John Tate examines the problems in the NHS and considers what lessons they contain for charities.

About 18 months ago I wrote a civilsociety.co.uk blog looking at what makes a ‘million-dollar’ team.

I talked about the importance of clarity of vision; effective communication; and developing a culture of openness, integrity and honesty. This was based on my experience of running and selling a number of technology businesses.

Over the last few months I have had some fresh experience of another organisation – the National Health Service. A personal contact has been unwell and has been in and out of hospital, and I have been a regular visitor.

So I thought I’d revisit the criteria I outlined for creating an effective leadership team and see how the NHS stacks up against this, based on my experience. My contact has been in hospital twice and in-and-out of two NHS care homes. At times the care has been supported by a local GP and social services.

A mixed experience

So what have my experiences been? Good, bad or ugly? Well, the honest answer is a mixture of all three.

In summary, most of the people I dealt with in the NHS were overworked and under-resourced. Systems were of mixed quality and administrative procedures were often poorly followed. The quality of care was often far from great.

Specifically, in terms of vision, I am very sorry to report that I felt the majority of people I met who were engaged in caring for my contact did not put her at the forefront of their focus in everything they did. As just one example, when discussing moving her back into her own house, I felt the care team were more interested in freeing up a bed for the next patient rather than making sure my contact was actually ready to go home and would be properly cared for when this happened.

No doubt there were new patients waiting for a bed and KPIs to be met in this area; but the inevitable happened. My contact went home before she was ready, became unwell very quickly and was readmitted to hospital. The recovery process took several extra weeks and caused her much additional discomfort.

In terms of communication there were lots of problems. Files got lost or misplaced; staff often didn’t complete or read paperwork properly; and at times the system did not provide an adequate level of care as a result.

Looking, finally, at the culture of the NHS, I found the people I dealt with were fairly open and honest with me and their colleagues, at an operational level, which was good.

However, at a ‘strategic’ level I felt there was deep dishonesty. For example, I don’t buy government assurances that resources have not, and will not, be cut at the frontline. I feel the government attempts to put a spin on the NHS which at times has little correlation with reality.

Demands are made of staff that cannot be fulfilled; and promises are made to patients that cannot be kept.

You have to care

For a perspective from employees in the NHS, I asked some of the people I dealt with how they found their work. Several said they had too much to do and that, despite voicing their concerns, additional resources were not made available.

A further common issue was the amount of paperwork and admin that needed to be undertaken – much of which the staff felt stood in the way of them doing a good job for their patients.

Some staff felt that a number of their colleagues didn’t care enough about patients, and treated the role merely as an unenjoyable ‘paid job’.

Nevertheless, despite a generally disappointing experience, I came across a number of people who really pulled out all the stops and did a fantastic job. In many cases this was despite the systems and processes they were supposed to follow. Several people showed real care and went that extra mile to help out.

If the NHS is going to be truly effective in the future it needs ‘million-dollar’ teams every bit as much as a successful for-profit enterprise. The same goes for every other civil society organisation.

Leaders of these organisations need to be clear about what they are trying to achieve and honest about how much they can actually deliver with the resources available.

Without this, the quality of services delivered to beneficiaries will fall short of what is expected, and the motivation of staff will suffer.

John Tate is a business consultant, IT adviser to CFG and a visiting lecturer at Cass Business School