Roy Lilley (via his nhsManmagers.net circular), has suggested (nay demanded), that the whole hospital Board of Colchester should be sacked “The whole lot, lock-stock and barrel, shown the door.”

He supports his stance with the following paragraph:
“Whatever their excuse, no matter how grovelling their apology, however cunning their justification, no matter how reasonable their reasoning, no matter how defiant their defence, no matter how spirited their resistance, their promises, their hand wringing. However limpet-like they cling on to their jobs, salaries, pensions and careers. We do not want you in the NHS.”

I noticed my mind was reeling from what was an unexpected onslaught at that point in my day, and took a moment’s reflection. I was aware of a few concepts floating around my head. For example:
– The commitment and dedication of members of this Board to the good of their community over the years.
– How systems, together with attitudes to the pressures of work and associated tensions can have the affect of creating a toxic culture, and how these can go un-noticed in the business of everything.
But most importantly, I was aware that axing the Board with no investigation, no right of representation and no appeal, would have an inevitable impact on both the organisation’s culture and that of the wider NHS.

After a brief respite, my eyes found themselves being drawn back to the text, where they read the following direct message to named individuals:

“Dr Gordon Coutts, Sue Barnett, Mike Baker, Katy French, Sean MacDonnell, Sarah Shirtcliff, Sally Irvine, Helen Parr, John Ashworth, Jude Chin, Tom Fleetwood, Christine Temple, Peter Wilson… the Board… ask yourself this; if M&S had poisoned customers with their food, Virgin killed passengers with their trains or planes, Ford had sold cars with brakes they knew didn’t stop the car… what would you expect the Board to do?”

“You may have been unlucky, you may have been caught out, let down, lied to… we don’t care. You are tainted and totemic of the bullying culture the NHS has to leave behind. You are emblematic of casual leadership, the complacency, the smugness, the self-satisfied, arrogant management that thinks it will be OK to apologise, ‘learn the lessons’ and move on. No. You have dealt a fatal blow to the credibility of the NHS. You have presided over cheating, lying, forgery and goodness knows what else. However well intended; this is on your watch. Just go.

In your hospital, on your watch a bullying culture has led to questions that ordinary people are asking, to which the only answer is, we don’t know how it happened but we will find out and be assured; we will never let any of these people near a hospital Board again.

Do the decent thing, resign, quit; go now.”

Another brief pause and a reflection of how I felt after reading this…
Honestly?…I felt more than a tad bullied. Bullied by being forced to reach the conclusions that each of the named individuals are to blame and the recommendation for the Board to jump or be pushed, without an investigation or reliable findings to help me get there. I had to acknowledge that I also felt somewhere between irritated and angry, that a widely circulated blog post might unduly influence a critical situation, where the responses and decisions made will impact on the culture and mission of the NHS.

The recommendation to either jump or be pushed, based on no investigation, no right of representation and no appeal, breaches the principles of natural justice and is more than likely to perpetuate a bullying culture. A fascinating and yet worrying irony.

In his honourable endeavour to protect the community, Roy Lilley’s approach may well unwittingly damage the community. His approach essentially moves him from the role of ‘rescuer’ to the role of the ‘persecutor’ (see the Drama Triangle Stephen Karpman).

So what is the potential impact of ‘jump or be pushed’?
– Less opportunity for insightful learning
– Valuable tacit knowledge leaves the organisation
– A climate that encourages mass Board resignation/sackings whenever an NHS Trust has a crisis, regardless of the extent Board members are linked to, or have a remit for, the issues that may have led to said crisis
– Quality people less willing to offer their time, talents and professional reputation to serve on NHS Boards.

So on reflection, I would wish the Board and the key decision-makers around this situation all the best in staying focused on creating a better future for the NHS, and resisting the easy paths that will inevitably compound “the bullying culture (that) the NHS has to leave behind”.
There’s a time for an unyielding determination of both professional and lay communities to roll up their sleeves to help the NHS move closer to its calling, and one can’t help feeling that time is upon us where these communities need to commit together to celebrate the principles heralded in the NHS constitution:

“The NHS belongs to the people.
It is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health.
It touches our lives at times of basic human need, when care and compassion are what matter most.”