Let’s all work together to move towards a more open, transparent NHS, says Dean Royles
Compassion. A word whose closest neighbour is love, a word we want to hear when those close to us are in need of care, a word that has been said more than any other in the NHS its 65th year. Unfortunately, it has nearly always come after the words “a lack of”. A lack of compassion. Four words that have been used to sum up the NHS. We need the humility to accept our part.
It may not be fair that events in parts of one hospital over five years ago have come to define the NHS, but that’s the reality. As the dust settles on the government’s response to the Francis report, it is clear the implications will change the way we work.
The NHS is constantly under the microscope and, along with increased media attention, affects staff and how the public views the nursing profession. We now have an opportunity to change that and it should be our collective responsibility to change the NHS for the better.
“Nurses are the eyes and ears of an organisation, they see what happens on the ground and must not be afraid to speak out”
When something bad happens there are calls for change. Initial reactions can be perceived as defensive but we only change by reflecting, acknowledging and learning. We know the NHS is the fairest healthcare system in the world. When it operates at its best, it is the best in the world. A recent Ipsos MORI survey showed it is the NHS that makes people most proud to be British.
The headlines from the government’s response focused on criminal sanctions, fit and proper person tests and losing insurance cover. The elements that didn’t grab the headlines highlight the importance of effective team work, valuing staff contributions, engaging and empowering staff, and creating a supportive culture in which staff feel able to speak up, challenge and take forward changes to benefit patients. That is how we drive safe, compassionate care.
There is absolutely no room for poor standards of care anywhere in the NHS but working in a climate of blame and fear is not good. Nurses are the eyes and ears of an organisation, they see what happens on the ground and must not be afraid to speak out; the professional duty of candour announced in the response will help facilitate that. We can’t legislate to guarantee it but we can test ourselves on whether, faced with an opportunity to be kind, we are. Surveys tell us staff can, and do, raise concerns but we need to be much better at feeding back what happened and supporting and praising staff for highlighting concerns.
As Professor Don Berwick says in his report: “The best keys to healthcare safety do not lie in blame, regulation or punishment, but rather in learning, support and encouragement to the healthcare staff.” That’s what most organisations want to create.
I have expressed some strong views against imposing arbitrary, national ratios for nurse staffing levels. That might sound odd but I know the folly of focusing on one staff group to define standards of care. So I welcome the government’s new proposals to set staffing levels locally, based on evidence, and to make these numbers transparent, retaining health providers’ flexibility and clinical expertise at a local level to best tailor teams to patients’ needs.
There is a link between safe staffing and the quality of care but we know good care is more than just numbers of staff. In today’s NHS, care is provided by multidisciplinary teams that include physiotherapists, dietitians, speech therapists, occupational therapists, scientists and others.
Now is the time for action. Let humility do its work. Commissioners, government, regulators, providers, staff and managers, let’s all work together to move towards a more open, transparent NHS - one that is innovative, looks after its staff and patients, and makes us proud to be British. Look around at the fantastic, compassionate care you see - and tell people about it.
Dean Royles is chief executive of NHS Employers