The Tory Blues

Tory Blues

Stop all the protesters, cut off their mobile telephones
Prevent them all from whinging. Confiscate their eggs and stones.
Fire up the Daily Mail and with muffled drum
Bring out her coffin, let the mourners come.

The liberal leftwing media keep moaning in our heads
Scribbling on their front pages the message
Ding Dong the wicked old witch is Dead,
While the rest of the country dies a death from 1000 cuts
Pour out 10 million for her funeral..lets have no 'ifs' or 'buts'..

She was our Tory North, our South, our East and West,
Our working week and our Sunday rest,
Our noon, our midnight, our talk, our song,
Till we stabbed her in the back and now she is gone

The miners are not wanted now, get rid of every one;
Pack up the Eurozone but never dismantle The Sun;
Pour away the unions and soak up Orgreaves blood.
And let’s have a massive barney over whether she was bad or good.

                                 

                                 

NHS Whistleblowers as heroes? The Twunt thinks not!!

OK...Richmond House we have got a big fucking problem. It has come to my attention that 
there is a concerted campaign to get two NHS whistleblowers installed as winners of the  NHS Heroes Competition. I have got to take a line on this. Here it is.

OVER THE DEAD BODY OF JEREMY FUCKING TWUNT!!!

This is a CODE RED situation. Repeat this is not a fucking rehearsal. The DoH Hit Squad has been alerted. These two fuckwits need to be neutralized

Target 1: Gary Walker (a.k.a @ModernLeader). Former CEO of United Lincolnshire HospitalsTrust. 

If you haven't heard of this baby-faced snitch before, here is a potted history which was added to this month when he appeared before the Health Select Committee and pretended that he had been forced out for challenging the target culture that David Nicholson is charged with presiding over because he was (and here is the unbelievable bit) "concerned about its implications on patient safety. I mean, is this guy for real?! His boss at the time,  Barbara Hakin told Walker to meet his target  'Whatever the demand'. I PROPOSE BARBARA HAKIN AS A REAL NHS HERO!! She is just the sort of person should should be leading the NHS. (Which is probably why David Nicholson chose her as his Deputy). 

Of course, his old trust and strategic health authority hotly contest that Walker is a whistleblower (on the rock solid grounds that a court hadn't declared him one). When he appeared before the Health select Committee Select Committee its a bloody good thing that no one was interested in asking why the SHA were willing to pay him off £500K rather than take their chances with an employment tribunal if he had such a good case, or why his payment was agreed by an unusual process called 'judicial mediation' in an apparent attempt to obscure those payments from gazing eyes at the treasury...and elsewhere. Of course,this may be due to my deployment of Team Twunt 1st Team star player Stephen Dorrell who gave Walker a good doing over with some surprising support from Rosie Cooper

Let me list the reasons why this shit bird Walker cannot be allowed to win

1) This fucker represents the most direct challenge to the NHS  hierarchy I have experienced in my tenure of this awful post

2) Walker has already seriously fucking embarrassed David Nicholson by making him lie to the Health Select Committee

3) But most importantly. Utterly fucking vitally...Walker is a symbol for the cultural revolution that Robert Francis called for in his report for the Midstaffs Public Inquiry. I cannot stress what a clusterfuck it would turn out to be if it ever came to pass that Walker won the NHS Hero competition. We cannot have CEOs or anyone else openly challenging the whims of the NHS leadership in the name of patient safety...especially if that leadership is me or people I support...or kind of support.

Look at this arsehole!! Just look at him and tell me is an NHS Hero for fucks sake...seriously ..Just look at this jumped up little bean counting shit strut his stuff.....




ACTION POINTS

i) Under no circumstances should anyone vote for this wanker in the NHS Heroes competition
ii) Efforts should be made to discourage others from doing so.
iii) Do not fill in this form for the NHS Hero Competition outlining any of the spurious reasons some people might be lured into using to vote for him

NB. Hopefully people will be put off from voting for Walker since as he rightly got the boot he doesn't work for the NHS anymore



Target 2: Helene Donnelly. Nurse. Formerly Midstaffs Hospital

People not voting for Walker may be tempted to vote for Donnelly. This preening fantasist was forced out of Midstaffs Hospital after blowing the whistle on nurses fraudulently altering the 4 hour target admissions data in A&E.

She represents the front line who have to bring about the Health and Social Care Act. They might have to deal with the stress of that and I'm sorry but shit rolls down hill and we cant have them challenging their managers every time a rule is bent or broken even if it means patient safety taking a hit.

Check her out swanning around the TV studios demanding that people whistleblow when they see poor care ....JUST WHO THE FUCK DOES SHE THINK SHE IS?!! Eh?!!  Does this prima donna deserves an accolade? I dont think so...I think she deserved to be bullied threatened and told she would lose her job. Just read her statement to the Francis Inquiry where she recounts not feeling able to walk safely to the car park after her shifts. Those 'bullies' are the enforcers of the NHS. We owe them a debt of gratitude!!

Why should she be rewarded for doing the right thing? Its utterly ridiculous! Ok, she took alot of shit for just doing her job properly but honestly you should see what I have to put up with on Twitter
.
If you had to explain to someone thinking of voting for Donnelly just ask them these four simple questions (I have provided some easy to understand answers in case they don't know them.

i) Did she go beyond the call of duty? NO! Its just that she was the only person stupid enough to.
ii) Did she suffer because of what she did? NO! She got on TV because of it FFS!
iii) Did she really have to be brave to do what she did? NO..She had to be really fucking stupid.DO WE REALLY WANT STUPID NURSES IN THE NHS??
iv) Does she represent any kind of example of the cultural change that Francis had in mind for indiciduals in the future NHS? If every nurse who could did what she did the whole NHS Shit House would go tits up. End of.

ACTION POINTS

i) Do not fill in this form for the NHS Hero Competition outlining any of the spurious reasons to vote for Donnelly  mentioned above.

ii) Efforts should be made to discourage others from doing so

Our comrade the King is a dead man walking. Who is the King?

I've got to tell you, I'm at a bit of a loss. Comrade Nicholson is up shit creek with a thousand NHS whistleblowers from hell on his case. WHAT THE FUCK AM I SUPPOSED TO DO? I dont want to give him the old heave-ho, no one has more intimate or labyrinthine knowledge of how the NHS works. AND he has always delivered. What? What was that? Oh, I know I cant sack him... I'm not really in charge of the NHS anymore. That would be down to the NHS Commissioning Board...I think.  But seriously, between us I'm not sure how long he can hold out. The big beast is wounded and it's beginning to look mortal.

So ..I wouldn't be doing my job if I didn't begin to start to think about the succession. Now if you were me who would you choose? Someone who believes in the founding principles of the NHS? Someone who believes the NHS should be free at the point of use? Decisions decisions. Well I was looking over the line up of candidates the other day and I've got to say one has really caught my eye. Oh...you want to know who? Well, get an eyeful of this guy

Now you may not think he looks the part but let me tell you why I'm so impressed. This guy is a fully paid up member of Team Twunt. His name is Mark Britnell.

1) Britnell left the NHS to work for KPMG just before the coalition took over. This man knows when to jump ship.

2) Britnell has aligned himself with the philosophy of  Team Twunt. He is on the record as saying that the NHS will become a form of state insurance and private providers will help you all get better when you are sick. So he's cool with the Health & Socal Care Act....He also predicted that the NHS will be "shown no mercy" in the first few years after the Health & Social Care Act were passed. The man is a prophet!!

3) The guy talks my language. He wants the NHS to be "entrepeneurial". 

4) He is very careful to make sure he praises the NHS while pointing out its faults and constantly makes the case for co-payments.

5) In case you thought that he was enjoying the benefits of the private sector too much to return the the open sore of the NHS, he has promised to come back.This man knows when to jump back on the ship. (When the captain has just been made to walk the plank)

So, you see what I mean? My kind of guy. It would be a shame if Comrade Nicholson had to go but....every cloud.....I think I'll just give him a ring.....

Credit to the NHS (A memo for members of Team Twunt)

***FOR TEAM TWUNT EYES ONLY***

You may have noticed this recent report regarding Standard & Poor's shot across the bows to G20 countries that they risk credit rating downgrades if they don't 'reform (1)' their healthcare costs. Now given Gidiot's dogged like attachment to the argument that austerity was in part to maintain the UK credit rating this represents an opportunity. OK ...he may have ballsed-up his execution but that's not the point. We should increasingly be using this threat of a credit downgrade as an argument for NHS spending cuts....especially in the run up to the next election. Positive reports that the NHS is among the best and cheapest healthcare systems in the world should be suppressed or ignored. This should not be too hard in the post-Francis era. We have to get this message on repeat NOW to soften up the public for the post 2015 cuts. And keep the 'The NHS is safe in our hands!" message on repeat...

Yours
The Twunt

(1) 'Cut'

The C word. The coming culture shock in the NHS

"If you want to change the culture, you will have to start by changing the organization." Mary Douglas (1921-2007)

OK I'm going to try out this blogging thing out, yah? Marvelous. And the thing I want to talk about first is **CULTURE in the NHS**. Now clearly, there are few people better to talk about this than The Twunt having been both Secretary of State for Culture and now Health (don't be convinced otherwise by this bogus survey on the right suggesting I was a shit culture secretary). My supporters (well, Camoron) don't let a little thing like that undermine their (his) ROCK solid belief in me. Yes, I'm talking about the culture of the NHS. If you don’t have the misfortune to live in the unbearably tedious world of health policy then let me tell you why this is important. 

Apparently, in the next few weeks some guy called Robert Francis is going to give me his final report of the MidStaffs Public Inquiry. Whats that? That’s the question I asked when I was told about it last week. You've never heard of it either? Well, the national media were pretty much absent throughout the proceedings and a fucking good thing they were too. It’s a nasty story. Read about it here. Anyway, Health Policy World is going nuts because it thinks that Francis is going to say that there is a problem with 'the culture' of some hospitals that ends up with horrors like MidStaffs. That’s why, in an attempt to preempt this issue I've cunningly started talking about culture in the national press and how we should sort it out and start assessing it. 

So…I can hear you thinking "What…the fuck…is hospital culture?". Good question.  I don’t bloody know but it sounds like something useful to put the blame on for all the shithouse problems in the good ship NHS. It's also a fantastic stick to beat managers, doctors, nurses and every other poor fucker who has to scrub the decks.


Let me give you an example of how people use the word when they talk about the NHS in a way that's relevant to Midstaffs. Last week, a clever SpAd (I had to sack him) sent me a recent article from the BMJ by some nobody called Brian Jarman entitled ‘When Managers Rule’. It's utterly tedious so let me use my genius comms skills to distill it down for you. Since the early 1980's there has been a change in the NHS to a situation where managers have developed more power than patients and clinicians. Now, the only reason I paid it any attention was because it cited three reports by private consultants (which obviously have much more weight given their origin) that contained statements like this

“The NHS has developed a widespread culture more of fear and compliance, than of learning, innovation and enthusiastic participation in improvement.” It also said “Virtually everyone in the system is looking up (to satisfy an inspector or manager) rather than looking out (to satisfy patients and families)” and “managers ‘look up, not out.’”

Now, this is exactly the kind of thing that people are saying was the root cause of what went on at Midstaffs. The kind of thing that I'm supposed to sort out for fucks sake! Imagine if you will, someone suggesting trying to change the culture of England? What makes anyone think changing the culture of the monolithic NHS would be more achievable?! Incidentally, the fact that these reports had to be wrung out of the DoH using Freedom of Information requests tells you something about what might be driving the 'culture' they mentioned.

So, I need to work out what culture is. That clever SpAd once told me that the word "culture" has a classical origin based on a term used by Cicero. He wrote of a cultivation of the soul "cultura animi" using an agricultural metaphor to describe the development of a philosophical soul, the highest possible ideal for human development. You see why I HAD to sack that SpAd?…bloody useless! Try measuring the development of the philosophical soul of a Hospital CEO with a C-diff outbreak trailing him round the wards, mortality stats going north and an annual PFI bill the size of Gidiots offshore assets.

The Oxford English Dictionary has Culture down as “The ideas, customs, and social behavior of a particular people or society.” Now that might be a bit more useful, but can it really help us come up with something we can assess? Try assessing that CEO's ideas or behavior directly where it matters. Its bloody difficult. Doing it for a WHOLE FUCKING HOSPITAL? Good fucking luck with that. 

If culture is something to do with our ideas and social behavior, what is 'the culture of the NHS'? Well there's been a cottage industry in academia looking at this for the last 10-15 years. Its proponents seem to think culture in the NHS is either attributes the NHS has, which it might be possible to change, or something the NHS is in which case changing its culture (on purpose at least) is probably fucking impossible. Can the culture of the NHS be changed? It does change, apparently (see refs below) but it is not at all clear that it will do our bidding.

A brief Google search will find you a shitload of business gurus and commentators (or 'legends' as I like to call them) telling us how to change the culture of an organisation. But you will notice they rarely define it and (however much they bang on about values and behaviours) the things they describe are changes in the procedures or operations or structures of their organisations. I'm not knocking what they achieved, it just doesn't seem to me like they changed culture, just how their employees 'did stuff'. Look at this example from the World Bank. And really, I think that's what people mean when they talk about culture in the NHS. How we do stuff. As Paul Corrigan puts it;  Culture - "The way we do things around here"  Read like that, a culture of compliance means too many people are too compliant when they should speak up. A culture of fear means a lot of people are afraid of ...speaking out when they should, losing their jobs, being bullied etc. Are these things, in themselves, culture, or are they are single outcomes of the wider, deeper and richer thing that culture is: what we are as people? More directly, they are outcomes of how institutions like the NHS are organised and managed. And that is where we come to Mary Douglas (see top) She is exactly the kind of person I wont be consulting in the push to change the NHS 'culture' because she was an anthropologist who studied culture her whole life and understood it deeply (and admittedly, partly because she is dead now). Just look at that quote of hers at the top. I don't think I'm going to get away with telling people the NHS needs more (dis/re)organization after the Health & Social Care Act clusterfuck, do you? Much easier to bang on about changing the culture than the organisation, and then change the organisation anyway..


This is all pretty complicated stuff isn't it?  Lets look at an example of the kind of thing that needs to get sorted out. Nurses now routinely accused of working in an uncompassionate culture in the NHS? Why? Is it because of 

a) Their culture?
b) They have too much work to do in too little time because of chronic under staffing?
c) They know that complaining about staffing levels and organisation will get them blackballed? (That incidentally is exactly what happened to the one nurse whistleblower we know of at Midstaffs) 
d) b+c ?
e) Something else e.g Hospital CEOs and boards have much harsher penalties for not meeting financial targets than for ensuring the quality of patient care that nurses give is good. 

How could the Winterborne View horror show be allowed to happen? Because of  the culture of the carers or as a natural outcome of the way care of this group has been neglected from the top down for years?

Take your pick. It really is complicated isn't it? The profession has launched its own preemptive moves to the Francis MIdstaffs report with the publication of 'Compassion in Practice' which outlines a three year plan for promoting a culture of compassion. At no point do its authors even attempt to define what culture is. That's the kind of deep thinking I'll be encouraging more of on my watch. 

There's one final point I would like to make. Whether you call it culture or not, whatever you call it, I'll bet you my detachable bell-end that the way people behave and the values they abide by in institutions is largely set by the way the people at the top behave themselves, and organize that institution. The NHS is nothing if not a fine institution full of large numbers of institutionalized people. So now, you see my problem? If the behavior of NHS workers is set from the top do you think someone like me is going to improve it, or change it? You may have read previous accounts of my business leadership. And look at the BSkyB balls up. Did I take an iota of responsibility for my team's behavior, or behave in in open and accountable way myself? Oh yes, Adam Smith could tell you some stories about the culture I promoted. But of course, I forgot! I don't lead the NHS, do I!? Who is in charge? Step forward Sir David Nicholson! Unfortunately SuhDave stands accused of presiding over the instigation of the very 'culture' of bullying which has been fingered as part of the problem at Midstaffs. Take a step down to CEO level in the NHS...read this. You see! NHS 'culture' isn't so different from the rest of Britain, and like I said, no one is going to be changing that in a hurry. Much easier to label the problem as culture and use it as a big stick to whack the NHS with before I pimp it out to Branson and Serco et al. 

So, workers of the NHS. Loyal subjects. Culture is probably something you are going to be hearing a lot more about over the next year or so. I urge you not to think about it too deeply. Just accept the word of The Twunt and your other over lords. We have the situation in hand. You need to change. We can help you do it.

My next blog will be about subcultures in the NHS. .................That's a joke by the way....

Further Reading 


Scott et al. (2002) Implementing culture change in health care: theory and practice. Int J Quality HealthCare 15(2). 111-118

Abbasi (2009) Your hospital was a ‘clan’, now it’s ‘rational’ J Roy Soc Med 102. 307

Mannion et al (2009) From cultural cohesion to rules and competition: the trajectory of senior management culture in English NHS hospitals, 2001–2008. J Roy Soc Med vol 102 8332-336