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We Can Make You Radical

September 24, 2014

My dad would be horrified to read this, but I sometimes think the person in our family with whom I identify most closely is his much-maligned little brother – now long dead, unfortunately. Two-and-a-half years my father’s junior, Gordon was the clever one: a scholarship boy at the grammar school, always top of his class – the future looked bright. But he went off the rails – “smoking and drinking when he was about fifteen” says my dad ruefully – and abandoned his studies to run away to sea.

My guess is that being an orphan – in the days when there was no child psychology and you just had to get on with it – affected my uncle badly. By the time he was seven both his parents had died and he’d been pitched into the care of a loving – but enormous – extended family where I suspect he got sort of lost in the crowd. Knowing he was so bright – but that no one at home seemed very interested – must have been incredibly frustrating. Perhaps things would have been different if my grandmother had lived: the only one of her children to inherit her musical talent, I fancy Gordon would have been her favourite. With someone to nurture and encourage him, who knows what he could have achieved?

It’s quite scary how closely my NHS career mirrors my late uncle’s school career: in both cases, early promise petered out into underachievement and finally disillusion. Through blogging, I’ve been able to rehabilitate myself. The opportunity to showcase my distinctive talents and place them at the service of the profession I have given my life to – and receive appreciative feedback – has been tremendously gratifying. But isn’t it interesting that I’ve had to step outside the NHS and use my own time to do it? In almost thirty years of service, I can honestly say that only one manager ever took the trouble to develop my way with words to the service’s advantage. And then she left, and that was that.

One of the most interesting Twitter discussions (and a great blog post, see below) to come out of last weekend concerned the question of whether large organisations like the NHS can ever truly support radical thinkers. Stand-out tweet for me was this one, from @GeorgeJulian. Referring to initiatives like NHS Change Day and School for Radicals, she said (with admirable succinctness): ‘My fear is that NHS leadership is using radical/change agent to control change, not create it’.

It was a comment that put me strangely in mind of something I heard historian Dominic Sandbrook say on a TV programme late last year. The subject was the Cold War, and Sandbrook was attempting to contextualise the foundation of the NHS in the wider political anxieties of the period. In 1948 the Second World War had recently ended, the Soviet Union was in expansionist mood and there were real fears that communism might be about to spread around the world. The NHS, Sandbrook hypothesised, was the Attlee government’s way of telling the British people: ‘we will give you free healthcare. You don’t need communism’. How times have changed! Now it’s the NHS itself that’s facing the revolution – the social media revolution – and is responding with a new message to its staff: ‘we will give you radicalism. You don’t need to make your own radicalism’.

What is distressing to me about this is what it says about how the NHS views the people who work for it: we are a threat. If our energies are not channelled in acceptable and approved directions, we might start to think, and even to say, things our leaders don’t want us to think and say. And then, because social media has the potential to turn what might otherwise have been a few malcontents on a fag break behind the bike shed into a mass movement, who knows what might happen. Far from being founded on mutual respect and a desire to listen to staff, there is a case for asking if NHS Change Day and all the rest of it is really just a digital-age re-vamp of age-old management insecurity.

Of course, just because something has emerged in this way doesn’t mean it’s necessarily bad – if Sandbrook’s theory is correct, you could hold up the NHS itself as prize proof of that. NHS Change Day for example (which I’m choosing because unlike Caremakers, I’ve never written about it before) at least has the benefit of alerting staff at all levels to the concept of change as good and desirable and something that they too can have a stake in. But leaving aside allegations of gaming, I would advise anyone who’s feeling a bit cheesed-off to visit the Change Day Pledge Wall. It’s hilarious.

Many of the pledges are vague (‘I pledge to support staff’), self-aggrandising (‘To use my inspirational vision to empower as many people as I can’ – remind me never to apply for a job where I’d be working with whoever pledged that), unrealistic for a lone individual (‘For the people of South Lincolnshire to live longer, healthier lives’) or just plain silly (I was ready here with a pledge from ages ago about someone who had vowed to invest in more comfortable shoes. But now I’ve found one that says – I kid you not -: ‘vcgfrdesfyuj,,llkkjj’. And five others have joined it). The point is that while I don’t doubt the sincerity and good intentions of many who signed up, this is about individual rather than system change. There’s no joined-up thinking here; and furthermore, there is zero feedback on how many of these pledges ever resulted in permanent benefits. It’s about tinkering round the edges. It’s safe. It’s got nothing to say about challenging vested interest – and it may even be a way of diverting attention away from it.

But there is an alternative to this madness. It’s called developing staff. Now I am not going to sit here and blame everyone but myself for my own failed career. One – it’s unedifying, and two – it wouldn’t be fair. But I will say this: in my entire professional life, no one ever sat me down and gave me career advice. No one ever looked at my interests, my strengths, my weaknesses and said ‘you’re a bright girl, how can we make the most of you?’. And what’s more, there was not even any mechanism through which that conversation could happen.

So when I read, in last week’s Nursing Times, that in the opinion of Liz Robb, chief executive of the Florence Nightingale Foundation “we promote people because of their clinical skill without any formalised training and then wonder why it’s difficult for them in a situation where they are dealing with conflict, complexity and a budget of over a million pounds” I think she’s got it spot on. How can we expect good leadership when everything is so hit-and-miss? On the one hand, nurses who want to further their careers are not getting the right help, and on the other, talented people are getting overlooked. And getting angry. And getting cynical.

But…could I have misjudged things? The back page of the same copy of the Nursing Times has a feature by Suzette Woodward on how to plan your career! Great! Now, what are the top tips? ‘Create a supportive network’; ‘Create a personalised learning plan’…OK, I get the picture. If you want a career, Do It Yourself.


For George Julian’s blog, see:
For Szette Woodward’s advice on planning your career. See:
The other Nursing Times article referred to is paywalled.

  1. Very honest and very true. Thank you.

  2. Thank you for commenting.

  3. As is often the case with your blog, I identified closely with much of what you wrote in ‘We can make you radical’. When I began my nurse training, the tutors were cocker hoop to have an actual graduate in their cohort. ‘With a degree and a nursing qualification, the sky’s the limit,’ my tutor told me. Now, every newly qualified nurse is a graduate and qualified nurses are meant to aspire to postgraduate qualifications, lifelong learning and continuous professional development. Despite this, many brilliant nurses seem never to go beyond the top of a Band 6, while senior management often seems to be made up of some of the most uninspired and uninspiring members of the workforce. Is this a symptom of power corrupting or is it a requirement of any senior post that you must be the kind of person who maintains the status quo and ensures that everyone else does too?

    I have also been one of those who has regularly looked outside the NHS day job for things to satisfy my need to be creative, imaginative and forward-thinking, and for recognition and respect for what I feel I can contribute to nursing. In my own time, I’ve initiated projects, written books and articles, appeared in an educational DVD, continued my studies and taught health professionals around the world, (and have been widely appreciated for doing all of this everywhere except in the organisation who employ me on day to day basis). My managers down the years have either been largely unaware of all this freelance activity, or bemused by it all. My career progression has been not a vertical ascent to the dizzying heights of senior management but a scatter-gun, sideways explosion. Most career movement for me has been, in the words of a song title from New York alt rock band Scarce, ‘All Sideways’.

    Recently, a senior manager suggested I see someone in the organisation with the job title of Head of Organisational Development. I duly met with the person who told me her background was not in nursing or even in mental health but in coaching. So, after three decades in the job, I had my first bit of coaching. I couldn’t help but wonder how different my career trajectory might have been had I been given some organisational development coaching after my first five, ten or even fifteen years of nursing. Would I now be a Director of Nursing or a Chief Executive? Would I have not bothered with all those side projects because I would have got all the satisfaction and status I needed from the day job? The Head of Organisational Development positively re-framed my unfocused sideways scatter-gun freelance activities as signs of a highly creative person who probably could never get everything he needed from one job or one organisation. In other words, she saw it as a strength rather than my Achilles heel, the sign of a natural-born, divergent thinker with a portfolio career rather than the flaw of character that had made me sabotage my promotion through the nursing ranks.

    Perhaps creative, articulate, radical thinkers who happen to be nurses are not what the NHS wants (even though it might be just what it needs). It doesn’t know what to do with us. At the risk of developing Messianic delusions, there is the Biblical idea that ‘No prophet is accepted in his own country.’ This being the case, there seems little point in raging against the deeply conservative management structure to be found in probably every NHS Trust, (however innovative they might like to think they are.) If we want to fulfil our potential, we have to sometimes venture forth and use our skills and knowledge where they will be better appreciated.

  4. Hi Tony,
    Thanks for a very eloquent account of how the NHS fails to recognise talent. When I saw the words ‘Head of Organisational Development’, my heart sank at first, thinking you would simply have been subjected to the usual management mumbo-jumbo. It was refreshing to read that it was a positive experience. This really should be something everyone can access.
    I think you get to the nub of it when you say that ‘perhaps creative, articulate, radical thinkers who happen to be nurses are not what the NHS wants’. I’m sure the NHS would swear, with some vehemence, that it absolutely does want them – but it’s a case of actions speaking louder than words, and if staff who are blessed with these gifts feel excluded or ignored, it’s not surprising that they become disillusioned and frustrated. I certainly became disillusioned when ideas I suggested were given the brush-off. Those moments stay with you.
    I suppose it’s to some extent inevitable that large organisations prefer conformity. But whether it likes it or not, the NHS will find itself employing nurses who are not conformist, and – linking to my post from this week on staff retention – in the present climate it has to find a way of holding on to them. It won’t do this if it makes no effort to understand or appreciate them.
    As a post script to the story about my late uncle, even though the Royal Navy in the 1940s was, I would think, an extremely conformist environment, his potential was noticed. He ended up working at the Admiralty.

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