Cultural change starts today

The NHS is 65 this year. Not as old as Marks & Spencer, which is 129 this year, or my football club Sheffield United FC, which will be 124. Or Barclays bank, which has reached a staggering 323 years old.

But even at 65 the NHS feels just as much a part of our lives as the British weather, queuing and chicken tikka masala. We’ve come a long way. The services and treatments provided by the NHS have expanded hugely.

Increasingly sophisticated drug treatments have been developed. Hip and knee replacements and cataract operations are now commonplace and mental healthcare has improved beyond recognition. And, at 65, we should be celebrating some great achievements like:

Being one of the most efficient healthcare systems in the world according to OECD.

Being one of the world’s largest employers with 1.3 million staff.

‘It’s great to be celebrating diversity and the contribution of different groups of staff’

Being one of the world’s most diverse medical workforces. The latest NHS workforce census figures show that 44 per cent of the 107,000 doctors are female and 37 per cent are from an ethnic minority group. I know we have more, much more, to do but it’s great to be celebrating diversity and the contribution of different groups of staff.

Deaths from cancer are falling thanks to advances in research and increasing effective and timely treatments.

And our staff have seemingly endless resilience and an ability to cope with the perpetual unrest caused by organisational change on top of organisational change.

An unhelpful image

I know the NHS is not a perfect system, I know it can go wrong occasionally and sometimes with catastrophic effects. And that for some people, the care they receive is not the compassionate response we should provide.

But these great achievements should be all over the press at this 65th year, right? Wrong.

That’s because the coverage is all about Francis and Mid Staffordshire, right? Wrong.

Perhaps because the Francis report was so long (almost 2,000 pages) with so many recommendations affecting so many parts of the NHS, there has been no strong centrally agreed narrative. So, a lot of the current coverage seems to be on whistleblowing, presented almost as a barometer of culture and the NHS’s ability to change. It’s an important issue, absolutely. We need a public debate and scrutiny about this.

But what we have is a conflation of two different things. Firstly, how staff raise concerns, make suggestions and improvements and so on. And secondly, how staff raise concerns externally when no one is taking notice of legitimate concerns raised internally by ‘whistleblowers’.

This is an important distinction because we have to explore why some people who blow the whistle are treated badly, and to challenge ourselves about what we need to change to get it right more of the time. This is really important for patient care and public confidence.

‘The perception created now is that any member of staff anywhere who raises concerns will face the sack’

But the perception created now is that any member of staff anywhere who raises concerns will face the sack. This parody is equally damaging to patient care. It’s not the fate of the majority of staff who raise concerns and what’s more, we shouldn’t rely on the press to present a ‘balanced’ discussion. The press solution is often to name and shame or criminalise and this only serves to exacerbate the cultural problem we need to address.

It’s the equivalent of banging the TV on the side to get a better picture quality. It may have worked on old tube TVs in the 70s but it’s not appropriate to your LED 42-inch flat screen. Installing a culture of fear may have been a response in the 70s when matron ruled the roost but this won’t work on the workforce we employ today – incidentally the same workforce responsible for those achievements I outlined earlier.

Creating change

Just like those flat screen TVs, the NHS is a complex, sophisticated operation. Ensuring a safe, reliable whistleblowing culture requires some complex interventions. It will take time to reassure staff but here are some things we can all do today:

• Accept that the recent media coverage will have had an impact on staff in your organisation and will have raised or exacerbated concerns about job security.
• Get a newsletter article, email or letter to staff highlighting the organisation’s commitment to and support of staff that raise concerns… today.
• Publish and celebrate examples of staff who have raised issues and the result has been lives saved or care improved. Make them local heroes… today.
• Have a look at your staff survey results, including the headlines and the detail within your organisation. Have you got variation? Target your attention, listening and engagement there… today.
• Bring forward the review date on your ‘voicing concerns’ or local whistleblowing policies and use it as an opportunity to engage staff and your local staff side reps in discussions… today.
• Publicise helplines and details of policies again and again. Let staff know who they can contact to discuss concerns… today.

I know this won’t convince everyone. I know it won’t solve all the ills.

I know in itself it won’t change culture. But the current media coverage needn’t daunt us. Instead it gives us an impetus to involve staff and create a bottom up approach and involvement. Every HR manager I have met wants that sort of open culture, with staff being able to raise concerns openly, confidently and safely. Take the opportunity to do something about it… today

Dean Royles is chief executive of NHS Employers