On Tuesday I got into a conversation with David Gilbert on twitter. If you don’t know David, I’d recommend you have a peek at his twitter and his blog and see whether you might need him and his thoughts in your life (you probably will). Our conversation was prompted by a tweet from the NHS Leadership Academy which was advertising a 4min clip from the Radio4 Today programme featuring Lord Stuart Rose. Rose, formally of M&S, has recently been advising the government about leadership in the NHS. You can watch the 4min snippet from Radio 4 Today below:

David pointed out that during his investigation into leadership in the NHS, Rose had somehow managed to forget about patients:

Hmmm @DavidGilbert43 @NHSLeadership @BBCRadio4 he also seems to think the #nhs is just doctors, nurses and administrators, ironic really

— GeorgeJulian (@GeorgeJulian) July 28, 2015

Somewhat surprising given a review into M&S performance without considering customers would be impossible. David and I exchanged some tweets about this, you can read Rose’s report here. During our discussion I observed that NHS Leadership is hugely professional focused, to the extent that it seems to forget there would be no NHS without patients. I also highlighted my expeirence of them as somewhat blinkered and oblivious to dissent:

@DavidGilbert43 sadly @NHSLeadership is hugely self/professional focused, seem oblivious to pts and any dissent from central msg @BBCRadio4

— GeorgeJulian (@GeorgeJulian) July 28, 2015

This tweet resulted in a number of responses from Mike Chitty (Head of Delivery at the NHS Leadership Academy). Mike responded by generously offering me a chance to ‘visit the academy’ and ‘find out first hand’:

@GeorgeJulian @DavidGilbert43 @NHSLeadership @BBCRadio4 perhaps you might like to visit or meet? Find out first hand?

— Mike Chitty (he/him) (@mikechitty) July 28, 2015

This was then followed this up with the suggestion that I contact people who have attended NHS Leadership programmes and ask them whether patients are at the heart:

@GeorgeJulian @DavidGilbert43 @NHSLeadership @BBCRadio4 or just ask those that have done programmes whether patients are at the heart?

— Mike Chitty (he/him) (@mikechitty) July 28, 2015

Then a little later Karen Lynas (Head of Leadership Development at the NHS Leadership Academy) suggested NVTweeting may have a useful view.

While I have no doubt that Mike and Karen both came from a good place, and I’m grateful for their engagement, the whole interaction left me with a bit of a sour taste in my mouth.

1) I think words express more than just their intended meaning. I’ve been musing Tuesday’s interaction on and off ever since and the language was perhaps just unfortunate, perhaps I’m over-sensitive, or perhaps it belies something cultural…. I believe that my experience is valid and useful, my observations are no less relevant or useful because I’ve not seen the NHS Leadership Academy first hand! Yet I experienced these interactions as not acknowledging my perspective and inferring/implying others had a better/proper/right/useful view.

2) What is it with the NHS and wanting to meet? It feels like there’s an almost instantaneous desire to take anything challenging or contentious offline and into the face-to-face realm. Katrina Percy, CEO of Southern Health NHS Foundation Trust (I’ll come back to her in a mo) spent months haranguing Sara Ryan to meet after her son died, even after the Chair of the Board explicitly promised that they would not (March 2014 Board Minutes, 7.3).

The last few occasions I’ve questioned those working in leadership in the NHS they’ve either not responded and/or the suggestion is made to ‘meet for coffee’, or ‘visit first hand’. Maybe on these occasions it is simply because the person offering isn’t comfortable discussing things online, and certainly some matters are complex and not easy to discuss in 140.

Yet, if people are going to have a presence on social media and engage in conversations or broadcast and share their perspective, I personally don’t think it’s unreasonable to expect them to engage in a conversation with someone who isn’t singing from the same hymn sheet, or who may be challenging their conventions.

3) The NHS Leadership Academy, and many NHS leaders, are visible on social media. They’re also visible and in my line of sight in the interactions I have with the NHS (not as regular occurrence at present as it has been in the past, thankfully, but still some recent experiences to draw on). Therefore to imply that NHS Leadership is about programmes, sort of misses the point.

I am not saying that my experience is more valid/useful/representative than anyone else’s, it is simply my experience. If the NHS Leadership Academy was as truly engaged with patients as I would like it to be, I think it’s communications, it’s visibility and it’s holistic impression would be very, very different.

4) I believe that patients are central to healthcare (blindingly obvious I know). I also consider that many of them are genuine experts in themselves and their care. They bridge the intersections of health, social care, housing and many other silos, and to do so isn’t an academic exercise, it is an exercise quite literally in survival. Patients, I believe, are the biggest untapped asset for NHS leadership, they navigate complex systems, they speak multiple languages, they tolerate uncertainty at a much greater level than most staff working within the NHS, regardless of the change fatigue that Lord Rose was keen to acknowledge.

In spite of this, it is my experience/impression that patients are not central to NHS leadership, indeed they may (in exceptional cases) be included but in no way does NHS leadership appear to want to start with them as their first port of call. Indeed Intersect, the latest systems leadership programme offered by NHS Leadership Academy (three days left to apply people) costs £12k, half that for NHS, public and third sector and no mention of any special discount or support for patients or patient leaders.

@DavidGilbert43 @BBCRadio4 yup I called this at wknd, another @NHSLeadership programme, £12k fees, £6k reduced, will keep pts away nicely

— GeorgeJulian (@GeorgeJulian) July 28, 2015

Roz pointed out that there was a chance of a full bursary, but the programme blurb is clear that will be exceptional, so I can’t imagine many/any patients thinking that would a) be relevant to them b) be worth applying for or c) create an environment where their skills and experiences are as central and core as anyone else’s.

I believe this failure to truly recognise and invest in patient leadership is inefficient, unsafe and to some extent arrogant. Which brings me on to my final point…

5) Who really counts? In all the talk of the NHS cuts, in the outrage about 24/7 working, in the awards ceremonies and lists, in the leadership programmes, conferences and seminars, who or what really counts? I hear so much about the impact on NHS staff, I hear about the pressure, the change fatigue, the exhaustion, the poor morale, the challenges…. and I’m not dismissing that. Really.

However, whatever the reality and however bad it is for staff, trust me, it’s much, much worse for those needing their care or support. I sometimes feel that is lost and forgotten.

So if the NHS Leadership Academy is serious about patients, and if they care about balancing out professional power, perhaps they could stop publishing glib articles like this, from the aforementioned Katrina Percy about ‘leading in tough times’. Or at the very least consider the impact on others of their publishing that, when there’s an ongoing police investigation and two further independent investigations into failures that led to a preventable death (in her Trust). Tough times, really, for who?

Perhaps the NHS could stop looking to its professional hierarchies and start focusing on patient or advocate leadership. True leadership, freely given to improve things for others, often from the deepest darkest places at great personal cost.

If the NHS Leadership Academy truly has patients at the centre of everything they do, perhaps they might start sharing the narratives and experiences of patient leadership. They could start by sticking this short film on every curriculum they have, as a reminder of what really counts:

The Tale of Laughing Boy from My Life My Choice on Vimeo.