NHS Whistle Blowers 2

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.

Roy's Rallying call

Roy’s Rallying call

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?

Phil Hammond calls us to action

Phil Hammond calls us to action

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.



NHS Whistle Blowers

OK – I had a lot of WILY (What I Learnt Yesterday) moments at this conference yesterday.  It’s full title was The Speak Out Summit, and Roy Lilley (editor nhsManagers.net) led, drove, chaired and generally corralled the whole thing.  The aim was simple, and therefore complex to do – ” Can we create best practice guidelines for handling feedback and encouraging Speaking Out?”

We had a lot of thought provocation. Dr Phil Hammond – ( why not NIGE instead of NICE – National Institute for Good Enough), and others like Gary Walker, Dr. David Drew – actual celebrity whistle blowers; legal aspects from Prof Christopher Newdick, Sir Robert Naylor who runs UCLH (about £1 billion turnover – this is not a little organisation – it is real business.) Nearly all of the speakers stayed to be part of the audience too – a testament to wanting to make things change, I feel.

Look, I’m going to do my thoughts and impressions from the great and good in further blog spots, but there were two absolutely pivotal, game changing moments in the day for me.

James Titcombe lost his son Joshua at Morecambe Bay hospital – needlessly.  He had to fight against the QC might of the authority (who I believe spent millions of our money defending the indefensible).  He is now a CQC adviser (The Care and Quality Commission – which may or may not be powerful nor focused enough…but that’s another story…).  “Joshua would have been a little boy of 5 now”.  I don’t need to say anymore.  I’d never met James.  I’d heard the story.  This is the reality, and I can’t see to type.  His fighting spirit, and Joshua’s legacy means a lot of lives have been saved since.

Then, a delegate from Mid Staffs.  Roy Lilley described it as ‘ ‘The Safest Hospital in Britain’.  I know what he means – the safest time to fly, statistically, is the week after a plane crash…  The chief executive seems to have had an amazingly galvanizing effect.  “I am so proud to work there.  We see Maggie all the time.  We all offer the best possible care to our patients”.  It was lovely to hear – heartfelt and totally real.  You can’t fake passion.

It is all about people.  And it helps if the vision is led by truly follow-able leaders.

Roy Lilley with me ("The Tie")