Many boards have been remote and inaccessible, and set no example in promoting the open communication that healthcare needs, says David Drew
We’ve just celebrated the first birthday of our seventh grandchild and are about to do the same for our eighth. The year has flown by and neither of them are what they were. They’ve grown. They’ve developed. They’ve achieved a great deal. And it is obvious that they are going somewhere.
As we approach the first birthday of Nursing Times’ Speak Out Safety campaign the occasion provokes the same reflection.
I don’t know in whose mind this baby was conceived or how long the gestation was but there is no doubt that since she saw the light of day she has grown as more trusts have embraced her. She has developed in her thinking. And she is definitely going somewhere.
The scandals and cover-ups in hospitals and care homes over recent years have shaken public trust in the NHS. Mid Staffs, Morecambe Bay, Colchester NHS Foundaiton Trust, Winterbourne View; the list goes on. It is true that these cases should not be generalised but they are common enough to leave an enduring image in the public’s mind.
‘The trust board and executive have the main responsibility for driving culture’
Abysmal care has been exposed. Patients have been physically and emotionally abused; they have died of incompetence and neglect. If you look closely at who has been responsible for exposing these scandals it is largely bereaved relatives and a small group of whistleblowers, a number of them administrative clerks. These brave souls have been ignored, blocked, threatened and suffered personal and professional loss as a result. They are an example to all who care about patients and the NHS.
Health professionals’ ethical codes means that they need to speak up for patients at all times, but especially when care is poor or harm is being done. Given that this has failed and continues to fail in some, or perhaps many places, pressure is now building for criminal sanctions against professionals who stay silent when they witness patient harm. Though I support such a duty of candour, I see it as an admission of failure; failure of basic humanity and failure of our professionalism. There is no excuse when professionals let patients down but there are explanations that we must learn from.
Recent inquiries have identified organisational culture as a principle culprit where care has failed badly.
The trust board and executive have the main responsibility for driving culture. Speak Out Safely encourages boards to develop an open culture in which it is not just safe to raise concerns, but where such feedback is actively encouraged, appreciated and, where appropriate, acted on.
In the past many boards, wittingly or unwittingly, have managed to foster cultures that do the opposite. Remote and inaccessible, the nameless, faceless suits have set no example in promoting the open communication healthcare requires. They have presided over a demoralised workforce on under-staffed wards, oblivious to the poor care being delivered. They have been wilfully blind to what has been happening.
As the Speak Out Safely baby approaches her birthday it is clear that not everyone has taken to her.
If I were a nurse working in the NHS in its new and evolving open culture I might just drop a line to the director of nursing to ask what the board is doing to ensure it is safe to report concerns. And by the way, has our trust signed up to Speak Out Safely? And if not, why not? Think of it as introducing the baby who will soon be a productive member of the family.
David Drew is a retired consultant paediatrician