Reality check needed for NHS to face the truth
Rich Taunt tries to make sense of the disconnect between his ConfedExpo experience and the restricted budgets and staff burnout in the NHS.
Emerge blinking from the industrial hulk of the Manchester Central Convention Centre, wend north along Deansgate, and, just beyond the cathedral, you’ll find yourself at the Glade of Light: a living memorial to the lives taken in the May terrorist attack seven summers ago. Where garden encircles marble. Marble encases memory capsules personal to the 22 people who never returned home. It’s sad, soulful, and deeply beautiful.
Designing memorials must be fiendishly difficult. Simultaneously a public work of art, a personal reflection of those it marks, but above all a way to help the individual and collective processing of pure emotion.
The need to process complex, human emotion is eternal in the delivery of healthcare. Healthcare is the most emotive industry there has ever been, and ever will be.
Emotional inevitability
It’s the scene of our own birth and deaths, our witnessing of the physical and mental pain experienced by those closest to us. And for those working in it, it’s even more: the fulfilment found when you can fix others, the powerlessness of when you can’t.
These are emotions that are never going to go away: however much we spend it will never be enough, pain will always persist, and death will always have the last word. The only thing we can control is how we make sense and work with such emotional inevitability.
How do we do this? Let’s nip back to the Convention Centre and this week’s gathering of leaders, the largest in the NHS calendar.
Those attending will all have a list of what scares them, what bedevils their days and keeps them awake at night. It’s not hard to put a draft together: the burnout experienced by their staff, the inevitability that restricted budgets will mean poorer care, the fears for their own job if they don’t deliver, the increasing distance from the reason they came into this in the first place.
Collective delusion
This is not the ConfedExpo agenda, nor has it ever been. Instead, digital front doors, maximising capacity, connecting data, interfacing systems. Robots loop an exhibition floor laden with giveaways of stylish umbrellas and beverages appropriate to the hour.
You won’t be surprised to discover I struggle. Struggle with the lack of soul, the vastness of the emotion lurking under the barely-scratched surface, and the creeping fear that I too am complicit in what could best be described as an exercise in collective delusion.
Organisational silence reappears time and time again in NHS history.
You’re missing the point, I’m told. This is a break. A chance for hope. An ability to provide distance from the day-to-day and precisely not to dwell on it. Think of it as respite care for NHS chief executives. NHS Disneyland.
Organisational silence
Maybe. Yet the reality is that we know that organisational silence – the collective phenomenon of saying or doing very little in response to significant organisational problems – reappears time and time again in NHS history. We could go back to the voices of Barbara Robb in the 1960s, or Robert Francis barely over a decade ago. But in 2024 we don’t need to.
“There is a culture which puts the reputation of trust in the NHS above the issue of patient safety,” said Rob Behrens, the NHS ombudsman, last August following the sentencing of Lucy Letby for the murder of seven babies.
The NHS has a “culture of defensiveness, lack of openness, failure to be forthcoming, and being dismissive of concerns” reported the Infected Blood Inquiry last month, where 30,000 people in the UK were given treatments infected with HIV and hepatitis C, resulting in 3,000 deaths.
Cultural malaise
We didn’t talk about this in Manchester this week. Scour the ConfedExpo agenda for either of these specific cases, or the cultural theme that unites them, and – barring an honourable single head-nod to an hour on Martha’s Rule – you’ll come away empty-handed.
Conferences like this are symptoms, not the cause, of a much deeper cultural malaise. A culture that chooses to suppress emotion rather than open it up, that prefers to dwell in a place that is fundamentally unreal rather than confront the cold light of day. These are traits of failed organisations the world over. Without major cultural change, the NHS will simply be added to the list.
The plan cannot possibly be to wait for a fresh-faced politician to save us. More than any other group, whether such change happens rests on the actions of exactly those who walked through the Convention Centre’s doors.
So if not here in Manchester, when does the NHS start to face the simple truth that it doesn’t like the truth?
Comments
I read this important and honest post from Richard Taunt soon after putting the phone down from a call with someone very close to me who had a scan in hospital recently, having taken herself to A+E in a lot of pain, and had enquired when she would know the results. Scan results are normally read two or three weeks after the scan, she was told, casually, even though the scan itself was considered urgent enough to be done within three days of her A+E visit.
My guess is there will not be a single person reading this without themselves or a loved one having had a similar experience, so routine has such systemic dislocation become in the NHS. And that is before we even get started on the scandals Rich mentions in his post. As Robert Francis put it in his report into the Mid Staffs scandal, “there is an insufficiently shared positive culture” in the NHS, and:
“To change that, there needs to be a relentless focus on the patient’s interests and the obligation to keep patients safe and protected from substandard care. This means that the patient must be first in everything that is done: there must be no tolerance of substandard care; frontline staff must be empowered with responsibility and freedom to act in this way under strong and stable leadership in stable organisations.” (Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013, paras 1.117-1.118).
Eleven years on, how much closer are we to an NHS environment in which the professionals are systematically ’empowered with responsibility and freedom’ to act in that way? Or are we actually even further away from it?
In the work my colleagues and I have done to support the development of such a culture in the NHS through self-organised teamwork, inspired in part by the success of Buurtzorg in the Netherlands, I have found a growing thirst for such a culture among the professionals – but accompanied, unfortunately, by growing frustration about the systemic obstacles to its normalisation. (Here’s a link to a report of an EU-supported project with relevance to this point and with significant insights about it. https://publicworld.com/wp-content/uploads/2023/03/TICC-Blueprint-English.pdf)
More money is needed but won’t fix this problem. Better tech is needed but won’t fix this problem. And, unfortunately, it seems the NHS Confed continues to duck it too. As Rich concludes his challenging post about its gathering this week in Manchester:
“The plan cannot possibly be to wait for a fresh-faced politician to save us. More than any other group, whether such change happens rests on the actions of exactly those who walked through the Convention Centre’s doors. So if not here in Manchester, when does the NHS start to face the simple truth that it doesn’t like the truth?”
Spot on. Elephant in the room needs to be talked about.
I retired from GP life 3.5 years ago. Now I am CMO of a company that improves metabolic health using a digital therapeutic.
When I retired it was possible to see a GP you probably knew. Not always the same one but some element of collective continuity.
Now all I hear from patients on the frontline is they cant get to see a healthcare professional or that is their strong impression. When we improve health, deprescribing often has to happen. This is a barrier that patients are saying is too difficult.
Collectively our profession has not over night become lazy, inefficient or not caring.
There is a tsunami of ill health and conditions caused or exacerbated by social determinants of ill health. The NHS is not well set up to fix these, so guess what- the outcomes are not great.
We need a radical shift in how we treat and prevent ill health.
Then we may get back to a place where we have occasional gaps in clinics (due to lack of demand), GPs who have time to have lunch and loo breaks (yes this is an issue!).
This is totally achieveable but might require significant new leadership that allow curiosity, question what we have been doing over last 30 years and root out any conflicts that have been holding us back.
Currently i do advise friends and family to get private health insurance or be willing to self pay. I hope in the future I will change this advice. This was not needed for the whole of my working career.
Outstanding Rich. This needs to be shared throughout the NHS.
Thank you for raising what is now an increasingly obvious situation. We seem to be so compliant… Is it because people are employed in the public sector?
‘an exercise in collective delusion’
We need to share free from this, and perhaps we do need a leader to rally around.
There are a few great examples of leaders that “have your back” even if you mess up. Sadly this is a minority as those who perpetuate the status quo tend to keep their jobs or move across and up. Courage is mistaken for trouble making so exactly the people we need are often forced out or ground down. Let’s point to good examples that set the bar of what is possible and ask of other leaders “why not here?”.
The whole matters more than the parts in the same way as when a river flows to the ocean it does not mourn its loss of identity as a river, it becomes an ocean.
We need to bring back meaning and agency to the work if we are the generate the goodwill necessary to do the day job and improve the day job at the same time.