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‘Could someone please explain…’ 10 Questions for NHS System's Leadership

Wed 20th May, 2015
‘Could someone please explain…’ 10 Questions for NHS System's Leadership

‘Nobody ever listens to what we want and need in order to deliver high quality, safe patient care’ is a common refrain we hear from thousands of NHS staff whose Trust CEOs have had the courage to embark on Listening into Action (LiA) in the past 3 years.

In total, 53 Trusts have adopted this new way of working since March 2012, impacting thousands of teams, hundreds of thousands of NHS staff, and millions of patients. It leads to improved outcomes for our massively under-valued NHS staff, improved outcomes around quality and safety of care for their patients/service users/relatives/carers, and improved outcomes for Trust finances and operational priorities.

The evidence base is substantial, substantiated, and growing. Yet, it is growing in a vacuum. And the vacuum is the NHS healthcare leadership system, largely – seemingly – impervious to what their frontline stars (the very people those at the head of our public health service would profess to be desperate to reach) are achieving day-in, day-out – often in the face of systems’ pressures that make that task all the harder.

Sure, there is the occasional: ‘We’ve heard some good stuff from Trusts doing LiA’, or ‘Engaging staff is the way forward for the Service’, or even ‘Staff tell us that this is the way they want to work’. Everyone is clear on what’s required. Many are convinced that the impact and the difference it makes to release frontline staff to care is the solution to many of our current challenges. But few at the top of our healthcare system visibly, demonstrably and proactively lead the change we all want to see.

So, in the hope of helping to bridge the significant disparity between the sunny uplands of the world inhabited by those running the NHS, from the reality facing staff working at the coal-face, here are 10 ‘Could you please explain…?’ areas that that would help staff immeasurably if there were any fixes emanating from those collectively and individually leading the system we’re all part of:

  • Why is it that we have spent £5.5bn in 2014-2015 filling workforce gaps via agency and bank staff when we spend so little engaging, empowering, valuing and retaining our doctors, nurses and other healthcare professionals? How on earth can it make sense to send senior management teams to other countries to plunder their qualified staff to bolster healthcare resources in this country, when we do so very little to address a 10% annual turnover rate of staff who are already qualified here?

  • How have we reached the point where the views, opinions and expertise of doctors and nurses - who we have trained, developed and invested in for years – are abrogated to managers who have no clinical or medical expertise whatsoever? In what other industry are non-experts given authority over experts to run a service? The airline industry? Nope. The Manufacturing industry? Nope. The Oil and Gas sector? You get my drift…

  • If there is a huge challenge facing the Emergency Medicines’ profession, dealing on a daily basis with massive increases in attendance at our A&E departments – in part due to the problems of an aging population unable to get appointments with their GPs – why doesn’t the system intervene to co-locate GPs and other primary care experts at those very centres to help alleviate the pressures? We are meant to be working towards an integrated care service after all

  • When we have overwhelming evidence that the volume of emails and the huge number of meetings staff have to attend on a regular basis across every single department in every single Trust up and down the land (that add no value whatsoever to patients and prevent patient-facing care), why is there silence on this widespread malaise from the centre? This is a very easy fix: disable ‘reply-all’ on email systems; make face-to-face time the norm; insist that meetings not focused on patient-care are de-prioritised for frontline staff attendance

  • Why are there no effective mechanisms for sharing what’s working across the NHS? The variation between departments within the same Trust, quite apart from the huge variations on levels of service and performance across peer Trusts is staggering. The ‘But we’re different!’ excuse for not listening to and learning from those who have cracked delays to discharge or length of stay challenges or outpatient clinic management or same day theatre cancellations has to stop

  • Why does the system make it so difficult for local NHS leaders to lead locally? If you need any more proof of the law of diminishing returns to kicking the seven-bells out of local leaders for their ‘non-compliance’ on a whole host of targets, check out the number of vacancies for CEOs/FDs/CDs, the number of interims in place across the country, and the paucity of a pipeline of wannabe CEOs or senior medics queuing up to have a go (extrapolate this to its logical conclusion, and we’re all in trouble – more carrot, less stick please!)

  • How it is that paperwork has overtaken patient-work as most important priority in the NHS? Nothing more to say

  • Why the fascination with the creation and development of ‘values’ across the NHS – driven from the top of the Service and manifest on the proliferation of values posters splattered across walls in public areas in our hospitals – when inappropriate and contra behaviours at all levels go un-checked and un-sanctioned every day? If you want to find a single challenge most likely to erode the morale and motivation of NHS staff, here it is

  • Why have NHS incident reporting systems not eradicated ‘never’ events from our hospitals? Huge numbers of staff report that they ‘don’t bother filling in’ the Datix systems they have today after an incident because, ‘nothing ever happens’ when they bother to highlight concerns – OMG moment perhaps!

  • Why, whenever there is a valid challenge to systems-thinking, is the automatic response to batten down the hatches, pull up the draw-bridge and pretend those challenging current convention are agitators with nothing to contribute to the solutions we all need? If you want to deliver a fundamental shift in how the system is run, you first need to shift fundamentally, and that starts at the top.

As everyone girds their loins to embark upon the next project to deliver the Five Year Forward View whilst simultaneously starting to change the service to deliver the 24/7 model (that should be ‘a given’ in any case - would you take a plane trip at the weekend flown by one first officer, a single cabin crew member and a reduced shift in the air traffic control tower?) maybe we should first spend a bit of time addressing some of the priorities our frontline staff have in providing the best possible care for their patients? Who knows, it might even give them a fighting chance of succeeding in the next wave of change coming their way?

Looking forward to hearing back, I think!

Copyright Gordon Forbes, Owner of Optimise Limited and Co-Creator of Listening into Action® May 2015 Tel: 07734 812311 Email:


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Angela Bradshaw

Wed 27th May, 2015. 9:40AM

This is music to my ears! I am a sonographer and radiographer who retrained to teach Alexander Technique after succumbing to a WRMSD that just wouldn't 'go away'. Resignation from my professional medical career was never part of my plan but seemed like the only option to retaining my physical health. It's now my pleasure to teach other Medical Imaging professionals #SelfCareSkills so that they don't similarly need to resign due to injury / reduce their working hours to cope / work in admin. Prevention is the best medicine. Empowering workers at the coal face is essential, listening to them, nurturing and supporting them will increase morale no end and ultimately improve patient care too, reduce waiting times and lists etc It's also a positive way to retain staff, protecting the large investment in their training. Time for action as you say!

Shazma Thabusom

Thu 21st May, 2015. 8:36AM

Hi Gordon this article is a breath of fresh air and so astute i agree with so much of what you say and you put it so elequently. My worry is the doing bit of all this. Will anyone listen to the fixes? The simple steps that are so needed to create the change such as minimise over expenditure and minimise top down approach especially from those with no integrity and credibility to be in those positions in the first instance...there is way too much time spent on meeting and less on doing

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6 New NHS Trusts Launch LiA!

Thu 26th March, 2015
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