Military metaphor and vanguards #5YFV #FutureNHS

Yesterday the healthcare world was awash with gleeful excitement as NHS England announced the 29 ‘vanguard’ sites, chosen to develop new ways of delivering integrated care. Last week I was chatting with Annie C, Helen K and others about the increasing use of military language in the #NHS:

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Then a few days later Clare Gerada shared similar sentiments and the conversation continued.

Then yesterday, a vanguard programme was announced. Who the hell is dreaming up this language? Have they any experience, at all, of life in the military? Do they even know the history of where their jazzy terms come from?

I suspect that on this occasion vanguard is some derivation of John Seddon’s system thinkings work, but the fact remains that’s not explicit and if you google vanguard for a definition this is what you come up with:

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So this is the advance guard, seeking out the enemy and securing ground, or perhaps trumpeters carrying messages to summon surrender, or clearing obstacles, ahhh yes, how’s that patient centred, holistic care working out. Everyone as equals, co-producing together.

In itself I’ve no problems learning from the military, in fact I’ll share three examples of where the NHS could take some immediate learning:

Values based leadership 

Lt Gen David Morrisson, Chief of the Australian Army. I’ve shared this video before, I love it, mostly because it illustrates a whole range of points, especially values-based leadership, not shying away from social media in a crisis (even with an ongoing police investigation) and a zero tolerance approach to bullying.

The standard you walk past is the standard you accept.

Humility and bravery

L/Cpl Joshua Leakey became only the fifteenth UK soldier to receive the Victoria Cross since the end of the Second World War. Awarded for gallantry in a joint operation, Joshua Leakey consistently reiterated that he was only accepting the award on behalf of every soldier in his regiment, and all those who have fought in Afghanistan. He was humble, brave and the personification of team spirited.

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Transparency and respect for the dead

A final thought around military values is what happens when people die. War is risky, a total of 453 military deaths have occurred since UK soldiers were deployed to Afghanistan (this doesn’t touch on those from other countries or civilians). I have heard first hand of the support available to families when family members die in conflict, the limitations and the small benefits of transparency. The mum of one soldier killed in Afghanistan had this to say in response to one of my earlier blog posts about the behaviour of the NHS to a grieving mother:

…when your child dies quite unexpectedly it is a profound shock and your whole world tilts on its axis. Family, friends and colleagues are essential and amazing when they have your well being in mind. They are the ones who help you to mend and so, in time, face the future with the sun on your face. But there are some who are so completely immune to your grief and pain and have absolutely no understanding and no desire to empathise with the your loss. Unlike Sara, I was able to find out the circumstances of my son’s death and it went a very long way to help us all. It helped the family to move on. Funny isn’t it, how one government department was determined to be transparent (the MOD) but another (the NHS) doesn’t have quite the same ethos?

This is it really, for all it’s talk of candour and honesty, transparency and learning lessons, the NHS, and specifically those in charge at Southern Health NHSFT seem completely and utterly committed to just spinning a line. They are stalling and prevaricating and doing all in their power to delay any progress, and stop any transparency. A year ago a report found LB’s death to be entirely preventable, and still no accountability has been shown.

Military language in healthcare

I’m not sure that I’m comfortable with the increasing use of military language in healthcare. If staff are on the frontline, then patients are under siege, the difference is that they don’t get to go home at the end of their shift. Sticking with this metaphor for a little longer though, one final reflection from me on the vanguard programme.

Vanguard or forlorn hope?

It is beyond my comprehension that a Trust that has recently been told by the CQC that they are under-performing and require improvement and who are under Police investigation for potential corporate manslaughter/manslaughter by negligence charges, can be ‘selected’ to be a vanguard site. My only comfort comes from the fact that in any pilot or development programme you need one or two ‘average’ sites to show it can work anywhere. Perhaps Southern Health are to serve the vanguard as a forlorn hope, it would fit quite well really, junior officers with hopes of advancement (seems to fit the meaningless-award-winning CEO culture at play) risking all or nothing in an attempt to make their name.

It’s all well and good certain bits of Southern Health being good performers, a Trust that size would have to have some bits that are good, but when there are people dying preventable deaths in other bits of its service, surely it is time to hold fire on the awards and pilots for a year or so, focus internally on improving the whole system (or alternatively start breaking apart the Trust into more manageable chunks) and take some accountability.

Today the CEO of NHS England pledged for #NHSChangeDay that he would focus on improving care for learning disabled people:

His exact words were ‘I personally am going to help lead the drive across the National Health Service to change the services that people with learning disabilities get’. Perhaps he might start by taking a bold leadership decision about Southern Health. It’s time that the system stopped pulling rank to protect those that are responsible, that there was some actual leadership and action from the top. I’m hoping that Simon Stevens will follow Lt Gen David Morrisson’s lead, dig deep and model L/Cpl Joshua Leakey’s courage and do the right thing. I don’t see any vanguard sites that are failing to meet their A&E targets, or who are breaching their cancer pathway targets, so why is it that learning disabled people are worth so much less?

If Simon Stevens is a man of his word, then he’ll intervene, after all the standard you walk past is the standard you accept.

3 comments on “Military metaphor and vanguards #5YFV #FutureNHS”

Jax says:

“This “sir, yes sir” business, which would probably sound like horseshit to any civilian in his right mind, makes sense to Shaftoe and to the officers in a deep and important way. Like a lot of others, Shaftoe had trouble with military etiquette at first. He soaked up quite a bit of it growing up in a military family, but living the life was a different matter. Having now experienced all the phases of military existence except for the terminal ones (violent death, court-martial, retirement), he has come to understand the culture for what it is: a system of etiquette within which it becomes possible for groups of men to live together for years, travel to the ends of the earth, and do all kinds of incredibly weird shit without killing each other or completely losing their minds in the process. The extreme formality with which he addresses these officers carries an important subtext: your problem, sir, is deciding what you want me to do, and my problem, sir, is doing it. My gung-ho posture says that once you give the order I’m not going to bother you with any of the details–and your half of the bargain is you had better stay on your side of the line, sir, and not bother me with any of the chickenshit politics that you have to deal with for a living. The implied responsibility placed upon the officer’s shoulders by the subordinate’s unhesitating willingness to follow orders is a withering burden to any officer with half a brain, and Shaftoe has more than once seen seasoned noncoms reduce green lieutenants to quivering blobs simply by standing before them and agreeing, cheerfully, to carry out their orders.”
― Neal Stephenson, Cryptonomicon

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