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OPINION

Helene Donnelly: 'Every trust should appoint an ambassador for cultural change'

We need an NHS that truly encourages and supports its staff in raising concerns, says Helene Donnelly

Following my experiences at Mid Staffordshire Foundation Trust and giving evidence at both Francis inquiries, I have been trying to raise the importance of nurses speaking out and raising concerns about care. I know full well how daunting and frightening this can be for a variety of reasons, which is why culture needs to change.

Through my role as ambassador for cultural change for the Staffordshire and Stoke-on-Trent Partnership Trust, I hope first to raise awareness about what raising concerns really means, and how it affects us in practice. I am helping to educate and support all trust staff and therefore encouraging them to raise any concerns they have. I want to hear from all staff, not just nurses, if they think things are not right.

“I believe all raising concerns policies should be standardised nationally”

I am looking at the trust’s raising concerns policy to see if it includes all that it should. Perhaps more importantly, I am helping to make the process of raising concerns more user friendly for staff, so that this in itself does not put people off.

I believe all raising concerns policies should be standardised nationally, so all NHS staff know what to expect, irrespective of where they work. I would like to see training on how to raise concerns to become part of mandatory and statutory training updates for all staff. Inductions for all staff need to include sessions on raising concerns, and I am happy to say that Staffordshire and Stoke-on-Trent is doing this.

I am also trying to give staff a channel through which they can voice concerns. Many feel they are not consulted about changes nor listened to. This needs to change. The staff who are doing the job day in day out, facing all the challenges that it brings, are the very people who should be listened to and valued. I want to act as an ally for staff to raise issues and help take this message to the people who can and should act upon it.

Some staff will still be sceptical about my role - that is understandable. Such is the culture in the NHS that staff do not feel comfortable raising concerns. Often, this is due to fear of repercussions, but it is usually because they simply see no point; nothing has ever changed and they have become demoralised by this.

One of the first issues staff have made me aware of is the lack of response to incident reports. I am concerned about this and have made the chief executive aware of it. I have been assured this will be addressed, and I will not rest until staff tell me that it has.
My chief executive has been very positive about wanting to know if things are not right for staff, especially if patients could suffer as a result. If he does not know about it, then nothing will improve.

I am keen to get this message across to staff. It is also a message that all trust chief executives should be sending out. One way of ensuring this becomes action would be to develop a similar role to that of ambassador for cultural change at their trust. There is a place for such a role in every trust. I would like to see all trusts signing up to the Nursing Times Speak Out Safely campaign and give a united message that the culture regarding raising concerns will change.

We all should be very proud of the NHS and should be working in healthcare because we care. Unfortunately, though, there may be times when we see poor care, misconduct or unacceptable behaviour and we all have a duty to speak out about it.

Nothing is ever perfect, but I would like to see an NHS that truly encourages and supports its staff in raising concerns. I want a culture that expects and accepts that people will raise concerns when things are not right, and it to be viewed as abnormal for it to be anything different.

● For more details on the campaign, go to nursingtimes.net/sos

Helene Donnelly is ambassador for cultural change at the Staffordshire and Stoke-On-Trent Partnership Trust

Readers' comments (25)

  • tinkerbell

    Well done Helene, good for you, good for all of us, let's make it happen!

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  • michael stone

    This is very close to something I've written about this issue - wonder if I can track down an e-mail address, to forward something to Helene I've already sent to a couple of MPs, two hospitals and a guy at the CQC ?

    This particular issue really does need sorting -it really does !

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  • We don't need 'ambassadors', 'champions' or anything else you want to call someone who has been given a created post which has no clout. I'm aware that Ms Donnelly spoke out against bad care, as many do, and received a lot of publicity for that. Good for her. But unless her job description actually carries any weight and is effective in not just highlighting, but in bringing about actual real change, then she is being used as a pawn to assuage the ire of the the public.

    Let's have a senior, experienced, smart and outspoken nurse who has clear strategies and is given the position and power to effect change.

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  • from the outside, it appears to me that there are far too many different job titles and roles in the NHS detracting in its complexity from the focus on adequate and quality patient care. to improve care what is needed is sufficient beds to meet demands and more nurses and doctors at the bedside with a few highly clinically competent people with genuine leadership qualities in charge in more of leading, motivating and challenging role which alllows every body to develop as autonomous professionals rather than a directive dictatorial military service style one.

    Parellel to this but not dominating the clinical areas all the other organisational services are required but with a flatter hierarchical structure.

    Salary structures and fringe benefits should also be simplified to match the jobs where administrative pay should not be higher than their clinical peers.

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  • I applaud her efforts, I know from experience how difficult and frustrating it is to say anything to managers about concerns, whatever they may be.
    I do think though that this is the job of the union reps - they should be fighting the cause for patients and staff. they, together with senior nurse managers/directors should really be putting their weight behind raising concerns and improving care. It has to start at the very top.
    It's time the union reps were given the authority, power and respect they need to stand up for everyone, no wishy washy don't want to rock the boat attitudes.

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  • It's time the union membership got behind the union reps.
    So few nurses in either the RCN and Unison voted on whether or not to accept the disasterous pension deal, that the unions had no remit to act. The leaders of unions are voted in by their members. So if you don't like the ineffectual leadership, then vote for someone else. How many have actually voted, ever? A lethargic, moany and inactive membership has no right to expect that others should do anything on their behalf. Get behind the unions, tell them what you want and most importantly be prepared to take action to get it.

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  • Anonymous | 26-Jun-2013 9:29 am

    We on the inside have been saying precisely that for years. We need to stop saying and start doing. By that I mean industrial action. And you on the outside, should really get on board and support us. It's your NHS.

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  • tinkerbell

    Anonymous | 26-Jun-2013 11:27 am

    Exactly. Let's have another vote NOW hopefully the outcome will be hugely different now that we have seen what is happening with a depleted work force and how much worse it has become, all the non stop corruption and how much worse sadly it is going to get.

    Come on, let's do it.Time for less talk and more action.

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  • Firstly, thank you to Ms Donnelly for her work, past and present.

    Unfortunately it appears that Ms Donnelly has been set up as a 'hero-innovator' with the responsibility of bringing about change.

    I say 'unfortunately' because people placed in such positions often tend to not only meet resistance to changes in various ways but ultimately come to reinforce the system through no fault of their own.

    I sincerely hope that I am entirely wrong in Ms Donnelly's case, but would recommend anybody to seek out and read T. Praill & S. Baldwin (1988) Beyond Hero Innovation: Real Change in Unreal Systems, Behavioural Psychotherapy 16(1):1-14

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  • 'ambassador for cultural change' - erm, like the Director of Nursing perhaps?

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  • What band will it be?

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  • tinkerbell

    whatever they're paying her it will never be in the same league as those manky parasites in the upper realms who have right royally screwed OUR NHS.

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  • Anonymous | 26-Jun-2013 9:03 am

    I agree. We don't need bogus posts which carry no influence or power.

    I'm afraid that the 'ambassador for cultural change' is in there with the 6Cs and that recent daft scheme involving students/NQs becoming 'compassion champions' (totally panned). All knee-jerk reactions and useless initiatives which will do nothing to change anything, because they do not address the core issues. The government have nothing to fear.

    I too applaud Ms Donnelly's actions. But they are no different to those of many nurses currently working today. The circumstances in which she was involved became public knowledge because of the likes of Julie Bailey and the families and friends of those who died. Put Julie Bailey in charge of NHS cultural change and give her the power to act. Now that would frighten the goevrnment. More importantly, it might actually bring about change.



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  • Anonymous | 29-Jun-2013 11:18 am

    I agree. all such actions are just stalling and detracting for the main problems in the NHS and wasting further precious resources, energy, time and money. why can't people just stay focused on the main job of providing the best patient care?

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  • We're going to get 'cultural' change alright - its called privitisation.

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  • We're going to get 'cultural' change alright - its called privitisation.

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  • no offense but I find this all rather patronising, senior nurses and nurse managers are already being paid to ensure a high standard of care is given to all patients and that nurses are supported, that is there job and they should be doing it properly, not employing some poor staff nurse to act as a puppet.

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  • it looks as if everybody is going to be controlling what everybody else does instead of getting on with their own job. what sort of working atmosphere is this going to create? one of trust? one of relaxed concentration and a creative environment to give one's very best? ... or a feeling big bro. is watching over one's shoulder all of the time waiting to run off and report the slightest error?

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  • I think people are missing the real point here: the unnecessary deaths and suffering at Mid Staff's - and those yet to be fully realised at other hospitals under investigation - has fatally wounded the NHS; it can't (and wont) be business as usual. I don't think the push will come - necessarily - from the government, but more likely from tax-paying public themselves.

    A 'Culture change Ambassador' is offensive: its like using a sticking-plaster to try to hold back the waters of a broken dam. A specialist nurse being appointed to show that this 'problem' is being taken seriously (like with infection control), just wont wash this time.

    Can you imagine if BUPA or any other private provider for that matter, had failed so abysmally? The company would cease to be.

    Things are going to change.

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  • "Can you imagine if BUPA or any other private provider for that matter, had failed so abysmally?"

    some do!

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