Being and well-being

This is a guest blog from my colleague Anna McEwen (@AnnaSharedLives):

The NHS is great for putting us back together. In the last month alone I’ve needed three different health interventions or procedures where my body has let me down. I am amazed at what modern medicine can do where in the past I’d probably have had to grin and bear it. Some of those interventions have been brilliant – community clinics carrying out operations rather than having to go into hospital, text and book rather than a series of letters in the post to appointments I inevitably can’t make; others less so when I’ve waited many months for a repeat of an intervention that didn’t work the first time, simply because that is the protocol.

But that’s the point of the NHS, putting us back together when we need it. It’s not so good at giving us a good life when we have conditions that aren’t a ‘one off’ or ‘put me back together and send me on my way’.

Last week I joined the latest cohort on the Leadership for Empowered Communities and Personalised Care (LECPC) programme. Some people have questioned why I’m doing this, when the very nature of what we do at Shared Lives Plus is in its essence based in the heart of communities and epitomises personalised care.  I’ve ‘grown up’ very much with those values at the heart of what I do in community based roles, advocacy and even as a commissioner very much engaged in finding community based solutions to the needs of local people.  However, I think it’s important for all of us as leaders to find time to stop, step back from the day job, listen and reflect which is why I’ve joined this programme.

On the first day of the programme I was struck by Cormac Russell’s analogy of Humpty Dumpty being picked up and not able to be put back together by the King’s horses and King’s men – what if he’d fallen on the other side of the wall and been caught by his neighbours, friends and community? What would have happened then? And we’re very quick to call something a ‘crisis’ and treat as such (homelessness, social care, loneliness etc.) when they are in fact a chronic situation and if we stopped the crisis reaction and looked instead to long term, community based solutions designed with and for the people involved we’d have a better chance of success.  The more we move into the acute, crisis mode, says Russell, the more we disable citizens.

As a commissioner, I was all about commissioning for outcomes but now wonder if we are commissioning for the right outcomes: those softer outcomes which really make a difference to people’s lives – like building relationships, talking to a neighbour, volunteering in the community, joining a local group. These are the things that give our lives meaning and purpose and ultimately give us well-being, not just ‘being’.

We know all about these outcomes in Shared Lives, people tell us they make new friends, join groups in their community that aren’t labelled as being for disabled people and gain a sense of well being that they’ve not previously experienced which can have profound benefits on both physical and mental health.  I was inspired by others on the LECPC programme who are leading some really innovative work in small patches around the country and I know there is a wealth of amazing stuff happening.

When I tell people about Shared Lives, they always say it’s a no-brainer, that it’s a brilliant solution etc. etc. But that no-brainer is still small, and struggling to break any ground as a healthcare solution. The 200-plus people who our Shared Lives Ambassadors (who have lived experience of Shared Lives) spoke to recently at NHS Expo all agreed that it was a brilliant idea, but still the system bogs us down and makes it difficult to do new things.

My take away from the leadership programme this week was to give away more power, listen more, and get more disruptive. So, for people who are ready to get disruptive in the health system and develop new ways to give people a good life, not just put them back together when they need it, we’re running a series of free workshops facilitated by Nesta to look at how you could develop Shared Lives where you are.

We really need people who think Shared Lives is a no-brainer to make it a reality for people so do sign up and come along to one of our sessions so we can help you to help more people have a good life. It’s free, there is nothing to lose, so come along or share the invite with a colleague and let’s get disruptive……

The workshops will take place from 11am – 3pm in the following locations:

Monday 28th October: London (Friends House, Euston Road, NW1 2BJ)
Tuesday 29th October: Birmingham city centre (venue tbc)
Monday 4th November: Manchester (Manchester Art Gallery, Mosley St, Manchester M2 3JL)

Click here for further information and to reserve your place.

Imposter or guest?

The King’s Fund published an interesting blog on imposter syndrome the other day, after participants in their third sector leadership programme consistently identified it as an issue – surprising perhaps for a group of successful and high-performing CEOs. Even these high flyers reported some of the doubts associated with a fear that they might not be worthy of their roles, or that others are better, cleverer or more suited. I can relate to that fear of ‘being found out’ and how it can lead to the urge to behave in ways that are motivated by managing self-doubt, rather than adding value to my organisation. This can be micro-managing, avoiding conflict or defensiveness in the face of the criticism which ultimately leads to personal growth.

The King’s Fund suggest some practical approaches to managing self-doubt, including seeing it as a skill and an emotion to be curious about, talk about and explore, rather than as a failing. As Lord Victor Adebowale of Turning Point has noted, leadership requires a combination of self-confidence and self-doubt: one to act, and one to act well. There are no perfect leaders, and the only truly bad leaders I have met in this sector have all had an utter lack of self-doubt in common.

The root cause of imposter syndrome is not, in my view, a failing in the individuals who experience it, it’s a symptom of the continuing mismatch between heroic ideas of leadership and what humans can actually achieve in leadership roles without being destructive. We are still conditioned to see leaders as people who can achieve the impossible – the elite athletes of the charity, public service or corporate world. But, just as witnessing elite sporting achievement is as likely to leave people feeling that sport is not for them, as to inspire them to try to emulate what they’ve seen, the cult of the heroic leader can disempower the rest of us, rather than inspire us to share in the awesome responsibilities which we are told these exceptional individuals can hold alone.

The cure for this lies not in improving the self-confidence of people in powerful jobs, but in distributing that power, recognising the unique strengths that each of us can bring and piece together, and including as many people as possible in that ‘us’: including people who are too often described as the ultimate ‘beneficiaries’, ‘patients’ or ‘service users’ of that leadership brilliance. Self-doubt may not be a demon to be vanquished, but the reality of how equal we all are or should be in worth, disrupting the power imbalances which we continue to tolerate and maintain, and to celebrate at every industry awards ceremony.

I have enjoyed reading Mark McKergow’s work on the idea of leader as ‘host‘, welcoming the whole team to the party, stepping forward to start festivities and stepping back to allow everyone to join in. But in the world of charities and public services, I wonder if a better cure for feeling like an imposter, may be to behave more like a guest. That means being able to hear when we are unwelcome, as well as when we are welcome. And more self-doubt as a leader might mean becoming more self-confident as an ally.

The smaller picture

I suspect I’m not the only person in a senior leadership job who regularly feels like a fraud: am I doing enough to justify my position? What vital opportunity or threat have I missed? Am I being strategic enough?

Ask most people who profess to know about how to do senior leadership and what makes a good leader, and they will often talk about ‘being strategic’. Taking a step back, getting a ‘helicopter view’, seeing the bigger picture.

There is truth in this: often as a senior leader you are in a unique position to have an awareness of what every part of an organisation is doing, which means you should be able to tell whether the parts are fitting together well or not and where the whole thing is heading. If you get bogged down in the detail of a single part, you risk losing that perspective and using up your time and energy on one part of an organisation whilst the others drift.

There are some problems with being strategic though. Firstly, we live in an increasingly unpredictable and chaotic world. However many steps back you take, there are huge changes, like Brexit, which the vast majority of the most powerful leaders did not see coming, and which even now it is happening, feels entirely unpredictable. We live in an age of social movements which bring great shifts in power for good or ill, but which the establishment cannot ignore and cannot always ‘manage’.

So the strategic skill of analysing and building complex systems is becoming less useful. You are as likely to make the right moves by being able to hear and move with fast-moving cultural changes. Savvy senior leaders talk about creating movements, but in reality, those movements are more likely to be started by a personal story and a hashtag, than a research and piloting budget. Working with the world in this way starts with building a shared values base for an organisation and requires closer and more communicative relationships with a much broader range of people.

The trade-off between strategic overview and a relationship with reality has always been under-estimated. For some years now, public service leaders have been talking the language of personalisation, person-centred care, communities and empowerment. Many of them have meant it. Few though, have been willing and able to translate those arresting visions for a more human model of public service into the collective activities of large organisations which continue to be run by middle managers who are performance-managed on balancing their existing budgets and ensuring their teams carry out a narrow and familiar range of tasks. The vision stays unengaged with the real-world pressures.

I see that disconnect when local leaders become passionate about developing their Shared Lives provision, but that passion dissipates as it meets the cynicism and stasis of their just-about-surviving teams. A mentor some time ago suggested to me that complex strategic plans, particularly if supplied by outside consultants, were always works of fiction. Instead, he recommended having a clear view of who you are as an organisation, which in turn would enable you to spot the opportunities to take, and the challenges to respond to.

I’m increasingly convinced of this.

You cannot of course, know who you are as an organisation, if all you have is an overview of it. You have to be prepared to get close to it too. Senior leaders who want their visions to become reality, have to be willing to get out of the helicopter and to work alongside colleagues on ground-level system change. And leaders who want to be sure that what their organisation writes about their values are real, must not only live those values in person but also spend time with people on both sides of its front line.

Step back from a large organisation or system, and instead of achieving a clear, strategic vision, you may fail to see the faulty processes which make the vision impossible to achieve, or fail to hear what people really experience. Bankrupt values will sink an organisation as quickly as bust budgets. The bullying culture Continue reading

The need for a Slow Policy movement

(I was not aware when writing this blog of this 2005 paper by Peter Bates which has a similar theme and which draws on In Praise of Slow by Carl Honore, also new to me. Some ideas percolate, well, slowly.)

There is a slow food movement, which began in Italy, based on the belief that fast food lacks real nourishment and flavour and that its intensive production methods and short cuts are unsustainable for the environment within which it is grown and produced. Slow food is produced with time, care and the understanding of local culture, farming and ecology which can only be developed over years, or even generations. It tends to value small-scale production for its sustainability and for being rooted in community and place.

At present, government and the NHS express the importance of a policy change through the urgency of the deadlines they set themselves and their partners and the amount of money they can ‘find’ in an emergency to fund the change. NHS Sustainability and Transformation Plans (STPs), in which every area was required to set out how its health system would transform itself to survive the current resource crisis and become sustainable, were clearly important, and therefore urgent. So, most were drafted by small groups of very senior people, who regretted they had not the time nor resources to engage widely, particularly with charities, grassroots groups and people with lived experience who are the most complex and time-consuming to find and talk to. It is no surprise that STPs, despite many containing necessary and pragmatic ideas, have been widely reported by the media as ‘secret NHS cuts plans’.

This cycle of crisis, frenzied activity and shallow changes is endlessly repeated. The urgency turns out to be illusory every time: whilst a report will be rushed out in months, underlying causes of problems will remain unaddressed for years. STPs are morphing into the next set of initials whilst the NHS and social care continue to go bust.

We need a slow policy movement in our public services: a new norm for how to create change. No more flurries of reports and plans from the same group of highly paid people, who remain embedded in group-think. No more heroic leaders on a mission to fix things.

Instead, the slow policy approach would be to cultivate different people and networks which are more deeply-rooted in the lives and service cultures of those affected: people with lived experience, their families and front line workers, who all need training, preparation and a slower pace in order to contribute meaningfully. A change programme would examine the problem or challenge from the point of view of people use services, families, front line workers and people who do not or cannot currently access the service. The conversations with them will start with “What does a good life look like?” not “How can we improve, cut or close replace our service?” The questions will include, “What are you willing to contribute to achieving the goal we all agree is important?” (which is a different question to “Will you pay for our service?”, or “Will you volunteer for us?”)

In place of short term pilots generating tentative findings, new models should be implemented on a small scale but with a plan to scale them up incrementally if they appear to be working, until they replace the current system. As my colleagues in Local Area Coordination say, ‘move slowly, to move fast’. With people who use services genuinely involved in their design and delivery, we would finally have the confidence to remove resources from models which do not work, rather than continuing to resource the status quo, regardless of how much more effective new models proved.

High Performance Failure

Every public service organisation has the potential to forget its purpose – working for the people who use its services – and instead being run for the benefit of those who work for or lead it. This happens in poor services through incompetence or laziness, but it also happens in high performing services, which get seduced by their own reflection.

The recent scandal of St Olave’s school, found to be unlawfully expelling sixth formers whose first year results looked like they might bring down the school’s A level results and threaten its league table position, is an example of this phenomenon. This was a state school, spending public money, which was lauded as one of the best, but which was in fact becoming in some ways one of the worst: wilfully failing and damaging young people at a crucial time in their education. This now appears to have been the practice of a number of ‘top-performing’ schools, who presumably shared the view that their league table success, and accolades for their leaders, outweighed the importance of harming those pupils seen as inconvenient. Arguably, this ‘wheat from chaff’ view of children is just a reflection of a wider crisis of values within the education system, with its lingering fondness for selective schools.

The school system has some features of which make this ‘high-performance failure’ more likely. The head teacher and the education system places huge value on the ‘heroic leader’, with ‘super heads’ wielding unchecked power. 2016 Harvard Business Review research looking at hundreds of heads showed that the most lauded head teachers, who made dramatic short term gains in academic performance, often through excluding more pupils, left no lasting legacy of success, but probably a trail of destruction as they removed ‘problem’ pupils and staff who disagreed).

Governing boards can lack real power, with parental voice limited or non-existent. Despite talk of empowering pupils, the focus of most school policies is on their compliance to rules set by others. An extreme example of this was circulating the internet today: the behaviour policy of an academy school, which, whilst clearly starting with the laudable aim to raise young people’s level of ambition (speaking clearly and confidently in full sentences, for instance) had strayed into an Orwellian nightmare: shy pupils could expect to be punished for speaking too quietly (city hypothetical future job interviews, this would make them appear ‘not that bright’) or even failing to smile enough, which was ‘ungrateful’ and ‘negative’. Despite glib slogans about how successful this would make children (“We’re Charter. We’re smarter”), it’s hard to see what leadership or creativity skills could be learned from being subject to such a monoculture.

This is partly a product of the gap between simplistic notions of success and quality in the education system, and what makes a diverse group of children not just as academically successful as they can be, but also as happy, kind and resilient – which are outcomes either unmeasured or which take second place to results. We also see this gap in adults’ services which are ‘high-quality’ but fail to help people achieve wellbeing or build resilience. Continue reading