I am just back from a couple of days in Liverpool at the NHS Confederation Conference and I am feeling a lot better about the NHS than I have done for a while. Since I returned to the NHS in February, the leadership debate has been pretty gloomy, focused, as it has been on a narrative of imminent financial disaster, with or without the Better Care Fund. Coping with adversity is part of being a leader but it can, nonetheless, be pretty soul destroying. So it was good to come away from the Conference a bit more upbeat.
Let’s be clear. This is not the “it will definitely be alright on the night” type of optimism but rather the encouragement which comes from the chance to reconnect with a shared vision of what we need to get right to create a health service in this country of which we can all be proud. One of those moments – like when you are walking in the mist on the mountains, not absolutely sure where you are, and the clouds disperse and reveal the landscape ahead of you. It may still be a long way to go, you may be off track, but at least for a short time you can see very clearly where you have to go.
There were in the discussions three major landmarks which, for me, pointed the direction forward.
The first was patient safety. It is over year a since the Francis report. My sense is that, while we do not have all the right answers on how to do it, there is a collective sense across the NHS that the events unearthed at Mid Staffordshire and other hospitals marked a point of collective shame which must not be allowed to happen again. It was moving to hear from, amongst others, Helene Donnelly, a whistleblower at Mid Staffordshire, and now an Ambassador for Cultural Change at Staffordshire and Stoke NHS Trust, about how a culture of unacceptable quality can imbed itself in an organisation and how, by the same token, a positive quality seeking culture can be developed. Data and technology have a key role to play as well and I loved a quote from Tim Kelsey about how transparent real time systems for feedback can “stop today’s small indignities becoming tomorrow’s tragedies.” We now know that whether we are doing well or doing less well we need to continue to keep quality on the agenda.
The second landmark was integration. Again we may not yet be succeeding but we are trying to do it and more than that we are doing it because we know it is right for patients, not just because it may help us better manage the finances of the NHS. There are two dimensions to this. First, the inevitable greater complexity in managing the care for a growing number of vulnerable individuals with multiple mental and physical long term conditions. Second, however, the impact of our tendency within the NHS in recent years to fragment the way in which we deliver care. While specialist knowledge has its place, I do welcome the growing calls for a greater emphasis on generalism and support primary care as the focal point for integrated care. Integration also needs serious investment in redesigning pathways from the perspective of patients and on ensuring there are identified care co-ordinators and care navigators to facilitate the integration care. The final thing integration needs is good relationships and the time to develop them. Good relationships between agencies, between professionals, between professionals and patients and carers.
My final landmark was the importance of the voice of patients and carers and the enormous contribution they can make in helping to transform care. We are trying to address this but have such an enormous way still to go beyond the tokenistic and disempowering systems and processes which have characterised patient and public involvement over the years. However one of things which is changing is the emergence of a new and totally inspiring generation of patient leaders. A number of those leaders , such as Ceinwen Giles, Mark Doughty and the wonderful Kate Granger were there on the Friday of the conference and did so much to impress and motivate all who heard them.
It is hard to capture just how good listening to Kate was but I was struck in what she said by how important the small things, such as introducing ourselves, are in defining the quality of healthcare. The small things are things we can all do and maybe in the age of social media the leaders of social movements like Kate are better placed to make them happen than any number of Chief Executives. Not only are we perhaps looking at patient leaders bringing not only a different perspective on change but also a different way of delivering it.
The politicians were probably the most disappointing part of the Conference. Not because I intrinsically dislike politicians. I’ve worked, over the years, with many of great integrity and with a genuine commitment to change things for the better. However my sense is that we need to look elsewhere for our inspiration. Jeremy Hunt, who is very good at self-deprecatory humour said he had been told when Culture Secretary that good Ministers were expected to provide two things – “Money and Silence”. Everyone now says that we should not wait for a masterplan from Richmond House. Perhaps we should do exactly that and get on with finding the answers ourselves.
It’s back to real life tomorrow and that might not be quite as straightforward but a touch of inspiration from my couple of days in Liverpool might well act metaphorically as my ferry cross the Mersey.
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