We are, perhaps, used to politicians saying one thing and doing another subsequently. We all have our own favourite examples of this, such as the UK Coalition Government stating that there will be no ‘top down reorganisation (privatisation) of the English NHS’, while Sir David Nicholson, its Chief Executive at the time, declared that the change was so monumental that it “could be seen from space”.
The current contradiction taxing me is how Welsh Government arranged specifically for the term “and Wales” to be removed from the consultant contract – previously, “England and Wales”, now just “England” – but now seems to be attempting to rejoin a ‘UK’ negotiation because it feels that the Welsh Consultant Committee (WCC) has been unreasonable in rejecting potential pay-cuts for consultants as a pre-condition to contract talks in Wales. WCC did this on the back of an unprecedented 450 e-mails from irate, upset and disillusioned consultants in Wales, many of whom highlighted just how much they are propping up a battered, creaking NHS in desperate need of repair. Talks, as they say, are on-going.
This is about patients. We have to do all we can to attract doctors to Wales, not drive those we do have away; we must value the contribution of staff and patients in fixing what we know is broken in the NHS in Wales.
Thankfully, you don’t have to take MY word for it, for we have yet another report highlighting how the NHS in Wales fails to listen, and still has a prevailing air of secrecy, fear and bullying. Let’s see what someone independent of both the NHS and politicians has to say – the ex-CEO of Panasonic UK, Mr Keith Evans.
You would expect someone so successful in industry to be good with words so let’s pick out a few from his review of the NHS Wales complaints procedure – Putting Things Right
First, he recounts his credentials and what it takes to be successful – put the ‘customer’ (patient) first. Indeed, you must “humbly wear your customers’ shoes and place yourself in their position at all times”. His comment about mistakes is also worth repeating: “From a customer perspective, it is important to accept graciously the kind assistance of those who have so far been patient with your shortfalls and let them teach you how to put them right”.
Instead of trying to sell us a commercial and managerial picture of the NHS he appears supportive of it;
“There is little that industry can teach the NHS with regards to delivering front line expert medical or clinical services. The NHS continues to be regarded by many as a world leader in the field of advanced healthcare delivery”. I like this man – it is almost as though he ‘gets it’, unlike so many others making decisions that affect our NHS in Wales.
So what is going wrong? Well, does the NHS welcome comments, criticisms or complaints; does it really want to ‘put things right’? (Shout out now).
“An organisation of any sort – public or private – that cannot receive a complaint with heartfelt thanks and deep appreciation will never succeed in the long term”. Indeed, “using the information gathered from users is a vital analytical tool in ensuring that the organisation is not arrogantly pursuing its own cause and direction…”
But we have changed our NHS, haven’t we? We have listened and acted and all is well? If so, why, post-Francis, is Mr Evans unsure if staff are more frightened or more open? Staff that, he says, are the “unsung heroes”… “giving of their very best to care for us when we desperately need it”.
Staff, like patients it seems, are also lost in that beast of a system that is the NHS in Wales. For a while now, Welsh Council has been considering the view that the manager led approach to the NHS is wrong; it just plainly hasn’t worked. The perception is of deep divisions in opinion; doctors and nurses asking for support and means to treat the patients in front of them, and managers asking for more managers to manage the NHS out of trouble. Both sides of this divide are drowning in processes and paperwork, with inadequate IT systems and conflicting priorities and purposes that will remain while non-clinically driven targets are put ahead of clinical priorities in the scramble for a restricted pot of Welsh Government cash.
But, Evans’ observes of the NHS in Wales; “There are too many levels of horizontal and vertical management; it is probably the most complex matrix organisation I have ever come across and mostly of its own making”.
As Evan’s implies from his comments on business, the NHS is not like a supermarket either. The introduction of General Management by Griffiths (from Sainsbury’s) in the 1980s started the burgeoning industry of NHS processes and management structures that have paralysed the health service in getting on with the job of treating and caring for patients and their families. Perhaps Morrisons have it right, when, in this age of austerity, they have proposed massive cuts in management levels – in order to put more people on the shop floor. It is, they point out, what their customers want.
Is this starting to sound awfully familiar? Ah, yes – it is what doctors in Wales have been shouting for a while now, so far to deaf ears, it seems.
Doctors believe passionately in our National Health Service for Wales. We have a unique chance to extend Bevan’s vision. But Wales is also poised to get it wrong. In delegating responsibility to Health Boards, setting an impossible task that sets finance against service, Welsh Government risks overseeing the decimation of our NHS. In not joining up the work of Health Boards, Welsh Government, Welsh Postgraduate Deanery, Universities and partners outside Wales, incrementalism is eroding the core framework that would allow a sustainable NHS in Wales. We will struggle to maintain piece-meal services and no-one will take responsibility. It may already be too late, but we’ll certainly know before the next Assembly elections in 2016.
Surely it is obvious to put the patients first and to support directly those who care for them? Evidently not. Put – don’t talk – things right, so that our doctors can care with due compassion and humility, as our patients have asked of us.
If you want to run the health service well, ask the doctors for their prescription. Do it now, please, while there is still an NHS in Wales to play for. If you don’t want to listen to us, then listen to the independent reports – or perhaps we might listen to, and learn from, our patients, for it is them we all serve.