Simon Stevens − put staff safety first and save the NHS

Simon Stevens, welcome back to the NHS and congratulations on your appointment to probably the toughest job in England. To some extent what you are coming into will be familiar to you since the current situation is pretty much the result of what you started during Tony Blair’s premiership; the current government has simply continued and accelerated the trend. Nonetheless, you will find that the economic downturn and the brutal reorganisation have destroyed goodwill and the morale is at rock bottom.

‘There are clearly serious concerns about patient safety but it is the wellbeing and “safety” of clinicians that is being overlooked’

I am not sure what you will bring from the US but I very much hope that you will have spent your time well there and learnt some good stuff from that very interesting country of contrasts. In particular I hope that you will have learnt from Paul O’Neill’s story.

Safety first

In case you are not aware, and for the benefit of others, on his first public appearance after taking over as the CEO of aluminium giant Alcoa, this is what Paul O’Neill said: “I want to talk to you about worker safety,” he said. “Every year, numerous Alcoa workers are injured so badly that they miss a day of work. I intend to make Alcoa the safest company in America. I intend to go for zero injuries.”

The audience, expecting to hear about profit margins, new markets and “synergy” or other business buzzwords were confused. Overcoming their initial surprise, they started asking questions about inventories in the aerospace division and the company’s capital ratios.

‘Worker safety has to be the start and if we can get it right it will provide the foundation for what else needs to happen to ensure a viable NHS in future’

“I’m not certain you heard me,” O’Neill said. “If you want to understand how Alcoa is doing, you need to look at our workplace safety figures.” Profit, he said, didn’t matter as much as safety.

The markets reacted badly and, so the story goes, one investor called his 20 largest clients and said: “The board put a crazy hippie in charge and he’s going to kill the company,” and ordered them to sell their stock immediately.

Within a year of O’Neill’s speech, Alcoa’s profits would hit a record high, and by the time he retired, the company’s annual net income was five times larger than before he arrived, and Alcoa became one of the safest companies in the world.

NHS parallels

There are parallels with what is happening in the NHS. There are clearly serious concerns about patient safety but it is the wellbeing and “safety” of clinicians that is being overlooked. The constant criticism and at the same increasing exhortation to raise concerns without decent support is taking its toll. Our team is currently completing the work on suicides by clinicians, which is the extreme manifestation of the stress of investigations, and the early findings give cause for concern.

You have a once in a lifetime opportunity to get to the nub of the problems of the NHS − and, like Paul O’Neill, by making worker safety the goal you could save the NHS.

If you know your recent American history, then you will also know that he went on to bigger things and became the Treasury secretary. He also took an active interest in healthcare and in a New York Times op-ed piece in 2007 concluded: “In the end, we cannot look at insurance coverage, medical costs, quality of care and information technology as separate issues. As we strive to make sure every American can get necessary treatment, we must look at every aspect of our health care system. We can do much better, and we should start now.”

But worker safety has to be the start and if we can get it right it will provide the foundation for what else needs to happen to ensure a viable NHS in future − it is your call.

We can all be the winners here, and you will have both NHS workers and patients thanking you. I will be looking out for your first public appearance and wish you the very best of luck in your new job.

Rajan Madhok is an independent public health doctor and chair of the British Association of Physicians of Indian Origin