The woman who banned the f-word

When Leonard Cheshire Disability hit the headlines earlier this winter to condemn very short visits to older people at home it marked a triumph for chief executive Clare Pelham.

The campaign hit a note of outrage and was picked up rapidly, not just by the media but also politically, with an amendment to the Care Bill tabled just days after its launch. Very soon, care service providers and councils began to promise an end to the practice.

“People did not know it was happening and now they do and they are not OK with it. It may be the best thing I have done ever,” says Ms Pelham.

But behind the headlines lies a more subtle triumph - that of rebuilding the organisation to the point where it was capable of such a campaign.

• Through the darkest times a good leader will be followed willingly
• Tackling the cultural challenges of leadership

Taking the helm

When Ms Pelham took the helm at what is the UK’s largest voluntary sector provider of services to disabled people in November 2010, she inherited an organisation that had lost its way.

There had been four leaders in just a few years and her immediate predecessor had held the post for just 18 months, pushing through a controversial restructuring with the loss of over 100 managerial and administrative jobs.

The deficit was running at £5.4m for 2010. The charity was also mired in controversy about selecting cigarette maker Japan Tobacco International as a commercial partner and the Care Quality Commission was poised to demand restrictions on some of its homes.

Today Leonard Cheshire is in surplus and implementing a five-year strategic plan to expand its supported living accommodation and refurbish its residential accommodation.

Turnaround traits

So how has this turnaround been achieved? Through a mix of passion, inspirational leadership, good management, proper procedures and tight financial control.

The passion was kindled in 1978 when, as a 19 year old studying at the London School of Economics, Ms Pelham volunteered for the student version of the Samaritans helpline.

“One Saturday night, I had a call from a young man who was a wheelchair user. He was very unhappy and thinking about taking his own life because he had no friends and no future. It was awful. I haven’t spoken about it much and I still find it quite difficult to talk about.”

As a result of that call, Ms Pelham wrote to Group Captain Geoffrey Leonard Cheshire, the World War II fighter pilot and hero who had founded the eponymous charity in 1948 and still ran it.

“I asked him is there anything I could do to help. Bless him, he replied and said: ‘Yes, come and volunteer’.”

So she spent the summer at Alne Hall in York - a residential home that is still home to 30 people with disabilities.

“I pitched up on a bus with my bag, put my stuff on a bed and got to work. It was a good place to start,” she recalls. “I remember very, very quickly I was doing things like giving bed baths. One lady said: ‘You have not done this before, have you?’ so we had a chat. I wanted to do it well and she talked me through how she would like it done.”

She “loved everything” about her time at Alne Hall: the people, the way the home was part of the community in the small agricultural village of Alne. “There are still people I know from that time when I go back there,” she says.

High flier

Her professional ambitions took her elsewhere and she returned to Leonard Cheshire only after a high flying career in the public and private sector.

But when she came back in 2010 she brought her teenage vision with her.

“My perspective was that this was a wonderful organisation with a glorious past and an inspirational founder going through a little bit of turbulence,” she says.

“I do not know what it is like to work in an organisation that is perfect but I think it might be just a tiny bit boring.”

‘A lot of organisations with a very charismatic founder have a tough moment when that founder is not there any more’

It was clear that “things were not as they could be”.

The trustees were very open with her about the financial situation and she sensed that the organisation had lost its way.

“It’s true of a lot of organisations that have a very charismatic founder that there is a tough moment when that founder is not there any more,” she says.

“It had lost connection to its purpose. I don’t want to say that everything was awful and now it’s wonderful; I think it was all there but needed to be supported to flourish.”

The big question, then, is how? “I always start with the people,” says Ms Pelham emphatically, before emphasising how many wonderful people work for the charity.

On day one, she talked one to one with senior managers. Next she visited homes. Then she took action. “I started in November and by the first week of December we had a new strategy. You do need to do things quickly. You also need to be clear as a group of people about why are we here? What do we believe in and how are we going to achieve it?”

It all flows from trust

She needed to create trust, from which she believes everything else flows. She started the ball rolling by holding a management board meeting with no agenda. “We talked about how we were going to work together. I suggested they all share with each other the things they had said to me personally.

“We came up with some ways of working. It was guidelines like, if you write anything down, it can be shown to anyone, copied or forwarded to anyone and you should be prepared to stand by what you have written.”

It is not easy, she admits. “It is really hard to do, particularly if you have slipped into another way of working. You have to practise.” She banned the “‘b’ and ‘f’” words: blame, fault and failure.

‘If people are open and there are no secrets then trust can develop’

The rules extend to conversations.

“We agreed you should never say something about someone you would not say to their face,” she says.

“So if one of my staff is saying: ‘It really annoys me when Clare sends emails at 5.30pm on a Friday asking me to do something because she knows I have children,’ and I walk up, the conversation should not stop. I should be able to hear that and say: ‘I am sorry, I forgot, let’s rearrange’.”

It is hard and it requires conscious effort, but if people are open and there are no secrets then trust can develop, she argues.

It also has to extend the length and breadth of an organisation that employs 7,400 people in over 300 different services in the UK and internationally.

Does it work? “Yes, I think it does,” she says. “And it has put us ahead of some other organisations when it comes to things like whistleblowing. In our last survey more than 90 per cent of our staff were comfortable with whistleblowing.”

The hard test of pride

After openness and trust came pride. “Our mantra is that we want to be proud of every single thing we do and if we are not proud then we should not be doing it. That’s a very hard test.”

The culture now is “you don’t walk past”, she explains. “If I am late or if anybody is late for anything and the reason is that it is because they saw something that was not OK and they stopped to address it, then that’s fantastic.”

It is an approach she developed from her work as an executive with Coca-Cola.

“The chief executive’s rule there was that if a customer called, it took precedence over anything else,” she says.

“If you are doing something to make life easier or better for any individual person, what else could you be doing that is more important than that?”

All of which is beginning to sound dangerously fluffy - which Ms Pelham is not.

‘I think leadership is a caring profession’

“I think leadership is a caring profession. You cannot do it well if you do not care about the people,” she says.

“You need the heart but you need to enable the people day to day and engage your head so I am quite big on having procedures because that’s how you measure. Let’s have ways of doing things, to protect the confidentiality of whistleblowers, for example, or ensure safeguarding. Sometimes you want to depart from them but let’s do that knowing you are doing it.”

She’s also big on information.

“You need information gathering so you can see where you are and see a trend. It is no good saying that this is a good idea and not measuring. That’s not going to do disabled people any good at all.”

It’s a discipline she brings to finance. In 2010, the charity’s income was £155m with a deficit of over £5m. In 2013, the income was £160m with a surplus of £3m. She has driven up voluntary donations by 20 per cent in the last two years to £13.4m.

Part of that has been achieved by making fundraising everyone’s business - 7,400 staff and 3,500 volunteers. As the leader she creates the narrative; practically she holds regular meetings to gather ideas and prompt action.

“It is not about a memo coming from head office to switch off the lights but connecting with why we are here,” she says. “Part of the role of the leader is to hold the narrative in their heads. As a civil servant you operate in a very constrained box. I have found it very different here, being more emotionally open. I do not think you can talk about what you are here to do if you do not talk about how you feel about it.”

Keeping an eye on results

But again there is a hard edge. She has saved “millions” on procurement by “doing it better” and driven up efficiency particularly by focusing on agency staffing, reducing it by more than one third and delivering better continuity of care in the process. She personally receives the reports on this every week.

The campaigning work comes out of the same set of values. Ms Pelham says her particular skill set is useful here - as a former senior civil servant, she knows how government works. But more important is the notion that campaigning must connect to the organisation’s people and purpose.

“Our 15 minute campaign came out of a conversation where one of my colleagues talked me through what a 15 minute visit meant,” she says.

“I asked: ‘Are we OK with this?’ We decided we would no longer bid for them and we would actively campaign against them. Our staff hate these visits and every day see people suffering. They love that we are prominent in trying to make this stop.”

Her mantras of trust, pride and being an authentic leader are ones that will strike a chord with any NHS leader. Yet she does wonder how conducive the continuous scrutiny of the NHS - public and political - is to developing them.

‘If the NHS found its heritage, as we have tried to do, it would be wonderful’

But she argues that NHS leaders need to take responsibility.

“I have said this to the people here because I feel it is right. It is my responsibility when things go wrong and if anyone is to blame it is me and if anyone is to go and answer for it or resign because of it, it is me.

“If you accept that people share your commitment and passion and values and they are not doing things as well as they can, you have got to look in the mirror first and ask: what is it that you could have done to help them do the job they came in to do?”

She knows some people will mock her for this. “It sounds soft and girly to say that and I can always hear [departing NHS chief executive] David Nicholson laughing.

“I do think that what you say when you think no one is listening should be OK for anyone to hear. And if it’s not, then that’s when you should start to worry. If you get that right, everything else should flow.

“If everyone in the NHS never did anything they thought was wrong, I think it might be different. And yet, I think that’s also achievable.

“We [Leonard Cheshire Disability] are about the same age as the NHS and if the NHS found its heritage, as we have tried to do, it would be wonderful.”