Posted by: ayrshirehealth | January 1, 2014

It may be stormy by @fionacmcqueen

It may be stormy now but it can’t rain for ever…………..……

FMcQ-1I honestly believe the leadership challenges we’re now facing are the biggest that any generation of leaders within our treasured National Health Service have faced.

But like the prize of conquering the peaks of K2 for the most determined mountaineer; the prize of improved health and outstanding healthcare is standing like a beacon before us.

At times, like the horizon, temptingly out with our reach.

FMcQ-3At times, like a game of snakes and ladders, with great pythons as snakes and kitchen steps for ladders.

FMcQ-4At times, an impossible goal, with obesity thumbing its nose at us, and poor care menacing us from the shadows.

So what can we do?  With David Prior, the Chairman of the Care Quality Commission saying the NHS has become ‘too powerful to criticise’ which causes some problem areas to be ‘out of control’; and poor care being identified sporadically, but frequently enough for us to question, ‘how safe is our NHS?’  it’s tempting to close our eyes and ears to what is going on around us and just work harder, and dismiss people who say things we don’t like hearing.   But it’s important to ask ourselves; ‘What are people really saying?’   Once we do that, we realise we do all want the same thing.  Improved health and well being, and safe, effective and person centred care.

High Impact Leadership

It’s tempting to feel sorry for ourselves; bemoan how hard we’re working; say it would be fine without politicians; and wish if only things were how they used to be………….   But how far back do we go?  To the time of Trusts when we could make decisions without thinking through the impact of what we were doing on other healthcare providers?   To the time when students took charge of wards, and patients were never told of mistakes that had been made?  FMcQ-92Or to the time that over three thousand people died of cholera in Glasgow?  You get my drift – we can never go back, and nor should we want to.  The solution to the cholera problems wasn’t better healthcare – but Loch Katrine.  FMcQ-5The city fathers thought the unthinkable and showed true leadership – against much opposition.   The solution to the turbulence we’re facing today is true coproduction and working as equal partners with our communities, people who use our services (customer owners or shareholders), and our staff.     And rather than trying to ‘manage people’s expectations’ we should be working with people to achieve best possible services and best possible outcomes.  This requires high impact leadership.

We need to not only  clearly articulate the 20:20 vision; but more importantly engage and understand why services are being held back in the murky underwater of pressures, and free up people’s thinking and provide the leadership for transformational change (or even just a bit of common sense and plain talking).

Forging Ahead

Going back is not an option. Forging ahead in uncharted territory is our only option.

Standing in the eye of the storm, it’s challenging to know how to break through the professional tribalism; the chillingly defensive culture of many services; the politics of health and local authority, as we plunge into health and social care integration.

FMcQ-6Had the NHS been a mobile phone provider we would have plunged to obscurity in the 1960s, or 70s, if we were lucky.  It is madness to think that we can continue to deliver our services fundamentally from the basis of how we were set up.   That’s not to take away from many of the fantstic developments we’ve grown and put in place across Scotland; or the real improvements we’ve made in safety.  However working harder will only get us to an early grave;  failing to hear the pleas of our staff for more resources, dismissing them as moaning and lacking in understanding of the economic position, will get us another Mid Staffs; and ditto for failing to really listen and engage with patients and their families who have been let down by our services.

FMcQ-7We need to lift our heads and learn from history; the industrial revolution; the decline of the shipyards on the Clyde; Wapping vs Fleet Street.

So what is our revolution?  Is it politician vs health service manager?  Is it GP vs hospital?  Is it Nurse vs Social Worker?  If only it were so simple.

Is it too hard?

At times it feels like Femet’s theorem- the  mathematical equation that remained unsolved for over three hundred years (a^n+b^n=c^n would have no solution for exponents greater than 2, in case you’re wondering).  FMcQ-8But in reality if we keep the fundametal of always putting people first; and remembering why we’re here; and most importantly radically change the way we do thing; we’ll make progress.

Yes, we do live in a highly politicised world, with seemingly diametrically opposed goals – make efficiency savings and invest in new services; invest in community services and fund all new drugs regardless of cost; deliver a 24/7 service but give staff off whatever time they need.

So, does that  mean we should retreat?  No,  we must  engage and lift our heads.  Engage with our communities and also with  front line staff.  Yes, our political masters operate from election to election; or even newspaper headline to newpaper headline.  The public want immediate access to local services.  Our job is to work within these parameters and lay down the foundations that will secure a thriving and successful future.  Yes, we need to have short term objectives to measure and monitor our progress along the way.  But in reality we need to measure change in terms of generations.  Professional regulation of nursing was first argued for in 1860 – the bill was finally passed in 1919.  The vocational system of Nurse Education introduced by Nightingale took decades to change into our current undergraduate model (which if I may say produces quite outstanding graduates).

New Chapter


We’re starting a new chapter in the story of health and well being of our communties; lets grasp this once in a generation opportunity and make our futures different by laying the foundations for future generations to build on.

Our time is now.

Starting off a New Year was @FionaCMcQueen (Professor Fiona McQueen), Executive Nurse Director in NHS Ayrshire & Arran, Chair  of Scottish Executive Nurse Directors and Honorary Professor at University of the West of Scotland.


Comments are always welcome, please click on the link.


  1. Thank you Fiona. This certainly captures where we are now and resonates with me so much, but it is a positive message in the maelstrom. Looking forward to doing my bit in moving forward. Viv Hamilton

    • Viv, if we all do one little bit we could create a huge force to change…….it does only take one person

  2. I admit to being somewhat disappointed with this article. I expected an article with focus on NHS Ayrshire & Arran and/or NHS Scotland. For example, Professor McQueen says : “With David Prior, the Chairman of the Care Quality Commission saying the NHS has become ‘too powerful to criticise’ which causes some problem areas to be ‘out of control’;”

    David prior was talking about NHS England, that is his brief – I believe. (“We make sure hospitals, care homes, dental and GP surgeries, and all other care services in England …………”)

    Is a comparison to NHS Scotland being made here – but not explicitly stated? Or do I simply not understand it.

    From the public domain.

    There are four publicly funded Health Care Systems in the UK (England, Wales, Scotland and Northern Ireland.) Each system operates independently, and is politically accountable to the relevant government: the Scottish Government, Welsh Government, the Northern Ireland Executive, and the UK Government which is responsible for England’s NHS.

    Reference: “The four systems are entirely independent, and operate under different management, rules, and political authority.” Harker, Rachel (April 03, 2012). “NHS funding and expenditure SN/SG/724”]

    • Brian, the short answer is ‘yes, a comparison is being made to NHS Scotland here’. I fully accept the significant differences between NHS Scotland and the rest of the UK(indeed I think we have a much better system). However I do think the point about the NHS being too powerful to criticise has resonance here in Scotland. Just ask patients why they don’t raise concerns at the point of care.

      Whilst as a Director in the Scottish NHS I absolutely believe we have to shift our relationship with patients and really listen to their feedback, and am confident that the NHS Board is fully committed to doing so, I believe many clinicians working within the service, as well as managers, struggle to receive criticism, or feedback that is not positive. My experience suggests this is for a variety of reasons; belief that the service is good; professional arrogance; or at times fear of being used as a political football by the media or politicians. It is difficult for the NHS to say ‘we got it wrong but are putting it right’ and I believe we are working hard at this.

      What is critical to improving however is that we keep talking and reflecting and our patients keep egging us on to improve. The political and media interest is the price we pay for living in a democracy with a free press

  3. A fine piece outlining the situation and emphasising the problem with a nod to the future. But what about the practical issues? Whst needs to change? What will it look like when it is working well? What will we be doing that is different.
    You speak of radical change and you are right! You mentioned mobile phone companies and how they addressed the market and realised that they could no longer control their customers but had to discover and meet their demands. Healthcare is in much the same place now as phone companies were then. It is dominated by a paternalistic approach especially by medicine that does not put the person at the centre, it does not consider how our psychological understanding of ourselves has shifted in the last 60 years. If the NHS is to make effective change it has to break the iron grip that the medical profession has on the way it is run and move to a much more psychologically based process (and I don’t mean psychiatry). As customers we are much more savvy, our expectations have changed and the doctor is no longer god (not that he ever was in any eyes than his own).
    It is time that the skills of the other professions were put on an equal footing and that the constant pathologising of psychological distress in health was addressed. Most people are scared in hospital – it is a normal response to a frightening situation and should be much more robustly managed. Medicine has been bad at handling this and so have management, eg repetitive cancellations, moving from ward to ward, constant change, all scary for someone who’s own short term future is uncertain.
    These basic requirements need to be addressed – what would it look like if a person moved through their health crisis in a safe and efficient way that wasn’t frightening or uncertain?

    Steve flatt 1/1/14

    • I couldn’t agree more that the basic processes need to radically improve. We should have no cancellations (other than the very few – caused by clinician illness on day of appointment) and no movement from ward to ward unless the patient benefits from the move. These are ambitions that NHS Ayrshire has.

      Fundamentally I believe we need to shift our relationship to that of coproduction where there is true equality between clinician and patient. This will take time – for many reasons- however just because it’s difficult doesn’t mean we shouldn’t press on. We need our service users/customers/shareholders/patients (never quite sure how to describe all of us who use the service) to demand more and better from us.

      • Thank you for a lovely reply. You end you comment with a question about what we should call ourselves (the stakeholders). Well, I think that the is a useful little pronoun there that you used – we – that sums it up nicely. We all need care in one form or another whether we are professionals, managers, patients or just plain people. What would it look like if we could all recognise the value in each other. I read a piece earlier about “the feminisation of the NHS” and how some medics (emminent researchers and scientists to boot) were using the most scurrilous prejudicial evidence to try to prevent women getting places at medical school. The misuse of power is one of the greatest issues the NHS culture has to overcome. Whether it is political, managerial commercial or clinical, in the NHS or every other human endeavour, learning to use power and influence effectively, responsibly and without bias is the greatest challenge we all face. That is the next big issue that we have to face to grow and develop as a species!
        Steve Flatt 6/1/14

  4. An inspiring piece that articulates the scale of the challenge and the need for leaders to have tenacity!
    I agree to some extent with the previous comments re paternalism and the historic power of the medical establishment. However, I am encouraged by the increasing numbers of medics who are very person centred.
    My concern is the political will to deliver transformational change. If you take the example of Quebec, which now has a more social model of public service delivery. It took three changes of government to deliver the medium term outcomes and deliver change. Are our politicians willing to pay the price for doing the right thing!
    I think Scotland is better placed than most comparable countries (our government is more joined up at a macro level). So I am looking forward to the new chapter!

    • We need to create consensus across the service and our public to ignite the change we need across our society- not easy when we start thinking about self management and public health. However it can be done

  5. An inspiring read Fiona. It strikes me that change in all things, both personal and professional, starts with one small step, not great big leaps. We all have a responsibility to take that step, to strive for quality change, with our patients’ and staffs’ care at the core of it all. On day 1 of 2014 the journey is set and I for one look forward to contributing, one step at a time.

    • Kate, many thanks – it’s an exciting journey to be on

  6. […] McQueen was looking at how people in the National Health Service must go forward positively in It may be stormy on the Ayrshirehealth blog. She provided some perspective on the current healthcare issues, with […]

  7. Fiona – Hi. I simply ask that quoted references – by anyone – are properly defined (in this case NHS England) and that care is taken to clearly distinguish between each of the four UK Health Services. In this case, I have no political agenda for doing so.

    I continue to support @NHSaaa and, as an Ayrshire volunteer, the community that made me who I am today. I strongly agree with your ambition for greater patient involvement. I cannot stress how much I agree with that! My previous articles on this forum should bear that out.

    You say “just ask patients why they don’t raise concerns at the point of care.” I did, during my recent stay in Crosshouse Hospital and, as reported in my last blog, I ‘threw down a challenge’ to readers to explain the responses I got!

    Finally, may I congratulate @NHSaaa and in particular Derek Barron for providing this platform. As a non-professional user, I see dedication, commitment and frustration.


    • Brian
      Firstly, my apology for the lateness of my reply. Thank you for your kind comments about the blog, they are much appreciated. I would however say that my role in curating the blog is made much easier because of the superb bloggers who have agreed to write blogs encouraging, challenging and sharing their perspectives on healthcare. In almost all case I have been met with an enthusiastic ‘yes’ when I’ve asked people to blog – yourself included.
      So, thank you to each of them and you – additionally of course thanks to those that read the blog, without whom there would be little point in doing it.

  8. Reblogged this on Fiona C McQueen and commented:
    This blog was first posted on the Ayrshirehealth blog on 1st January 2014

  9. Snakes and ladders and Loch Katrine . Yes that sums it up to me,our ancestors certainly cleaned up our water supply and then used lead pipe and lead storage tanks,that probably caused more damage to the public than cholera.

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