Why did you want to take on this project?
I’ve obviously done some other management programmes with the BBC, a series called I’ll Show Them Who’s Boss, and the idea was to try and take the same idea, so looking at a business - those were family businesses - into something which was larger and more institutional, to see whether or not the kind of rules that apply to management in those situations also apply on a larger scale. My own view was that they were always going to, and in fact I think it turned out to be very much the case that the same rules did apply.
What did you imagine the management of an NHS hospital was going to be like?
I think it’s always very hard to remember back to exactly where you started, but I remember feeling quite frightened by it in the sense of thinking oh my God, what have I let myself in for here, because I do think that the rules are maybe the same, but the circumstances operating in the NHS, has indeed turned out to be the case, I thought could be very different, and it certainly was. And, obviously, one’s always concerned about going into an area where you don’t actually know in any technical sense anything about the business that you’re going into, and I have had no experience at all in the Health Service.
How much was your task about changing people’s attitudes?
I think management is always about attitude. It’s about setting a scene in which people can do things, they feel they can do things, they feel they have the space to take a chance and actually get on with it. I don’t think I’ve ever come across a situation where that attitude was very much not the norm, and changing the way that people feel about the organisation that they work within is incredibly difficult. And it was very clear that to get any change at all, to get people to think that you could actually do something now rather than waiting six months or maybe a year, sometimes two years to actually do something - you talk about it now but you don’t actually do it now - just getting that idea into people’s head that you need to get out there, look at what the problem is, solve it now and move on. Getting that thought process was extraordinarily difficult.
Was it more difficult to changing people’s mind sets in the NHS, compared to other organisations you’ve worked with?
Oh much more difficult than it would have been in any commercial organisation because there is a sense in a commercial organisation of a commercial, you know, imperative. People know what the object of the exercise is, and by and large people working in commercial organisations, have worked all their lives in commercial organisations, and they know that you need to make things happen and you need to make it happen now, otherwise in business you run the risk of dying on the vine. The Health Service, you’re very protected, so you can take your time, you don’t have to change, it’s all very casual and very, very different; much, much slower than it would have been in almost even the worst run commercial organisations.
What was the greatest surprise to you throughout the 6 months you were working at the hospital?
I had two surprises really, in opposite directions. One was just how incredibly separated the various parts of the hospital were. There was no communication of any real value that connected between many of the medical parts and many of the management parts. But the other thing that struck me was just how good some of the people were. I was very pleasantly surprised by the calibre of people, particularly on the management side.
What are the key basic skills you feel is all too often lacking in management?
Well, more often than not I think the thing that is lacking in the kind of institutional management is first of all that sense that management is a mystery, rather than a sense of it’s actually pretty straightforward and this is what you need to do and let’s do it. That’s the major thing that’s missing. But also often missing is a sense of leadership, a sense of we’re all in this together, being able to get people excited about being part of something, which is after all, one of the most important things you can do, this is more important than selling Coca Cola or whatever other product that you may be involved in. This is really key, exciting, valuable stuff. So if you can’t get people revved up about doing this, I don’t know what you can get people revved up for. That capacity, that leadership element of management, I think is probably the biggest single thing that’s missing.
How well managed do you feel that the Rotherham General Hospital is?
I think Rotherham, as a hospital, was certainly way up there in terms of the average, I mean probably way above average as it won all the necessary stars, it was its own independent trust, it had all of the things that the NHS was asking for. And as such they were a pretty good group of people involved. But it wasn’t managed in any way that I would understand management in the sense of having just a structure within which things could be just discussed quickly, the solution found and implemented. It just literally went up each individual line. And so you’d have a line for nursing, there’s a line for individual specialties within the consultant body, there’s a separate line for management, there’s another line for anaesthetists. Anything at all that involved more than one discipline was pretty well guaranteed either not to happen or to happen very, very slowly.
Do you think the NHS is recruiting the right people as its managers?
I think that if you think of what you’re talking about as a general manager of the hospital or chief executive, whatever title you give it, you are asking quite a lot, it’s quite a technical job. There are a lot of things happening. There’s a lot of stuff actually happening on the ground. It’s a bit unpredictable in terms of what’s going to come at you. It’s very, very difficult in the sense of stuff coming at you from the top like from the Department of Health and down from the senior echelons in the Health Service itself. It’s actually a very, very tricky job. You’re looking after a budget in Brian’s case of - I can’t now remember the figures - but about £140 million. It was there or thereabout, £136-140 million. That’s a big job, and we don’t compensate people enough.
When I think of the money that’s being thrown at the Health Service, one single thing which was to recruit really high calibre people, even if that meant paying £350-400,000, £500,000, to actually get the right person, would have been money really, really well spent because if you think of the £23 billion extra money that’s been thrown at it that went into salaries and got fritted away in all sorts of other ways, if you think about the fact that they spent a fortune on a computer system that has yet to deliver - and I mean I’m talking billions - quite a small sum of money getting the very best people running particularly the larger hospitals would have been the best investment by far. But that would have meant the kind of outcry you’d have got if you started paying £½ million for a hospital manager, but that’s what it needs.
Why is it so important for management to listen to people at the sharp end?
I think that no matter what discipline or no matter what area you’re looking at, the people who really know the answers are the ones who face the problems right down at the sharp end. They know what the issues are, and they know how to solve them. Because management is often not about the solution to problems because the solutions are often very, very simple; management is about actually seeing that there is a problem and seeing that something can be done about it. And that’s nearly always held at the root of the business, people who really do it at the shop-floor. Now you only manage to kind of garner those ideas, to actually harvest them and to do something worthwhile with them if people feel that they can bring them forward, have them discussed in a useful way and that something might actually happen.
Well I think, probably years ago, and it’s very difficult to know, that belief was lost. I don’t think people on the shop-floor believed for a minute that it’s worthwhile talking about any idea because it ain’t going to happen. And that absolute sense of it doesn’t really matter what you say and you can talk about it and go around the houses on it because actually nobody is going to do any of this stuff, that sense is a killer, because unless people feel that they can get that idea, they can be recognised for it, people can say well done, if they feel that that can’t happen, they very quickly stop coming up with anything, and that’s what’s happened.