Doctors in Wales have spent a great deal of the year examining the state our NHS in Wales is in and where it is going. Before Francis, Welsh Council had already started to debate the culture that exists within the NHS in Wales and how it needs to change. Fear breeds secrecy, but openness fosters blame if those responsible at the top do not take time to understand how the system as a whole has failed those caring directly for our patients. There is much to learn, yet NHS Wales fails to do so with regular monotony; the ‘system’ remains largely a poor listener. Whereas it could and should welcome and act on continuous feedback of our service, it seem to have become over-complicated and stifled individuals’ ability to make things better, in favour of a bureaucracy for complaints, concerns and whistle-blowing. What should be a matter for a continual desire to improve, remains an adversarial-based cumbersome machine, with no prompt mechanism for sorting out what went wrong, for learning why it did, nor for putting it right in a timely fashion. That is what makes a difference to patients and front-line staff.
Any new way of working means understanding how groups and teams best work; how to make broken teams better and how to build cohesion out of a system that seems to be encouraging fragmentation of the continuity of care that was the hallmark of yesteryear. I suggest that part of the answer lies in the professional role of doctors being re-visited and valued – and this is our challenge for the year ahead. Many of us seem to have become resigned to an acceptance that the future is not in our hands. I disagree and I know that many of you do too.
Key to me making this statement is that doctors are central to providing clinical leadership in NHS Wales. This goes way beyond the traditional consultant firm, into the new territory that is the multidisciplinary environment we find ourselves in. But it is vital to understand what a leader is – “someone who is able to influence those who will follow”, and it becomes necessary to then link it to followership – “the ability to influence those who lead”. The NHS spends millions on the former and pays scant attention to the latter, then wonders why leaders can’t lead and the front-line staff feel disempowered and under-valued.
At a recent leadership event, organised by the DCMO in Cardiff, the dropped penny was finally revealed. Our ability to lead is not just based on a set of skills and learned accomplishments, but on behaviours and feelings – valuing the people we are asking to do extraordinary work, often in challenging circumstances, every day. If you don’t care about the carers you cannot expect them to provide the sort of quality and compassion you would wish for. Check out
http://www.leadershipacademy.nhs.uk/discover/leadershipmodel/ not necessarily for the complete answer, but for an interesting take on a new direction that shows great promise, I think.
So in 2013, BMA Cymru Wales has helped move forwards the debate on reconfiguration and service reviews, with the publication of specific guidance on both. Our lobbying strengthened both the Human Transplantation (Wales) and Active Travel (Wales) Acts and we influenced the Public Accounts Committee report on the consultant contract when we highlighted the need for training in job planning. Numerous BMA members have also been supported through their individual problems in the work place.
Our task for 2014 will involve effective union action on consultant and junior doctor contracts, but also the professional contribution we can all make as doctors to take the NHS in Wales forwards, not backwards. I’m frequently asked “what makes doctors different?” It is intangible and defies easy definition, but I know of no doctor who does not feel that the transition from student to doctor and beyond has not affected them fundamentally. It is this difference that cannot be consumed by apathy or resignation to an NHS that does not work for our patients. This is why we must not give up on the NHS in Wales, for it needs us more than ever – precisely because doctors are different. And that matters.
I wish you and your families a happy and peaceful Christmas.
Dr Phil Banfield