Guest blog by Gail Beer, Director of Operations, 2020health
The latest report on the state of the NHS by Professor Don Bewick is a well considered and thoroughly sensible document. There is very little that anyone could disagree with. His emphasis on the empowered and engaged patient who is considered an equal in the provision of their care is welcome. Transparency along with accountability and trust strike a chord, although it is a chord been struck a few times before. Then there is also the absolute truth in his assertion that quality and safety must be above all. I defy anyone to disagree.
Yet there is nothing in this report that is new. We know the problems and we even know the solutions. The solutions in this report have been espoused many times before. You could look through any policy or strategic document from the early part of this century and see some of yesterday’s recommendations in other guises.
Therein lies the problem. Professor Berwick’s solutions to putting quality and safety above all have been used in the past. For those of us who worked in the NHS during the Gordon Brown years, who doesn’t remember the KP leadership diagram? Some of the approaches were on occasion misinterpreted and poorly implemented by those who did not have sufficient skill or vision to make good use of the tools on offer. We must guard against this happening again, but not use this as an excuse to take no action at all. So what are we going to do differently to make sure we deliver the kind of service that Professor Berwick promotes?
Firstly, we need to make sure that we do deliver a blame free culture, where picking up on issues is praised and encouraged and where prevention of near misses is lauded. Too often we have been terrified by the consequences of highlighting problems. Clinicians and managers must be able to challenge without fear of reprisals by their own managers, subordinates or colleagues. Secondly, we must listen to patients and their loved ones and respect their input. They are essential members of the team and with their participation we will achieve much more, not only in improving the quality of their care but regaining much of the trust the NHS has lost.
Thirdly, we must not knee jerk or overreact. The main focus of the media has been the suggestion that staff would go to prison for wilful or reckless neglect. As Professor Berwick rightly says this would only apply to a very small number of staff. Indeed there are any number of laws in place that could already be used to prosecute managers and clinicians. We should be wary of creating new laws that may overshadow the priority of treating the patient. We should do all we can to prevent more box ticking and fear.
Finally of all the recommendations the one that gets least comment, unsurprisingly, is that “society in general, opinion formers, politicians, (both locally and nationally) commentators and media have a role to play in shaping a positive culture.”
Most people in the NHS go to work with the intention of doing a good job and indeed want to deliver good care for their patients. After all the reviews and all the media glare we need to help them get on and do it. Now is the time for deeds not words.