Richard Smith recently shared a quotation from Erling Kagge’s Walking (which sounds like a great book):

The greater the physical distance between the decision makers and those affected by the decisions, the less relevant the decisions appear to the people impacted by them.

This rings true, and chimes with discussions I often have about senior leaders in large organisations.

Wendy and I have both worked in plenty of large organisations, inside and outside the health sector. Over time, we’ve observed that the more successful senior leaders tend to be those who spend a lot of time—perhaps even the majority of their time—with staff members from across the organisation and with customers / patients / service users. The least successful tend to be those who talk a lot about their ‘visibility’ and ’open door policy’ but whom the majority of staff members rarely, if ever, see in the flesh.

That is, the successful hospital chief executive is the one who stalks the wards and corridors, the one you might accidentally bump into on a ward round or in a clinic and think little of it. They know the organisation from top to bottom because they live it. They thank every staff member with genuine earnest, they are encouraging, they are interested in every person’s role. They harness the power and energy of the organisation they lead to make arguments about funding for them.

The unsuccessful hospital chief executive is the one who makes videos and blogs, whose visits to the wards are an ‘event’ to be prepared for and photographed. They judge success entirely on key performance indicators, and intuit the culture from surveys and managerial reports. Nobody really knows them locally, but they’ll trade on their personality and achievements with national leaders to try to drive the organisation’s interests.

The successful leader of a national organisation is the one who pops up in every regional outpost now and again. They often use them as a base when they have meetings in the area, which they do frequently because they don’t want a HQ-centric view of the world. You might accidentally bump into them in the kitchen and think little of it. They understand the tensions between parts of the organisation because they are surrounded by them. They hear about people’s successes organically, and celebrate with them, and lend an ear when times are tougher. They drive the organisation forward in an organic and engaging way, and use the reputation of the organisation they build to convince funders to follow their lead.

The unsuccessful leader is the one who holds webinars about how open they are, whose visits to ‘the regions’ involve lots of pre-planned choreography and dedicated ‘come and talk to me’ sessions. They judge success based on PowerPoint presentations, and understand the culture to be what people declare it to be. They are aloof and distant to staff, but chummy with those who set the organisation’s remit and hold the purse strings, using their person cachet as a tool to influence.

And lo, I present the ‘Simon’ theory of large organisation leadership. The successful leader of a large organisation intuits that their job is to build confidence in themselves among staff members, and confidence in the organisation among funders and external partners. They prioritise internal management, absorbing and influencing the culture, selling their vision, and making people believe that the organisation’s goals are worthy and achievable. They delegate even the most important external-facing discussions, using their limited access as a tool, appearing in the room to apply the final thumb screws and to seal the deal.

There are caveats: the leader must understand that their internal role is leadership, not management, lest they breed a culture of micromanagement or promote the acquisition of a set of what the military would call ‘long screwdrivers’. The leader must be reasonably personable to avoid appearing to ‘hover’ unnervingly. The leader must be skilled at knowing how and when to ‘fix’ things, and when to just listen.

This theory is based on my cumulative zero years of leading large organisations, and inspired by my burning desire to absolutely none of it in the future.

Maybe I can spin this off into one of those awful airport bookshop leadership tomes?

The image at the top of this post was generated by Midjourney.

It has been asserted that we live in a ‘Post Truth’ society, where political debate is hampered by an inability to agree on basic facets of reality. This assertion holds true in many instances.

There are those who struggle to grasp the many meanings of the word ‘true:’ the moment someone uses a phrase like ‘my truth,’ they implausibly claim that veracity—‘the truth’—is the only sense in which they understand the word. It’s disheartening that they must go through life without any true friends.

So, I was delighted by the last section of the most recent episode of Politico’s podcast, ‘Westminster Insider.’ In the episode, Ailbhe Rea discusses the art of the political interview. In the final section, she addresses the disastrous interview which prompted Andrea Leadsom to withdraw from the Conservative leadership election in 2016—the infamous ‘motherhood’ interview.

Rea conducts interviews with both Leadsom and Rachel Sylvester, the journalist who interviewed Leadsom. The two have markedly different recollections of the crucial part of their interview which, on first hearing, seem entirely irreconcilable.

The genius of this episode lies in the fact that Rae then plays the dictaphone recording of the original interview for the listener, without comment. It immediately becomes apparent that the seemingly irreconcilable accounts are, in reality, both accurate.

Naturally, Sylvester and Leadsom’s recollections differ because they are viewing the same encounter from different perspectives, focusing on different aspects of it. Neither is recalling the complete picture: and with only their own perspective to work from, how could they?

The episode serves as a poignant reminder that disagreement on basic facts is not always born of deceit: sometimes, recollections can differ in ways that are entirely honest. Despite appearing contradictory, neither Leadsom nor Sylvester’s account was inaccurate. ‘Facts’ that appear mutually exclusive aren’t always so.

The image at the top of this post was generated by Midjourney.

‘Staining wooden furniture’ is nowhere to be found on the very short list of DIY tasks at which I’d consider myself vaguely competent. It’s something I’ve never tried to do. Staining furniture has a reputation as being a messy and difficult task which carries a high risk of ruin.

Yet, our IKEA outdoor furniture was looking a little worse for wear, and it was obvious that re-staining was in order. I reasoned that I might as well give it a go—the worst that could happen would be a need to get new furniture, which would probably also be the result of not staining it. I visited my local Wilko and procured some Ronseal wood stain, a sanding block and some paint brushes.¹

To further reduce the risk, I started with our table-top because IKEA sells those separately, so if I ruined it, I could easily replace it. I gave the top a very light sanding with the sanding block, just smoothing off any rough patches, and then applied the first coat of Ronseal with a paint brush.

I was surprised that it turned out to look absolutely fine. I went on to re-stain the rest of the furniture, and to complete the three recommended coats over the course of the day.

It doesn’t look perfect, of course, but it does look much better than when I started. I enjoyed spending six hours or so in the sunshine with nothing to do but a low-stakes, physically undemanding bit of DIY. It was a mental rest that I wouldn’t have given myself any other way.

The image at the top of this post was generated by Midjourney.

1. Our local IKEA doesn’t stock IKEA’s own wood stain, which is a bit of a head-scratcher. ↩

Wendy and I have been lucky enough to visit the blockbuster Donatello exhibition at the V&A. As the museum puts it, this was an opportunity for us to ‘explore the exceptional talents of the Renaissance master Donatello, arguably the greatest sculptor of all time’.

Except… well… it didn’t feel that way. We were a little pushed for time, but found it a bit of a challenge to work out what we were supposed to take from each item. For example, the ‘God the Father’ from Milan Cathedral, above, has no connection whatsoever with Donatello. The label suggested that the technique used to make it was uncertain, but that it might have been a technique that Donatello might have also sometimes used. Right.

And the exhibition rather continued in this vein. Neither of us knows the first thing about Renaissance art, and so perhaps we’re not really the target audience, but we left with no real appreciation for why Donatello was so especially revered.

We did both comment that the Donatello works seemed to stand out in the exhibition, thought couldn’t quite work out whether that was due to an inherent quality of them or the curation.

I was struck by the incredible detail of Donatello’s rilievo schiacciato, a phrase I’ll never remember a week from now which refers to the low-relief marble carvings like the one above. Weirdly, these felt a bit tucked into a corner in the exhibition, with more space and focus seemingly given over to Donatello’s possible (but uncertain) training as a goldsmith.

I think maybe I’ve been spoiled by Vermeer, but I was left thinking that I’d have preferred there to be less in this exhibition to allow the Donatello to breathe, and to help us understand why he’s so revered.

‘Donatello: Sculpting the Renaissance’ continues at the V&A until 11 June.

There’s nothing I could write today that’s even half as spot-on as yesterday’s Economist leader.

The recipe for saving the NHS requires radicalism, but of a simpler sort: turning the NHS from what it has become—a sickness service—into what its name promises—a health service. That will mean spending more money. But to spend it productively requires a shift in focus: away from hospitals to the community, from treatment to prevention, from incentivising inputs to encouraging better outcomes.

A system focused on hospitals is one designed to treat people only after they have become really sick. That is the equivalent of buying more fire extinguishers while dismantling the smoke alarms.

The whole thing is well worth five minutes of your time.

The UK press is waiting with baited breath for publication of migration statistics at 09.30 today. Each outlet will then pick over the statistics and find a of presenting them which reinforces their pre-existing view of the world.

So, allow me to write preemptively about something completely different that’s due to be unveiled today, in a way which entirely reinforces my views.

Today, a major part of the work going into the restoration of Notre-Dame de Paris is being unveiled, as the triangular structures that make up the framework of the choir and apse begin to be unveiled. These have been made using techniques dating back to the 1200s.

We’re supposed to be awed by this, but I can’t help but feel a little depressed. In the great tradition of cathedrals, Notre-Dame included, the French could have chosen to blend spectacular history with spectacular modernism, to have explored and redefined the meaning of the cathedral for the modern age. This could have become a beacon, something to rival La Sagrada Família for demonstrating how ancient traditions apply to the twenty-first century.

Instead, the response was “put it back as it was,” using centuries-old techniques to reconstruct a centuries-old building, neither truly preserving anything (it’s newly built) nor connecting it to the modern world (it was designed to work in the 13th century). Through striving to avoid controversy, the project also avoids relevance.

Pretending things are preserved in aspic is very rarely the best way to conserve them.

This song, which is somehow more than two decades old, has been in my head while I’ve been writing this. It has northing to do with either of today’s revelations, and yet somehow feels like it connects the two:

The image at the top is by Ranopamas on Flickr, used under this licence.

It’s been way too long…

I recently gave blood for the 75th time, and I’ve been pondering my blood donation history.

I remember the first time I gave blood: it was in Southport at the Holy Trinity Church Hall. My mum drove me there because she was worried about me driving after donating. She was scandalised by the need to ‘pay and display’ to park, especially because—in those days—it was hard to know how long to pay for. There was no appointment service: it was a ’turn up and queue’ affair. These days, I book appointments from an app on my phone.

I can’t accurately place this episode in time, though. I think it must have been when I was 19, as I don’t think I donated before starting medical school, and I assume I must have started during the summer holiday at home.

I’ve posted a few times on this blog about donating blood, and was surprised to find that it was in 2012—a little after my 25th donation—that beds were replaced with reclining chairs. They still strike me as somewhat new-fangled, even though I’ve clearly now made two-thirds of my donations in one.

If I did start at 19, then I’ve now been donating for half of my lifetime. A total of 75 donations over 19 years means a frequency of 3.9 donations per year, which is more than double the average. This isn’t because of any particular deep-set sense of altruism, it’s just because I always make the next appointment straight after my last session, and the logical option is to schedule it at my earliest convenience. I’m lucky these days to live within walking distance of a blood donation centre, so I don’t have to try to be available when a peripatetic session happens to be nearby.

Each donation is 450ml, so I’ve given a little short of 34 litres in all, or a little over three times my total blood volume. There’s a cross stitch on display at my local donor centre:

The ‘75’ is, in effect, a slight exaggeration. The rule is—as far as I can make out—that if the donation needle pierces the skin, then that counts as a ‘donation.’ But on very rare occasions, perhaps two or three times over the years, the needle misses the vein, in which case nothing comes out. These days, there seems to be a ‘one attempt’ rule: they won’t even try the other arm to save the bother of coming back another day. I’m sure they used to be more gung-ho about it.

Other than the occasional bruise, I’ve only suffered two minor side effects in those 75 donations.

I remember at a session in Stockton, at the end of my donation, the carer shouted to a colleague, ’I’ve got a leak!’ I assumed there was something wrong with the collection bag, but came to realise quite quickly that it was the enthusiastic blood flow from my arm after the needle had been removed that was the cause for concern. A bit of pressure and elevation sorted that pretty quickly.

On another occasion, the fault was entirely mine. I had a quantity of alcohol after donating (against advice) and took my blood pressure medication and got up too quickly out of bed and stood up to pee. Post-micturition syncope was the predictable consequence. I think this is the only time in my life that I’ve ever fainted. My overriding memory from the event is how fainting didn’t feel like I expected it to: it was much more a feeling in the gut than a light-headedness. No cartoon birds circled my head. I did feel a little foolish.

Never in 75 donations have I ever experienced any pain.

I feel very lucky to have enjoyed good health over the years, and to have been eligible to donate. There are many people who would like to, but cannot.

When I started donating, the National Blood Service gave those who reached 75 donations was an Edinburgh crystal plate—now found in numbers on eBay. My mum could have hung it on her ‘plate wall’. These days, NHS Blood and Transplant give only a pin badge—and, since 2022, a social media badge:

If I make it to 100, I get invited to a special ceremony and—most importantly—I’m pretty sure I get the day off work to attend. There are some days when I’d gladly swap 45 litres of blood for a day off.

This paperback has been taken on numerous trips as my ’emergency book,’ in case all other sources of reading material fail me. I recently decided to retire it from that role and actually read it.

Unfortunately, this really wasn’t my kind of thing. It’s a Sunday night TV drama of a book about a group of Brixton residents mounting a campaign to save a lido that the Council wants to sell off. It’s black and white, residents good / developers bad sort of stuff. It’s a warm mug of cocoa of a book, with no unsettling surprises and no challenges to any preconceptions.

To me, I’m afraid, it was very dull. But others have found it uplifting and heartwarming, so each to their own.