The NHS Common Purpose: Towards A Million Change Agents

Philosopher Robert Roland Smith said that for change to work, the discontent with the present must be greater than the tolerance of it. Isn't this the perception we are being fed about the state of parts of our NHS? Might this not suggest that it is being deliberately sabotaged from within?

The most damaging failings were illustrated following the 31 month Public Inquiry into unnecessary deaths at the Mid Staffordshire NHS Trust between 2005 and 2009, failings in which elderly and vulnerable patients were left unwashed, unfed and without fluids. When presenting his findings Robert Francis QC told his audience, “This is a story of appalling and unnecessary suffering of hundreds of people. They were failed by a system which ignored the warning signs, and put corporate self-interest and cost control ahead of patients and their safety.”

The report contains 290 recommendations for change across the whole of the NHS. Francis claimed there was a lack of care, compassion, humanity and that the most basic standards of care and fundamental rights to patient dignity had not been respected. He also claimed that there was a lack of leadership. Amongst the report’s recommendations were that an NHS leadership college should be set up so that managers can share best practice.

Potential Conflicts Of Interest?

According to the Public Inquiry website, “on 15 October 2010, the Chairman appointed four assessors, specifically chosen for their experience and knowledge in key areas of interest for the Inquiry, both within the NHS and other fields.” 

One of these assessors was Sir Cyril Chantler. Chantler is also on the Board of the Media Standards Trust, where he has been sitting alongside Sir David Bell (Common Purpose and an assessor at the Leveson enquiry) and Julia Middleton CEO, Common Purpose. The Leveson enquiry website indicated that its assessors “were appointed by the Prime Minister for their expertise in the range of issues being considered by the Inquiry, as well as their complete independence from any interested parties.” We all know how false that claim has turned out to be.

It wasn’t difficult to establish that Sir Cyril Chantler was Chairman of the Kings Fund London from 2004 until 2010. According to the Kings Fund Youtube channel they have been “developing confident, able and imaginative leaders within the NHS for more than 30 years. Now, more than ever, the NHS needs the right leaders at all levels, who are prepared to drive improvements and inspire change at a time of enormous financial challenge.”

On the page dedicated to him on the Public Enquiry website Chantler has omitted this past connection with David Bell and the Media Standards Trust..

Sir Cyril Chantler - Mid Staffs Inquiry assessor, Media Standards Trust board member
Clockwise from top left: Anne Benson, Belinda Weir, Martin Kalungu Banda, Caroline Duckworth
Richard Bandler - Co-founder of Neuro-Linguistic Programming

NHS Leadership and Common Purpose

Common Purpose NHS leadership training hasn’t once been mentioned in the three volume Francis report. Despite this there is considerable evidence that many NHS staff have received such training. For example, The Health Service Journal peddled it sometime ago in their article Unlocking Leadership Potential in the NHS, published on 20th May, 2008. Here are a few typical quotes:

“An innovative leadership development programme is helping managers connect with people they would not ordinarily meet by bringing together diverse groups of people from the private, public and non-profit sectors for unique learning experiences ...”

“The aim of the programmes, run by training organisation Common Purpose, is to give leaders the skills, the connections and the vision they need to lead more effectively, and to push them to extend their influence beyond their own organisation, locality and culture ...”  

“Chris Simmonds is general manager of the Medical Practice in Doncaster. Chris attended a Common Purpose programme five years ago, which inspired him to develop the practice in innovative ways.”

The East Midlands Leadership Academy, Common Purpose and the Kings Fund

The East Midlands Leadership Academy advertised an emerging leaders programme 2010-2011. This 9 month programme was delivered in partnership with Common Purpose and the Kings Fund. 47 delegates and their sponsors attended an inspiring day with key note speaker – Dr Gerry McSorley, CEO Northampton General Hospital NHS Trust, along with inspiring presentations and stories from Professor Rachel Munton – Director of East Midlands Leadership Academy and Martin Kalungu Banda of Common Purpose. 

The Emerging Leaders programme delivery team included: Anne Benson, Belinda Weir and Kemi Togun of The King’s Fund and Caroline Duckworth, Saragh Gale and Martin Kalungu Banda of Common Purpose. 

Further evidence of the involvement of Common Purpose in the provision of NHS Leadership training is provided by reference to the Doncaster NHS Leadership & Talent Management Strategy 2009 - 2011. For example, on page 9, it described the building of Strategic Alliances via Common Purpose programmes: Focus, Profile, Navigator and 20:20. On Pages 26 & 27 it tells readers that Focus is for Directors and Assistant Directors, Profile is pitched at Director level and above, Navigator being for Clinicians and GP’s and 20:20 being aimed at Chief Executives and Deputy Chief Executives. 

Interrogation of the database of names published by reveals that Common Purpose graduates have, for many years, been occupying positions within the Department for Health, Strategic Health Authorities and at Board and senior management level at Primary Care Trusts and NHS Foundation Trusts.

Four examples of Common Purpose linked personnel operating at NHS Director level are:

- Dr. Mahmood Adil, Deputy Director of Public Health for the North-West. He is a Common Purpose 20:20 graduate, Fellow of the Royal College of Physicians and Associate of the Nuffield Trust.

- Jacky Chambers, Director of Public Health Birmingham Teaching PCT & Member of the Management Board of Common Purpose.

- Richard Mendelson, Director of Health Improvement, Eastern Birmingham Primary Care Trust and Common Purpose Graduate.

- Salma Ali, Director of Nursing, Heart of Birmingham Teaching Primary Care Trust and Common Purpose Graduate.

Despite the lack of recognition of Common Purpose training by the Francis report one has to ask what values has this and other leadership training instilled into the minds of NHS managers and staff?

Dr David Pencheon
Sue Slipman
Helen Bevan
Dr Natheera Indrasenan

NHS Leadership Training Using NLP

Amongst the trainers within the Kings Fund we discovered Paul England and Janet Wilson. Paul England, Leadership associate, holds an MA in change management and is an NLP practitioner. Janet Wilson is an executive and leadership coach and consultant. She qualified as a coach in 2003 and then completed further training as an NLP coach in 2004. 

In addition to Common Purpose & Kings Fund courses many other leadership courses are being offered to NHS staff.

For example, Coaching Innovations claim to have extensive experience (across the range of NHS organisations including Foundation Trusts, Primary Care Trusts, (PCT), Mental Health and Acute sectors), working as directors of Human Resoruces and Organisational Development in the public sector, over a number of years. They also claim to be executive coaches and NLP practitioners. Amongst their clients they list the Welsh Assembly, NHS Employers, Heart of Birmingham Teaching PCT, Portsmouth Hospitals NHS Trust and Stafford Hospitals NHS Trust. 

Innov8 NHS Commissioned and Funded an Accelerate Leadership Programme commencing in November 2012. The Yorkshire & Humber NHS accelerate flyer provides the following detail:

“Held on a monthly basis, the course leads to the award of Certified Practitioner of NLP by INLPTA, the International NLP Trainers Association. The course comprises 9 x 2 day modules, designed to provide you with insights and understanding as well as techniques and skills to help you work even more effectively as a manager and leader. The course will be delivered by Dave Thornton and Chris Grimsley. 

“Dave works as a successful and sought after Executive Coach and ‘top team’ developer for a range of organisations across the UK. He is a qualified NLP Master Practitioner, Executive Coach; MBTI facilitator and has a whole host of other experiences under his belt. He is a member of the ‘Windsor Leadership Trust’, is an Associate of the ‘Kings Fund’, works with a number of Royal Colleges and is on the NHS Institute of Innovation and Improvements Senior Team/Board coach register. 

“Chris Grimsley is an INLPTA Certified NLP Trainer and Master Practitioner, with a passion for bringing NLP into public services at organisational / managerial levels, and to service delivery. He is founder and principal trainer of the Institute of NLP for Public Service, and is acclaimed for making NLP training accessible, and practically useful. He has trained and developed with some of the leading lights from the world of NLP and contributed to its practical adoption throughout many public services.”

NLP life includes amongst its trainers Dr. Richard Bandler and stage hypnotist Paul McKenna. Bandler is the co-founder of the technique of Neuro-Linguistic Programming. 

Also featured is Dr Natheera Indrasenan. She is the UK’s only licensed NLP Master Trainer approved by Dr Bandler and the Society of NLP who is also a practising doctor with nearly 20 years experience. For the last 3 years she has trained over 3000 doctors all over the UK. She is founder of AcuityDoctor which is “a unique organisation bringing NLP to all healthcare professionals in the UK. Acuity Doctor consists of Natheera and a team of Trainers who are GPs and psychiatrists by profession.”

According to Natheera “[p]atients need motivating in areas like weight reduction or smoking cessation. By using NLP language and rapport building techniques the doctor and patients are on the same wavelength opening up the way to creating the changes. The Meta model questioning techniques are particularly useful to nudge patients forward when they get “stuck” in their lives and are being taught increasingly to doctors to add them to their toolkit of communication skills.”

The Centre for Sustainable Healthcare

The Centre for Sustainable Healthcare (formerly known as the Campaign for Greener Healthcare) claims to be inspiring people to realise the vital importance of the overlap between their wellbeing and environmental sustainability, particularly in the field of healthcare.

The Centre for Sustainable Healthcare works closely with partners both within and outside the NHS. Its partners include: The Climate and Health Council, The Carbon Trust, 10:10 Campaign, The Sustainable Development Commission and the NHS Sustainable Development Unit.

According to their website, “[t]he NHS Forest is an exciting national project coordinated by the Centre for Sustainable Healthcare. One of this project’s central aims is Greening the NHS Estates and planting 1 tree per employee amounting to 1.3 million trees within the next 5 years.” 

The NHS Sustainable Development Unit

This national unit is based in Cambridge. It aims to help the NHS fulfil its potential as a leading sustainable and low carbon healthcare service. It claims that it does this by developing organisations, people, tools, policy and research which will enable the NHS to promote sustainable development and mitigate climate change. The NHS Sustainable Development Unit took part in the Rio+20 global UN Conference on Sustainable Development via a pre-recorded film, presented by Dr David Pencheon.

There are a number of priority areas that NHS organisations are targeting to reduce carbon, improve efficiency and save money. For example, engaging staff and the public in sustainability [my emphasis].   

According to the NHS Sustainability Boards Leadership programme summary report (2010)

“Delivering a sustainable health system provides a positive vision for engaging with staff, organisations and the public to deliver transformational change ...

“Trusts need to take long term actions that benefit communities and patients and which fit with short-term performance targets, otherwise the shift to preventative care will not happen.” 

The video NHS, Cutting carbon and improving health (a short presentation for all staff who work for the NHS) evidences that the Sustainable Development Unit has calculated the carbon footprint of the whole NHS. Whilst buildings and transport contribute 40%, procurement is responsible for 60% of carbon emission. Nearly two thirds of that total comprising drugs, medical supplies and surgical equipment.

The Foundation Trust Network 

The Foundation Trust Network (FTN) is the membership organisation for NHS public provider trusts. FTN is a member owned charity working “to promote a vibrant and sustainable NHS public provider sector”. At the time of the horrifying events at Mid Staffordshire Foundation Trust Sue Slipman was CEO of the Foundation Trust Network.

Slipman has a colourful career history. She served as a member of the executive committee of the Communist Party before joining the Social Democrat Party as a founder member in 1981. As Director of the National Council for One Parent Families (1986 – 95) she rallied support for the discredited Child Support Agency. Slipman left her post at Foundation Trust Network in July 2012. She is now a non executive director at Kings College Hospital Foundation Trust and is described on LinkedIn as a Policy Strategist and Change Leader.

NHS Institute for Innovation and Improvement and its influence

Helen Bevan is Chief of Service Transformation at the NHS Institute for Innovation and Improvement. She co-authored a research document entitled Towards a million change agents, a review of the social movements literature: implications for large scale change in the NHS. Within this document comparisons were made between a project management approach to change and a social movements approach where “people change themselves and each other – peer to peer”.

Bevan refers to the following definitions of a social movement:

 “A group of people who consciously attempt to build a radically new social order; involves people of a broad range of social backgrounds; and deploys politically confrontational and socially disruptive tactics.” Zirakzadeh 1997

“Collective challenges, based on common purposes and social solidarities, in sustained interaction with elites, opponents, and authorities” Tarrow 1994

Isn’t this precisely what we are witnessing in relation to the major transformation now taking place within the NHS?

Other documents attributed to Bevan include the 46 page How to build unstoppable change and The power of one, the power of many-bringing social movement thinking to healthcare improvement.

The Health & Social Care Act 2013, The NHS Leadership Academy, Clinical Commissioning Groups, and the Leadership Development Support Framework

Since the Francis report the Government has published new regulations under Section 75 of the Health & Social Care Act 2013 (SI 257 - The National Health Service (Procurement, Patient Choice and Competition) Regulations 2013). These regulations create requirements for virtually all commissioning done by the National Commissioning Board and Clinical Commissioning Groups to be carried out through competitive markets, forcing through privatisation. They contain legal powers for the new NHS regulator, Monitor, to enforce the privatisation spontaneously or at the request of private companies which lost bids. According to the Royal College of Physicians “these regulations go much further towards privatising the NHS than ministers implied when the legislation was going through Parliament.”

A total of 211 CCGs will, from 1 April 2013, be responsible for £65 billion of the £95 billion NHS commissioning budget.

The NHS Leadership Academy have commissioned Ashridge Business School to provide a series of short courses specifically to support potential CCG leaders. The Ashridge Centre for Business and Sustainability is Ashridge’s in-house think tank on sustainable development and the implications for leadership, strategy and change in organisations. Established in 1996, the centre leads influential research and thought leadership in collaboration with external partners, and works collaboratively across Ashridge to support Ashridge’s education and consulting work around leadership and change for sustainability. 

The NHS Leadership Academy has also established a National Framework of CCG Leadership Development Support. CCGs or groups of individuals or CCG leaders can use the framework to secure quality leadership development support. The framework is made up of four lots: Setting up and leading a high performing CCG; Working collaboratively and across boundaries – promoting partnership working; Managing and influencing local and national politics, and, Engaging and leading colleagues in general practice through distributed leadership – ensuring that the organisation is clinically led.

If the above seems like reading Common Purpose speak you would be perfectly correct. Amongst the approved providers we discovered the PwC National Clinical Commissioning Group Development Alliance. This alliance includes: Price Waterhouse Coopers, The Kings Fund, Common Purpose, Practive, Cumberlege Connections and Wragge and Co Solicitors. 

Consultation on the ‘Sustainable Development Strategy for the Health, Public Health & Social Care system’

Between January and May 2013 there is a Consultation on the Sustainable Development Strategy for the Health, Public Health & Social Care system. Ex communist Sir David Nicholson, CEO NHS Commissioning Board and Duncan (‘don’t rely on the NHS, look after yourself’) Selbie, CEO Health England claim that “[w]e have a clear responsibility to take a leading role in tackling climate change and have a genuine opportunity to influence change for our patients, service users and the public.”

There is also a Youtube video where Sir David Nicholson speaks at the launch of this consultation. This video has attracted one cutting comment on the Youtube page - “Question. Sir David Nicholson, will the patients who suffered at Mid Staffs be involved in the Sustainable Development Strategy? No they wont Sir David as they are no longer with us. This video offended me from beginning to end.”

If you thought that the primary role of the NHS was to provide curative health care for those suffering illness or injury the evidence we have uncovered suggests otherwise. The transformation is already towards preventative healthcare, privatisation of services and the ‘nudging’ of patients towards sustainable lifestyle choices. In some areas, if nudging doesn’t produce the desired effects the NHS resorts to bullying. It now becomes obvious that the NHS is acting as a change agent for the common purpose.