  I am there, will go the extra mile or ten, will work with them as hard as it takes to make that difference. If I don’t see that commitment and understanding then I will walk away. And that sometimes costs us money!!!!! But some things are more important. We are good at what we do and can  make that genuine difference, but not if the organisation hiring us has different goals or is looking for a different set of results. I can cut your costs, but  won’t do it at the expense of quality. I can reduce your  staffing but I won’t do that if it leaves people at risk. But I can cut your costs and improve your quality if you don’t think throwing money at services improves them but rather it is about leadership and direction. I can reduce your staffing if you can think creatively about what you do and what the people using your services actually want rather than what you think you can or should provide.

So, I think what I am leading to is that my integrity caused me to take what could be seen as a perverse decision: I walked away from a project before completion because I knew that I could not, if I was to understand my own motivation, remain in place as effectively as I had been given the changed circumstances. I would, to put it simply, not have performed. Not have wanted to perform might be nearer the truth. I would not have done the best that I could for the client hiring me, or for the people using and working in their services. So integrity meant that I moved on. Integrity also meant that I did everything possible to mitigate that before moving on, as well.

I like my integrity – it walks with me and reminds me why I do what I do and that it isn’t all about me. It does sometimes give me a hard time and a sleepless night, but I forgive it because it has also meant that I have met an infinite number of great people and had opportunities to make a difference and have had a real ball along the way. And it continues! I am having another great time with some fab people even as we speak, and if my integrity had not pushed me away from my last project I would not be in my current project and loving every minute of it. Thank you, Integrity! You may join my bad knee in the list of Unexpected Things That Have Improved My Life………

Self, self self………

Sometimes being selfish is awfully hard.

I enjoy my work, I genuinely love what I do for a living. I am lucky. Mind you, I do it quite well……

During my work I meet a huge variety of people, most of whom I like, all of whom I respect and from all of whom I learn something, usually profound, but even if it is  just how not to do something or how to achieve a serious level of being-annoying-ness it is worth knowing! It is my genuine pleasure and privilege to do what I do with whom I do it.

Sometimes during a project I find I have done as much as I want to do or achieved as much as I wanted to achieve and run out of steam. I plunge all my energy into my projects – that is why they generally succeed. I energise the planning and research, I embrace with enthusiasm the refining of the planning and the partnership working that supports success. I review and refine and refine and review, and I lead a team towards success, making sure that they know they are succeeding. Then, the project is complete. Either because it has concluded and achieved resolution, or the parameters have changed and it is no longer attractive to me.

Not long ago I moved on from a project because it had concluded for me. Lots of reasons, the shape had changed, the direction changed, and someone with whom I could never have shared oxygen for any salary joined the project, and I would have to share oxygen with them if I stayed as I was.  The project was still Live, had legs and was moving onwards. It was me that had concluded, for all of the above reasons.

Like any relationship it took some reflection, pain and work to draw to an end, especially as it was me ending it and I had been invited not to end it. It was, like the end of any relationship, painful to a degree – not devastating, but painful enough to sting. But, like many relationships, enjoying it at the beginning was no guarantee that I would keep enjoying it or that it would continue to be attractive to me. The people I worked with were fascinating.  The work itself was the work that I love:  the planning and actioning and the drive towards excellence and the leading of a team and the thinking and the slowness and the rushing and the remorseless need to respond quickly and the hustling and wheeling and even the dealing. All the component parts were there, and I loved it. And then I didn’t.

Knowing what it is that attracts you to a particular project or job ( or partner…..you can see where I am going with this!) matters, because if you get it right and choose correctly you will be happy. If you are happy you are more likely to succeed, and to form good relationships. Equally important is knowing what repels you, or what the warning signs are when the role begins to lose its lustre.  I have been in some conversations about a role when I have instinctively thought “back away slowly, this one will bite”……..and on analysis it is clear that it was because of the interviewer who, be honest, is the representative of the organisation for whom you may one day work. In one, I sat with my back to a biggish window facing out of the guys office onto the open plan area. Not a good start and either he meant it to be uncomfortable or he was an eejit. He spent the entire time peeping round me at the open plan office area. Eventually I politely asked him if I could help him find who he was looking for so that we could get on with the interview in peace. I did not wait to hear if I had been successful………

In another, I brought along as requested a carefully crafted, well planned and thought through, rehearsed and (I thought) effective presentation only to be told the laptop was not working and cheerfully told not to worry as it didn’t matter anyway……this did not make me feel valued and it certainly did not impress me with the interviewers skills……..I left.

I have also had conversations with people of great charm and courtesy, who enthused me so much I took even more care to make sure I shared with them my achievements and enthusiasm, people who had infectious and bouyant interest in not only their jobs, but mine as well, and were clearly genuinely interested in the people around them. I liked them, and I have worked with most of them. We clicked.

I think what I am driving at is one of my favourite phrases: “Life’s too Short”. I don’t have time to spare to work with eejits and bores who have no prospect of change or any redeeming features. Why would I? I spend a lot of my time and energy at work, with the people with whom I work – if the chemistry isn’t there, what is the point? Eejits and bores can pass the time well enough but don’t ask me to spend my working days with them. I don’t spend my personal time with them either. Life’s too short………and if you have tried hard, reflected and thought it through and there is no realistic prospect of fresh developments or of repairing any bridges, well……………..

BUT,  in any relationship there are subsidiary relationships. I have left behind some dear people about whom I care deeply, and with whom it was a pleasure and a privilege to share space. And this is the point of this post: I had to be selfish and back away from a project that was still in progress, and leave behind some great people, because otherwise I would have been too unhappy to be as effective as I would want, and that would have been toxic for those relationships. Painful as it was I had to walk away from some people with little warning, because of the need to be selfish. And being selfish was very hard.

BUT, I urge you to be selfish. If you want those good relationships to survive, want to keep the sanity of the “family” of people you have had the honour of working with, be selfish. Know yourself, know your warning signs,  understand if the role is worth struggling to revive, and if not do the decent thing and stride off towards a new adventure with those lovely memories intact for everyone. Make sure you do as much as you can to relieve the pain, tie up the ends, tuck in the straggly bits, smooth over the jagged bits, leave a nice smell behind if you can. But make sure you do just that: leave. You and they will be happier – and who knows, perhaps it will prompt some development in someone else as well. And you can be proud of that.

Restorative Justice starts here……..

….with you and with me.

I have been following The Forgiveness project for a while now – it is a  a UK-based charitable organisation which explores forgiveness, reconciliation and conflict resolution through real-life human experience. They work in prisons, schools, faith communities, and with any group who want to explore the nature of forgiveness whether in the wider political context or within their own lives.  The Forgiveness Project has no religious or political affiliations.

I work at the moment, and have done previously, with people with many reasons to forgive and be forgiven and little opportunity to do either as survival is the priority. When I read and hear the countless personal stories in my own sphere as well as through the Forgiveness Project the bitter defiance and hunger of the unforgiving almost pierces the skin. Those who are unforgiven are lacking in a human aspect, but those who are unable to forgive suffer more with each reminder of what they cannot forgive. 9/11 is opening some dreadful wounds and there is some toxic stuff coming out, poisoning the future for those who cannot forgive. It is not their fault.

One of the things I have reflected on is my own lack of forgiveness. Not towards others – I could not bear a grudge  for the winning lottery ticket – but towards myself. More than the usual perfectionist thing of  beating-oneself-up at work, I have also consistently failed to forgive myself for just about every possible wrong I have committed. An example: recently we adopted a greyhound and had everything in place to allow him to get used to our much loved cat before letting them loose together. But it went horribly wrong – as I describe it I can just about smile with a grimace – it all sounds a bit Brian Rix to me now – the dog killed the cat, but while it was all happening and we were trying to separate them I was hauling on the dog and found blood on my hands. I instantly knew what I had to do and I punched the dog to the ground to free the cat, but it was too late. All over in seconds. I took the cat to the vet at once but he was too badly mauled and we had to do the decent thing. I blame myself, of course. Not only that but a few days later I ran over a blasted rabbit while driving to work down one of those country roads where the small animals fling themselves suicidally under the wheels of passing cars in the early hours. I should add I am vegetarian. Picture that. I arrived at work feeling like Jack the sodding Ripper.

But more painful and more troubling than all the other transgressions rolled into one is the one I find most difficult to even think about forgiving myself for: my Mother died earlier this year after a stroke – my Father had died three years before after a stroke as well. She suffered the most degrading and neglectful nursing in hospital at first until I made a quiet fuss and things improved. But my own shock and pain and the need to be constantly on the alert – no time to take ones eye off the ball –  to ensure decent care for her made it difficult for me to do as much as I should have done. I played her favourite music for her through my headphones on my iPod as she died, sharing it with her with one earpiece in one of my ears and the other earpiece in one of her ears – I do not know if she heard, the stroke was so massive and so determined to take her that it was not possible to know if she knew I was there or not. But just in case, I held her hand, played her music, talked a bit and sat with her and waited, for such a long time. I did things like the crossword in the Telegraph and read a bit as well to keep a grip on my sanity – but I so regret that now. Why didn’t I keep talking and playing music all the time? Or would that have just been annoying for her – perhaps she preferred to have some peace, some quiet to contemplate and prepare? I know that whatever I did it was the wrong thing and the right thing, and as I can never know I am unsure about how to  forgive myself. Relationships are complex and we had a challenging relationship – she was a charming but difficult woman and I suppose I am a little assertive… All of which means I am left with the most tremendous guilt, which is unfair on the rest of the family who bear it with me.

But the people I have heard and read during my following of this project have caused me to reflect: they are humbling in their own humility and forgiveness and need to understand, and somehow, their forgiveness starts with themselves, their understanding is rooted within. I need to think that through, perhaps there is work to be done – perhaps I should remember that my Mother would probably forgive me, and if she can, maybe I should also forgive myself and free myself up to forgive others, let me and let my family off  the hook. I need to do that if I am to prepare my children for what may happen in the future too and reduce their pain in advance. Like the outstanding, human people you will read about if you follow this link    http://theforgivenessproject.com/about-us/

Please do – for your sake as well.

The blessing of slowth…….

In my last blog I rattled on a bit about my bad knee and how I had been brought sharply up by experiencing disability and severe pain first hand. It shifted my view of things, gave me an opportunity to experience what it actually means. It was genuinely humbling and annoying in equal parts, and still is. I am still in pain, sadly, and have gone from the “when this gets better I will start cycling again” to ” I had better buy a couple of decent designer walking sticks that match my clothes……” and I have, in short, begun to suck it up.

Since reaching that conclusion I have noticed that, in fact, things have become easier. The pain is the same and don’t get me started about that. The first ten minutes of a car journey are spent groaning aloud until the pain settles – yes, I am a baby. So the disability remains, unchanged. What has changed is me. I am beginning to genuinely value the opportunity to look around me, take in the sights and smells and enjoy them (most of them)  and interact a little differently. It has made a difference not being able to leap up from my desk and trot down to the next department for a chat and the chance to rattle cages – I now walk a little slower, which gives me time to chat on the way as well as when I get there. As a super-focussed active achieving ambitious driven revved-up dynamic boss with buckets of energy (pauses for a round of applause….) it has been hard to adapt, to realise that I can still achieve, can still express my drive and focus, can retain my energy, but I have to use different tools. I have noticed that, because I am almost forced to talk at more length,  I am learning more about people; I am looking at people more closely; I am hearing different answers and asking different questions; I am using my energy to absorb as much as to reflect. The drive  and energy I have is spreading over a denser area and is actually achieving more because it has time to sink in. I have re-evaluated what matters to me during the day as well – the walking stick factor means I have fewer hands so need to rationalise what I carry around. Now when I travel around I know I have the things that matter with me, no more and no less. I have discovered, by accident, a new fresh way of managing and leading and it is fun! Accustomed to achieving and leading it has been a revelation to follow a different path towards success and find that it is even more satisfying than it was before.  This has both astonished and delighted me.

I believe the people I lead are also happier – there are more opportunities to be heard, more avenues to understanding. Before The Knee I believe there were those opportunities – after all, I had created and embedded them, recognising the need for those interactive oases and hot-spots, a bit of directed interaction. Since The Knee I can see that those oases were drying upa little  and needed to be refreshed. So Thank You Knee

My designer walking sticks are fab, by the way………and I have discovered the Walking Stick Club. I had not realised the covert winks and nods that go on between walking stick owners – the exchanged looks that say “nice stick, I know how you must feel. It’s ok”. I have had countless absorbing conversations with fellow walking-stickers and have even taken instruction from a perfect stranger, who was perfectly charming, who described to me how he had made the rather fabulous stick he was using when we met in the orthopaedics waiting room. Fascinating! It’s opened up a whole new universe for me! And this website sells some really gorgeous walking sticks: http://www.walkingsticksonline.co.uk/

So I say Thank You Knee. I wish you didn’t hurt, I will be glad when we have sorted you out, but Thank You for pointing me towards fresh conversations, new insights and better communication.

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