It is now almost a week since The Speaking Out Summit, chaired by Roy Lilley. (nhsmanagers.net) Here are my (very) edited highlights of the day.
Roy Lilley quoted himself: “I don’t know why managers don’t crawl on their hands and knees, from one end of a hospital to another and grovel, to be told what the front line knows.” The tone was set. The aim? “Get the right people in the room (administrators, whistle blowers, lawyers, senior bosses, managers), and see if we can thrash out something practical doable and useful to help people to speak out”. Easier to write than do, of course, but there was energy in the room.
Dr. Phil Hammond felt he was very inspired by whistle blowers. “Difficulty is the excuse history never accepts”. (I told you the day was full of thought provocation!) If we think of whistle blowing (which is still too pejorative a phrase, and is tainted with ‘snitch’ mentality), but turn it around to feel it is about constructive dialogue for clinical accountability – think of it positively – then we may be on the right journey? You got the feeling that as lawyers may be complicit in covering up the stench of raking over the masses of dirty linen, the level of inaction on what can only be described as avoidable deaths may well still be occurring?
Dean Royles from NHS Employers gave the management view and presented us depressing stats: 54% of complaining staff feel they are never listened to. If you raise concerns and it is acted on, courageous whistle blowers know that they are likely to lose their jobs. As soon as lawyers get involved, then there is allegation-tennis, claim and counter, and money being wasted. This was the first mention in the day of mediation being a logical start for all, and keep the lawyers out. It has worked in Construction – another seriously litigious sector.
It was great to hear from our first ‘celebrity whistle blower’. Dr David Drew, former Paediatrician. ‘Former’ – that is the reality of whistle blowing. Trumped up and spurious allegations to blacken the reputation of the complainant. And we all lose the services of a good medical practitioner. It just feels so sad.
Our second celebrity WB, Gary Walker, was a CEO of a trust. Boards were running hard to hit targets. I got the feeling that target chasing can yield needless deaths? Isn’t that sobering?
I loved Prof Christopher Newdick, from University of Reading. The disasters that have occurred (and he took us through many) centred around core problems: a lack of leadership, a lack of accountability, and a lack of infection control causing a Clostridium Diffcile outbreak in one hospital. In Stafford, 120 to 150 clinicians ‘knew’ what was happening. Chris again brought up the target driven mentality leads to the wrong things being done, such that concerns about patient safety, morbidity and mortality were lower down the list of objectives than they should ever be.
700 days is the average tenure of an NHS CEO. Bucking the trend is Sir Robert Naylor with 14 years at UCLH. Showing and sharing the vision, leadership, empowerment and sharing of the objectives – like a proper organisation should be run – were the cornerstones of clinical excellence. He would be the CEO crawling on hands and knees to find out more from the front line…
I’ve mentioned James Titcombe and the avoidable death of his son in my last blog. It does make all the rest of the day pale for me. We just have to do more to make speaking out work quickly and effectively.
And that’s where we ended up. A final brain storm of what to do next. Roy and the team are currently working on Best Practice Guidelines. I want the emphasis to change to rewarding speaking out. Let’s think of Speaking Out as the equivalent of Suggestion For Improvement boxes that some organisations still have. And if the suggestion – any suggestion (investigating poor clinical practice, saving a wasteful methodology, adding a new operating procedure, removing a poor system, pointing out outlying HSMR and why), and lumping them all in together as positive, then we have the change in mentality that is necessary. And so we can then offer incentives if the suggestion leads to savings. It just might help the change in behaviour we so desperately need.