NHS Change Day

Cock-up or conspiracy?

Blogging can be addictive. I try to limit myself to one a week. But after the Secretary of State announced yesterday that a pay “settlement” will now be imposed on junior doctors, given that extended negotiations have so far failed to reach a conclusion satisfactory to all parties, I feel I have something to say.

I know many junior doctors, including the daughters and sons of friends plus those I meet directly through ongoing contact with the NHS. These young people, who hold other people’s lives in their hands on a daily basis, are sensible, bright, compassionate, committed and driven. I don’t understand how a Secretary of State who was brought in to settle down the NHS after the mess the previous one created can have allowed himself to get into an intractable dispute with so popular and articulate a group of NHS staff.

But nor do I buy into conspiracy theories about privatisation by stealth; there would be better ways to achieve this than by alienating an essential section of the workforce. It is far more likely to be a cock-up. Someone probably advised him that the existing contract was, as most senior NHS managers including senior doctors know, overly complicated and no longer fit for purpose. (If indeed it ever was. This is not the fault of the junior doctors, by the way.)

And so he decided to immortalise his legacy as a moderniser by spearheading the introduction of a new contract. But because he isn’t a manager himself, he set out without understanding that the only way to change the contracts of any group of public sector staff, especially doctors who have possibly the most effective union in the country to negotiate for them, is to improve on their current terms and conditions. There is nothing that upsets people more than attempts to introduce changes that significantly worsen their position. And at the heart of the dispute is the fact that for everyone else in the NHS, Saturdays are not part of the core working week. And although there is little choice for the majority but to work on at least some Saturdays, doing so incurs additional payment. (That people in shops and restaurants don’t get paid extra for working on Saturdays these days is of no relevance.)

The Secretary of State also fell into a communications trap by talking about a 7-day NHS, when the group he was targeting already work shifts across 7 days. He chose the wrong example. To get a true 7-day service, he needs to persuade all other NHS staff who don’t already do so to work shifts over 7 days. And to find considerably more of them because spreading 5 across 7 just makes a thinner spread. And that would cost a great deal of money, which he doesn’t have.

What I know from my junior doctor friends is just how difficult it is to get onto a training programme that takes account of personal circumstances. These young people are already in their mid – late 20s. They have slogged away for 10 years plus to get to where they are now. Only the most elite get the pick of training jobs in university teaching trusts; everyone else is bundled around the country with little choice on short placements that have to be filled, because they are the medical workhorses of our NHS. This plays havoc with personal relationships and family life. So they are not a group for whom losing what little control they had over their Saturdays was ever likely to go down well.

With all this in mind, chief executives of trusts work to a bottom line, which is to deliver safe services within the money available. And 20 of them have found themselves in an invidious position.  These 20 were asked whether the latest offer being made was, in their opinion given the circumstances, fair and reasonable. Having replied in most cases that on balance, they felt that it was, they found their names being included in a letter from the chief negotiator to the Secretary of State in support of something about which they had not been asked, ie an imposed settlement. For the sake of the point I want to make next, it doesn’t matter whether this was a cock-up or conspiracy. (I suspect cock-up, because they are far more common. And we humans make mistakes.) The letter caused a massive flurry on social media. And these people had to decide whether to keep quiet, incurring the wrath of their own junior medical staff and others who support the doctors, or come out and say that they had not agreed to the imposition, potentially putting their own careers at risk. That the majority did the latter fills my heart with hope for the NHS.

And my key point is this. To be a leader in today’s challenging NHS, there are seldom going to be obvious right answers. You will frequently be faced with dilemmas of this nature. If you don’t have the nous to work out when to put your head above the parapet and when to stay quiet, plus the courage to do the former at the very time it seems most lethal to do so, you haven’t got what it takes.

In other news, the Head of Google, Europe told the Public Accounts Committee yesterday that he couldn’t remember how much his own remuneration package was. Either he really couldn’t, in which case he is an idiot and has no right to be in charge of anything. Or he dissembled because he knew it to be a sum of many millions, embarrassing with Google under fire for paying so little corporation tax. Chief Executives of trusts have their salaries published every year and get pilloried for it in newspapers like the Daily Mail. And they all know exactly how much they earn, which is a tiny fraction of the forgetful man from Google. And yet each carries many times more responsibility than he would have a clue how to handle.

My worry is that there is a scarcity of people with the right attributes and courage to do these NHS leadership jobs. And we really, really need them. As we do our wonderful junior doctors.

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Blessings

books

Books that have inspired me this year by @Suzypuss @jamestitcombe and @molly_speaks

 

 

 

 

 

 

To keep depression at bay, it helps to count one’s blessings. My Twitter friends are a very big blessing. Here are some thank you messages for 2015:

  • To campaigning journalists @andymcnicoll and @shaunlintern for supporting underdogs including mental health care and people with learning disabilities. Please never stop.
  • To Adam and Zoe Bojelian who lost their dear son @Adsthepoet in March 2015 but keep his legacy alive via Twitter. You are in our thoughts as you face a first Christmas without your wise, beautiful boy. We will never forget him and what he taught us.
  • To @JamesTitcombe who lost his baby son and has courageously campaigned for greater openness over mistakes in the NHS, despite some vile online abuse. I treasure my copy of Joshua’s Story. And I thank James for all he continues to do to make the NHS safer for patients and their families.
  • To all who bravely act as patient representatives, such as the indomitable @allyc375, and remind regulators, commissioners, managers and clinicians what the NHS is actually for. Only they know the cost of speaking up. Go Ally, @anyadei @ianmcallaghan @DavidGilbert43 and others who’ve earned the right to call themselves patient leaders.
  • And to @HSJEditor for taking a risk and running the first HSJ list of patient leaders. Thank you Alastair. I think it was a game-changer.
  • To those who’ve grasped one of the most feared conditions and are making life better for those living with it. I mean you, @dementiaboy and @dr_shibley. To you and others like you, thank you for refusing to leave dementia in the too-difficult box.
  • To @Liz_ORiordan who is generously sharing her experiences of breast cancer care, which for a breast surgeon is a pretty massive deal. And for some other stuff.
  • To @EastLondonGroup, who introduced many of us to a group of previously little known landscape artists from the early 20th Century. Sunday Morning, Farringdon Road has become a landmark of my week.
  • And to @penny_thompson, for pointing me to ELG and for always being true to her values.
  • To poet @Molly_speaks for painting pictures with words in her lovely new book Underneath the Roses Where I Remembered Everything
  • To @HPIAndyCowper, for his excoriating, original analysis of the NHS, and for his support to me in my scribblings.
  • To @clare_horton for running the excellent @GuardianHealthCare and even including some of my pieces. This meant so much.
  • To @seacolestatue @EAnionwu @trevorsterl @thebestjoan @pauljebb1 @joan_myers and many others for plugging away in the face of seemingly impossible odds. The Mary Seacole Statue will rise in 2016 as a permanent memorial to someone who showed how, if something matters enough, we should never give up.
  • To @nhschangeday @PollyannaJones @helenbevan dani_ellie @jez_tong @LydiaBenedetta @cjohnson1903 @WhoseShoes @fwmaternitykhft @DaniG4 @damian_roland and so many others for including me in NHS Change Day 2015. I was meant to be helping you but I gained many times more than I gave.
  • To @TimetoChange @suebakerTTC @paulfarmermind @carolinewild @danbeale1 @2gethertrust @NTWNHS @rethink @mindcharity and a whole raft more for being a major part of my life this year, working together to tackle the stigma that still exists within the NHS towards folk who, like me, experience mental illness from time to time but are so much more than our diagnoses. Here’s to you.
  • To @nurse_w_glasses @anniecoops @drkimholt @gourmetpenguin @AlysColeKing @DrUmeshPrabhu who show by words AND actions that compassion is alive and kicking amongst health professionals
  • To wonderful women leaders such as @SamanthaJNHS @BCHBoss @JackieDanielNHS @ClaireCNWL @CharlotteAugst @KMiddletonCSP @Crouchendtiger7 @DrG_NHS @VictoriBleazard @JaneMCummings @CarolineLucas @juliamanning @TriciaHart26 @clarercgp who stick their heads above the parapet and make the world a better place
  • And folk like @NHSConfed_RobW @ChrisCEOHopson @cmo @profchrisham @ProfLAppleby @WesselyS @nhs_dean @NHSE_Paul @ScottDurairaj  @stephen_thornton @jhazan @rogerkline  who prove that leaders on Twitter don’t have to be women to be fabulous
  • To bright, bubbly new leaders like @anna_babic and all those I’ve met via @NHSLeadership, who fill me with hope for the future. And to @Alannobbs @kirsti79 @NoshinaKiani and all the other great folk at the NHS Leadership Academy. You do stunning work.
  • To @GrassrootsSP and everyone who works to prevent the long shadow cast by suicide. Thank you.
  • To everyone who supported me in my bike ride for @samaritans in the summer. Especially @NurseEiri and @JackieSmith_nmc. They know why.
  • To @Suzypuss whose book The Other Side of Silence has inspired me to get on and finish mine.
  • To wise owls @johnwalsh88 @TelfordCC @KathEvans2 @gracenglorydan @timmkeogh @RecoveryLetters @profsarahcowley for being beacons when the world feels a bit too hard
  • To friends who also experience mental illness from time to time and who share their thoughts and feelings so generously. Thank you @BipolarBlogger @Sectioned @BATKAT88 @annedraya @clareallen @corstejo @schizoaffected @rabbitsoup_zola and many, many others. On a not-so-good day, yours are the tweets I look out for. You bring me hope.
  • If I could, I would add everyone else I’ve chatted with on Twitter this year. To everyone I follow and who follows me: Twitter is 97.5% good for my mental health, and that’s because of all of you. Thank you all so much. I wish you all much love for 2016. You rock :mrgreen: :😎💃❤

 

Pride and Prejudice: post NHS Change Day ponderings

20.30 from Birmingham New Street to London Euston

20.10 Birmingham New Street to London Euston

You know how it is. There’s been a big event in your life – a special birthday or a wedding. Even NHS Change Day.

Now the party’s over. Everyone’s gone home, you’ve done the clearing up and read the thank you texts. You’ve got a hangover and sore feet from dancing till dawn. And you feel a bit flat. And you wonder what the point of all that fuss was.

I was feeling a bit like that the day after NHS Change Day. Maybe you were too? I’d given my all to various events in Birmingham. I was made extremely welcome by amazing people at Birmingham Children’s Hospital, at Birmingham Community Trust, at two children and young people’s mental health services and by patients, users, carers and staff at a West Midlands Health and Care Voices event in the evening.

It felt very special to share thoughts with patients and staff about things we all care very much about. Everyone seemed up for playing their part in changes that needed to happen. And our NHS Change Day: Time To Change campaign also seemed to hit the mark for many of the folk I came across.

A student nurse called Ellie did something on NHS Change Day that I didn’t have the courage to do until I was 58. In this blog, she beautifully describes what happened to her in front of 40 other people. In our Time to Change video, I ponder what may have made me take so long.

So that’s the pride part. I felt proud of my small contribution to NHS Change Day.

And the prejudice? It was to realise that some of the naysayers also had a point. While NHS Change Day 2015 has been amazing, people who have never heard of it continue to do stunning stuff. Like my friend Alison, a sister in a hospice, who with her colleagues care for dying people with such skill and compassion, I defy anyone not be able to learn something from how they work. Their hospice is one of the most joyous and hopeful places I have ever been invited to visit.

Or another friend, a clinical leader in an acute hospital, battling to get colleagues to see people with dementia for what they really are, human beings with wants and needs, rather than “inappropriate admissions” or “delayed discharges”. Or a third friend, a health visitor with a caseload so huge, and with clients with so many complex health and social problems, I cannot imagine how she is coping. But she is, as are so many others like her.

On Friday, my mother and I went to visit my auntie, her only sister, in her care home. Most of the staff who work there earn not much more than the minimum wage. As always, we were moved by the tenderness shown towards those living at the home. These staff truly love the frail and confused people whose care has been entrusted to them.

People like this don’t need a special day. What they do every day is extraordinary.

The NHS has to change. We cannot go on as we are. It’s an honour still to be involved, as a helper now rather than a leader, and to play a small part in bringing some of those changes about. NHS Change Day is an enabler. But it is no more than that.

Life, and death, continue 24/7 across all parts of the NHS and the services that support it.

If you work in the NHS, I hope you had a wonderful NHS Change Day. Thank you for what you do every day. I am most humbly grateful.

 

#NHSChangeDay is not a distraction from #Kirkup. It is how we will fix things

This week, a number of people have been challenging those of us involved in NHS Change Day to demonstrate its value. Particularly in the light of the Kirkup report about what went wrong with maternity services at Morecambe Bay Hospitals over an extended period.

For example @GeorgeJulian wrote this interesting blog.

There are others questioning whether NHS Change Day is a cult, a cheer-leading exercise led by those with not enough to do, a distraction from the grindingly hard work of running the NHS without sufficient resources, even an opportunity for organisations to put a gloss on how tough things are for patients and staff.

I can see why they might think that. I have another take on it.

The Kirkup report was shocking, for me even more so than the Mid Staffordshire Hospitals report. It got to the heart of what can go wrong when staff go rogue and collude, when key professionals who should be working together in harmony for the benefit of patients declare war on one another, when clinicians are simply not competent to practice, and when managers, commissioners, regulators and even the ombudsman indulge in a form of magical thinking, ignoring the evidence of high rates of death and other serious incidents and accepting assurances that should never have been given. The courage of families, including the man who worked at the hospital and lost his wife and new baby, and James Titcombe and his wife whose baby son Joshua died, has been extraordinary. We owe them a debt of gratitude for never giving up and continuing to insist that the evidence must be looked at properly.

So how can NHS Change Day help? I write now as a nurse and a manager. There have been many times in my 41 years when I have been aware of something not being right. The first time I blew the whistle, I was just 18 and hadn’t even started my nurse training. You’ll have to wait for my book to read the details; suffice to say, I was ill-prepared, it didn’t go well and I was sent away with a flea in my ear. Sometimes it was me that made mistakes, sometimes it was someone else; these things can happen, and we were rightly taught always to own up if we had erred. But what about the surgeon with the shaky hands that everyone was expected to ignore, or the night sister who slept in the laundry room when she should have been supervising us? Who wants to be hated for being a sneak and reporting people who are liked, or may be experiencing personal problems?

My blood ran cold reading about those midwives at Morecambe Bay. They reminded me of maverick teams I have known. Teams who are brusque and unwelcoming however hard you try to engage them, who repel enquiries, describe managers who visit their services and ask questions as interfering, or even talk about bullying if an aspect of their working practice is questioned. And what about more senior clinicians, such as doctors, who are described by colleagues as brilliant but eccentric, and can be extremely unpleasant and difficult to deal with. The ones who write you long letters describing, with great charm, the stupidity of your ways for trying to introduce a change to improve the experience of patients. These people are the exception, but they have a massive impact. I can remember as an executive being told by a senior clinician that to expect to see the results of their clinical audit reports was tantamount to a slur on their professional standing. Eventually a brave junior member of staff blew the whistle on this person. They were dismissed for gross misconduct, upheld on appeal. But despite a ton of evidence, their regulatory body decided to allow them to continue in clinical practice.

The point I am making is that it isn’t easy to be a whistleblower, nor is it straightforward to tackle poor practice. The law is loaded on the side of employee rather than the employer, rightly so, but in healthcare this can and does affect patients.

Initiatives like NHS Change Day are the antidote. They put patients and caring, committed, non-defensive staff where they belong, in the driving seat. Leaders, including patient leaders, set the direction and tone, patients and staff come up with the ideas, and managers support them to deliver these together. Those who object to the change being proposed have the opportunity to discuss it and put the alternative case forward. Ultimately, the majority will decide. Encouraging an open, enquiring culture that is always seeking to improve practice is the best possible way for the NHS to become safer and more compassionate for patients and the vast majority of staff.

It isn’t easy always to be open to change, but we should all be learning and improving continuously.

I’m leading the Time to Change initiative for NHS Change Day. This video explains why – the key bit is from 3 mins 20 seconds. I hope it explains why I feel so strongly about change and in particular, reducing the stigma of mental illness within the NHS.

Thank you.

 

 

 

It’s #NHSChangeDay. And it’s #TimeToChange

My blog today may be the most important thing I write this year. So forgive me if I seem to be plugging it rather a lot!.

We all have mental health. And we all experience mental distress from time to time. But only some of us (1:4) get mental illness. This 3 1/2 minute video explains it well.

One of the hardest things about mental illness is the stigma associated with it. From society but also family, friends and work colleagues. But most of all from ourselves. It stops us seeking help. For example, people wait a year on average before talking to someone else about their depression. This delay causes great suffering and harm.

Time to Talk Day  took place last Thursday, part of the national Time to Change campaign. The purpose of setting aside a day every year is to open up conversations of just 5 minutes between people, and to help each other. I had some amazing conversations via Twitter and face to face with people, including at a reception for the national mental health heroes held by Nick Clegg, Deputy Prime Minister.

You may feel that politicians are jumping on the mental health bandwagon in the run-up to the General Election. But I think that’s OK. Because after the election, we can join together and hold whoever is elected very firmly to account to make sure that mental health services stop being the Cinderella of the NHS that they still are. It’s not enough for politicians to say nice things. We need carefully thought-through policies that make a positive difference, and significant investment in real terms over the life of the next parliament.

Stigma has many other negative impacts as well as on policies and funding. Time to Change have found that, while the public are gradually improving their attitudes towards people who experience mental illness, there has been no discernible improvement of attitudes within the NHS. In fact some people who use mental health services say things have got worse.

This produces all sorts of horrible results:

  • People with mental illness can be treated without the compassion and respect that are essential for effective health care
  • People with mental illness may not receive the treatment that they need in a timely manner. They may have to fight to get the right care. And they may not even receive the right treatment at all
  • The links between mental and physical illness can be forgotten or ignored, causing detriment to people with either or both. For example, people with serious mental illnesses die on average 20 years earlier than the general population, often linked to preventable diseases such as heart and/or lung diseases, some types of cancer and strokes. People are people, not single diseases
  • People with mental illness report that NHS staff can have a pessimistic outlook on their life chances, including relationships, education, employment and social contribution
  • Staff who work in mental health services can be blamed for things that are not their fault, or criticised for not providing a service when it hasn’t been commissioned or adequately funded
  • NHS staff who themselves experience mental illness often feel the need to hide it from their colleagues, and when applying for jobs. Mental illness is not seen as something to be proud of overcoming in the way that some physical diseases are portrayed

Part of our #NHSChangeDay #TimeToChange campaign asks NHS staff who have experience of mental illness to consider talking about it with their colleagues. Please be assured, we are not in any way pushing people to do this. We ask anyone who is considering doing so to think about it carefully, and look after themselves, including getting support. There are some good resources here. I know from my own experience how hard making such a disclosure can be, and how significant are the ramifications. But that takes us back to stigma. It really shouldn’t be so hard. And if we cannot be compassionate towards our colleagues who may be experiencing mental illness, how can we, and they, be expected to be compassionate with patients?

When we find ourselves troubled about something that we hold dear, it is human to want to disagree. Or run away. I felt very upset when I first heard the findings of the Time to Change research, and wanted to say no, surely it must be better than this. But then I listened again, and realised that, unless we face up to what has been uncovered about attitudes within the NHS, things will never improve.

If you have 6 minutes to spare, you can watch me talking about it here. Including the long-lasting effect that one nurse’s probably unintentional lack of compassion had on me, also a nurse.

The #NHSChangeDay #TimeToChange campaign aims to tackle this stigma within the NHS head on, with compassion, but also with wisdom and hard work. From it, we are building a programme within Time to Change that we hope will leave a very important legacy for NHS staff and patients.

Whether you are a patient or an NHS clinician, a catering assistant or a Chief Executive, please join us. Everyone can commit to one of our actions or create an action of their own. It’s NHS Change Day on 11th March 2015. And it’s Time to Change.

Thank you.