Who can you trust?

Who can you trust?

Who can you trust?

I read the Paterson Inquiry report today. Which is an unusual thing for me to do. I don’t normally read inquiry reports. It’s not that I don’t care, or I’m not interested. It’s just that they so often leave me feeling hopeless and shocked.

Harm, death, missed opportunities, cover ups, negligence, pain and fear. These are usually common themes underneath the technical language and the chronological analysis. Sometimes it just feels like too much to take in.

But today for some reason I felt obliged to engage in a story about a man called Ian Paterson, a supposedly renowned and respected surgeon, now serving a prison sentence for 17 counts of wounding with intent (and many hundreds of other victims in addition). 

Maybe it’s because I’m 48 years old and everything to do with my woman’s body increasingly feels like an emerging medical issue: I’ve joined a Facebook group to prepare for the menopause, I have the regular joy of my smear test next week and my friend is starting at breast screening. These things are all our arguably admirable attempts to seek advice and support proactively and without delay; an opportunity Mr Paterson misused, and mis leveraged to the criminal hilt.

So, with all this on my mind, I grabbed a cup of tea in a motorway service station, braced myself and read the report from cover to cover.

Underneath the stories from the 211 patients and relatives who gave evidence was one over-arching and pervasive theme: who can you trust if you can’t trust the medical profession? And this is what I pondered as the service station staff cleaned around me and my tea went cold.

We place unquestioning trust in our medical and clinical colleagues of almost any designation. Even in this day and age of informed patients and Google diagnostics, we trust those who we think know better than us. We trust the people who we are referred to, the organisations that employ them, the agencies who regulate them, the bodies who accredit them, the colleagues who work with them, the managers who oversee them, we trust the reputations people create and the charisma that we see. We just trust it all. And why wouldn’t we?

So, when sadly our trust is betrayed, on many levels, in many ways and over many years what can we take from the trauma of betrayed trust?

Well we take the Right Reverend Graham James’ recommendations in the good grace that they are provided to us. We hope that this time systems, checks, culture and processes will improve meaning that we can’t be betrayed in this way again in the future. We take a more cynical, eyes wide open view into our next medical consultation. We do our research, talk to whoever we can and check our spider senses for things that don’t feel right. And after that we have to trust again. It’s all we can do. And we do it with compassion for the betrayed and contempt for the betrayers. We do it also knowing that the vast majority of the people we have to rely are thankfully not like Ian Paterson. We hope.

Lancashire and South Cumbria as a New Commissioning System: The Journey So Far

Lancashire and South Cumbria as a New Commissioning System: The Journey So Far

August 2018 marked a one-year milestone in Lancashire and South Cumbria’s journey towards a new commissioning system. This article describes that journey, focusing on the lessons learnt in the first year of what will ultimately be a long-term plan for change.

Key to Lancashire and South Cumbria’s experience is the importance of putting the right people alongside the best processes and using the most honest approach to get reform in a complex and multi-faceted system successfully off the ground. We talk about the importance of buy in and co-production as well as the need for clear project design and the incorporation of bespoke ways to make decisions based on data and evidence as well as passion and governance.


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Programme Directors: More than project managers, more like acrobats with stamina

Programme Directors: More than project managers, more like acrobats with stamina

Ask recruiters what you need to be a successful Programme Director and they may tell you the following:

‘….you need to be someone with a disciplined approach to project management who can deliver project execution on time and on budget…..’ or maybe that you need to be

‘….adept at using technology to streamline business outcomes, increase productivity, drive efficiencies and deliver savings….’

For some, you also have to be an expert in change management, business intelligence, assurance and strategy, comms and engagement and relationship management; you have to understand outcomes and be relentlessly focused on quality as well as be a principled and skilled leader who can grow capabilities in almost any team of people. Oh, and you have to be generally fun to work with!

And of course, you do need to be all these things and much, much more. But, in my experience, above all the business school skills, the EQI and the work based competencies, there are 2 qualities that a successful Programme Director just absolutely has to possess; one is agility and the other is resilience.

A good Programme Director has to be organisationally nimble; moving between stakeholders and across projects like continually climbing and descending a complex series of interconnected ‘ladders’.

They must navigate the prerequisites at the top of the ladder (accountability, regulation, politics and strategy) as well the fundamentals that form the very foundations of the programme, (people, processes, values and delivery).

They must reach across to other ladders to smooth inter-departmental and inter-organisational conflict and build new ladders where none existed before. They must create a stable form, a fit for purpose structure, a space for mobility with an eye on design; all the time keeping a precautionary view on the overall stability of this complex web of ladders, ultimately deflecting things that may lead to them being inadvertently toppled. They must be comfortable at the top and familiar with the bottom. They must balance and stretch and point and hold. They must bend and straighten, stand firm and flex. Programme Directors have to be acrobatic!

And to be this continually agile Programme Directors have to be strong. They have to be resilient.

It takes relentless energy and optimism to operate across the multiple rungs in a complex set of programme ladders. While moving around and avoiding the gaps, Programme Directors are reassuring those in precarious positions that help is on its way. Mitigation abounds with the Programme Director. They are checking foundations while scaling new heights. They are constantly solving the structural engineering challenges that the programme ladders throw up; and all with integrity and enthusiasm for bouncing back even when a ladder gets all bent out of shape. Programme Directors have stamina! They have to be resilient.

So Programme Directors are not glorified Project Managers, though excellent Project Managers are essential in any high performing programme. Programme Directors are acrobats with stamina.