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| Will there be a cultural revolution in the NHS? | Will there be a cultural revolution in the NHS? |
| (4 months later) | |
| The NHS in England is awash with promises of change. In the wake of health reforms and the Francis inquiry into the Mid-Staffordshire scandal – which examined the failure of the system to identify and act upon poor standards of care that may have led to hundreds of deaths between 2005 and 2009 – staff have been bombarded with vows of clinical leadership, an end to bullying and a renewed focus on patients. But will NHS managers really take this on board? As one NHS figure puts it: "Do you seriously believe they won't still scream down the phone at you?" | The NHS in England is awash with promises of change. In the wake of health reforms and the Francis inquiry into the Mid-Staffordshire scandal – which examined the failure of the system to identify and act upon poor standards of care that may have led to hundreds of deaths between 2005 and 2009 – staff have been bombarded with vows of clinical leadership, an end to bullying and a renewed focus on patients. But will NHS managers really take this on board? As one NHS figure puts it: "Do you seriously believe they won't still scream down the phone at you?" |
| The revolution is supposed to begin with clinical commissioning groups (CCGs) having autonomy to make their own decisions. Blackpool GP and co-chair of NHS Clinical Commissioners, Amanda Doyle, believes NHS England, which has a brief to improve health outcomes for people in England, "is very much committed to working with clinical commissioning groups. We have to give it a chance". | The revolution is supposed to begin with clinical commissioning groups (CCGs) having autonomy to make their own decisions. Blackpool GP and co-chair of NHS Clinical Commissioners, Amanda Doyle, believes NHS England, which has a brief to improve health outcomes for people in England, "is very much committed to working with clinical commissioning groups. We have to give it a chance". |
| She accepts that NHS England, not CCGs, is controlling the response to accident and emergency departments struggling to cope with an unsustainable increase in patients, but adds: "If we are going to get the most from CCGs we are going to have to be given the breathing space to look locally, transform locally and listen to what local patients have to say. If we try to do things on a national scale we are not going to get the value out of CCGs we need." | She accepts that NHS England, not CCGs, is controlling the response to accident and emergency departments struggling to cope with an unsustainable increase in patients, but adds: "If we are going to get the most from CCGs we are going to have to be given the breathing space to look locally, transform locally and listen to what local patients have to say. If we try to do things on a national scale we are not going to get the value out of CCGs we need." |
| Leeds GP Dr Richard Vautrey says: "A&E and activity in acute hospitals should be CCGs' bread and butter, but the risk is that those decisions will be made at NHS England and CCGs will be left to manage primary care, which they shouldn't be doing – their primary role will become how you stop GPs referring into hospitals." | Leeds GP Dr Richard Vautrey says: "A&E and activity in acute hospitals should be CCGs' bread and butter, but the risk is that those decisions will be made at NHS England and CCGs will be left to manage primary care, which they shouldn't be doing – their primary role will become how you stop GPs referring into hospitals." |
| David Paynton, national clinical lead for the Royal College of General Practitioners' centre for commissioning, believes CCGs need to take responsibility for "making sure the old culture does not reinvent itself. Unless CCGs realise this is an opportunity for some bottom-up leadership it won't happen." | David Paynton, national clinical lead for the Royal College of General Practitioners' centre for commissioning, believes CCGs need to take responsibility for "making sure the old culture does not reinvent itself. Unless CCGs realise this is an opportunity for some bottom-up leadership it won't happen." |
| Some trusts are already responding to the Francis inquiry. Heart of England foundation trust chief executive Mark Newbold personifies attempts to make the NHS more open, using his blog and more than 3,300 Twitter followers to have conversations with staff, local people and the rest of the NHS. Board meetings take place in public, the trust makes greater effort to explain its decisions and the complaints system has been overhauled. | Some trusts are already responding to the Francis inquiry. Heart of England foundation trust chief executive Mark Newbold personifies attempts to make the NHS more open, using his blog and more than 3,300 Twitter followers to have conversations with staff, local people and the rest of the NHS. Board meetings take place in public, the trust makes greater effort to explain its decisions and the complaints system has been overhauled. |
| "We are trying to change the way we interact with everyone around us, making ourselves far more open," Newbold says. | "We are trying to change the way we interact with everyone around us, making ourselves far more open," Newbold says. |
| Like many trusts, Heart of England has sharpened its data analysis to spot problems at an early stage. While many have dismissed the government's "friends and family" test, Newbold says the 1,600 monthly responses allow the trust to drill down to the performance on each ward, which they cross-check with other information to identify issues, such as staff shortages and poor attitudes, before they lead to safety breaches. | Like many trusts, Heart of England has sharpened its data analysis to spot problems at an early stage. While many have dismissed the government's "friends and family" test, Newbold says the 1,600 monthly responses allow the trust to drill down to the performance on each ward, which they cross-check with other information to identify issues, such as staff shortages and poor attitudes, before they lead to safety breaches. |
| Salford Royal foundation trust has among the highest staff satisfaction ratings in the NHS. Its clinicians lead improvements and managers take firm action to stop bullying. | Salford Royal foundation trust has among the highest staff satisfaction ratings in the NHS. Its clinicians lead improvements and managers take firm action to stop bullying. |
| The chief executive, David Dalton, says: "Staff have to see the signals coming from the leadership in everything they do. We have been very clear about the values we support, and where we have not seen that exhibited – especially with senior staff – they will be called to account. That has happened a couple of times recently." | The chief executive, David Dalton, says: "Staff have to see the signals coming from the leadership in everything they do. We have been very clear about the values we support, and where we have not seen that exhibited – especially with senior staff – they will be called to account. That has happened a couple of times recently." |
| Responsibility for standards | Responsibility for standards |
| Robert Francis QC was clear in his report that responsibility for standards at a trust ultimately rests with its board. Jane Ramsey, chair of Cambridge University hospitals foundation trust, says her board is linking financial data with workforce and quality information so it will be able to investigate, for example, if staff shortages are affecting care. | Robert Francis QC was clear in his report that responsibility for standards at a trust ultimately rests with its board. Jane Ramsey, chair of Cambridge University hospitals foundation trust, says her board is linking financial data with workforce and quality information so it will be able to investigate, for example, if staff shortages are affecting care. |
| "The quality information was always available but was not always coming to the board," Ramsey says. | "The quality information was always available but was not always coming to the board," Ramsey says. |
| But while CCGs and trusts are trying to focus on the patients, engage staff and take decisions locally, there is widespread doubt about whether NHS England can fulfil its part of the bargain. | But while CCGs and trusts are trying to focus on the patients, engage staff and take decisions locally, there is widespread doubt about whether NHS England can fulfil its part of the bargain. |
| It has already instructed local "urgent care boards" to be formed and to come up with plans within three weeks to address the current accident and emergency problems. | It has already instructed local "urgent care boards" to be formed and to come up with plans within three weeks to address the current accident and emergency problems. |
| Homerton University hospital foundation trust medical director, Dr John Coakley, says: "When the people at the top give a message out that this has to be dealt with, then that automatically results in a top-down sacking, bullying, laying waste … They are going to go in and say 'your job is at risk'. | Homerton University hospital foundation trust medical director, Dr John Coakley, says: "When the people at the top give a message out that this has to be dealt with, then that automatically results in a top-down sacking, bullying, laying waste … They are going to go in and say 'your job is at risk'. |
| "I don't see any evidence that the behaviour of politicians or the Department of Health or NHS England has changed." | "I don't see any evidence that the behaviour of politicians or the Department of Health or NHS England has changed." |
| Bill McCarthy, NHS England's national policy director, is adamant that the commitment to less control is "absolutely genuine". | Bill McCarthy, NHS England's national policy director, is adamant that the commitment to less control is "absolutely genuine". |
| The dominant leadership style is personified by NHS England chief executive, Sir David Nicholson, who has announced he will be retiring next March. Coakley says it would have become "increasingly difficult to secure the required change while he was still there. His name has become associated with that style. He is now tainted by association with Mid-Staffordshire." | The dominant leadership style is personified by NHS England chief executive, Sir David Nicholson, who has announced he will be retiring next March. Coakley says it would have become "increasingly difficult to secure the required change while he was still there. His name has become associated with that style. He is now tainted by association with Mid-Staffordshire." |
| The debate in the NHS in the wake of the Francis inquiry and the reforms have given a voice to years of resentment at a controlling, sometimes bullying, management culture. | The debate in the NHS in the wake of the Francis inquiry and the reforms have given a voice to years of resentment at a controlling, sometimes bullying, management culture. |
| While trusts and CCGs are determined to play their part in developing an NHS where staff feel valued and the focus is on patients, there is deep scepticism about the prospects for a new style emanating from NHS England. Some of this suspicion is bound to be lurking beneath the surface at the annual conference of the NHS confederation, which opens today in Liverpool with the Guardian Healthcare Professionals Network as media partner. | While trusts and CCGs are determined to play their part in developing an NHS where staff feel valued and the focus is on patients, there is deep scepticism about the prospects for a new style emanating from NHS England. Some of this suspicion is bound to be lurking beneath the surface at the annual conference of the NHS confederation, which opens today in Liverpool with the Guardian Healthcare Professionals Network as media partner. |
| To prove the sceptics wrong, NHS managers and all other stakeholders will need to be relentless in their commitment to greater autonomy and intolerance of bullying, no matter what the political pressures for a short-term fix. Otherwise the Francis inquiry will all have been for nothing. | To prove the sceptics wrong, NHS managers and all other stakeholders will need to be relentless in their commitment to greater autonomy and intolerance of bullying, no matter what the political pressures for a short-term fix. Otherwise the Francis inquiry will all have been for nothing. |
| • The Guardian Healthcare Professionals Network is the media partner of the NHS Confederation Annual conference and exhibition 2013 | • The Guardian Healthcare Professionals Network is the media partner of the NHS Confederation Annual conference and exhibition 2013 |
| • This content was supported by the Foundation Trust Network | • This content was supported by the Foundation Trust Network |
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