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How to make every day NHS Change Day

Roger Kline and Brendan Martin, 28 February 2014

Next Monday will be NHS Change Day, and already more than a quarter of million NHS staff have made pledges to “challenge the status quo and try something simple but different to improve patient care”.

It is a grassroots movement, started last year with a single tweet in the wake of the Francis Report into the Mid Staffs scandal. It produced more than 180,000 pledges in its first year and the 2014 target is half a million.

Do we need better proof of the determination among NHS staff to take responsibility for protecting and improving a service that some have brought into disrepute and the government is intent on privatising?

While celebrating this inspiring initiative, however, let's be clear that pledges and the determination of those who make them are not enough to produce the radical culture change demanded by Francis.

Indeed, the 2013 NHS staff survey, published last week, provides a sobering reminder of how far we still have to go.

There has been progress:

  • 65% (up 3%) say that if a friend or relative needed treatment they would be happy with the standard of care provided by their organisation.
  • 66% (up 4%) say that care of patients and service users is their organisation’s top priority.
  • 58% (up 3%) would recommend their organisation as a place to work.
  • 69% report that their manager helps them with difficult tasks and 72% felt supported in a personal crisis.

But you only have to turn those numbers around — 34% don’t think care of patients and service users is their organisation’s top priority! — to be cured of any complacency those improvements might induce.

Moreover, only 41% of all staff were satisfied with the extent to which they felt that their employer values their work, dropping to 21% for ambulance staff, even lower than last year. What is going on there?

Only 30% feel that there are enough staff to enable them to do their jobs properly, dropping to 20% amongst ambulance staff. Only 28% of staff report that senior managers act on feedback from staff.

In addition:

  • 39% (up 1%) said they had been unwell as a result of work related stress in the previous 12 months.
  • 68% (down 1%) said they had attended work in the previous three months despite not feeling well enough to perform duties.
  • Nearly a quarter of all staff reported being bullied by their line manager or colleagues (23%, down 1%).
  • 85% (down 1% ) felt encouraged to report errors but only 44% (up 2%) that they were given feedback on changes made as a result.

While only 14% felt that reporting of errors would lead to punishment or blaming of those involved, that is still a worryingly high proportion, given the evidence in the Francis Report that such a culture perpetuated the Mid Staffs descent from compassion to cruelty. And:

  • As many as 29% were unable to say they would feel safe if reporting fraud, malpractice or wrongdoing, and only just over half (54%) would feel confident that their organisation would address such reports.
  • Little over one third felt that communication between managers and staff is effective (36%) and even fewer (28%) reported that senior managers act on feedback from staff.
  • Although only 10% of white staff do not believe their trust provides equal opportunities for career progression or promotion, the figure rises to 23% for BME staff.
  • Similarly, while 9% of white staff report experiencing discrimination at work in the last 12 months, one quarter (25%) of BME staff do.

The survey shows that some Trusts are outstandingly good, but to bring the rest up to the standards of the best we need to take the spirit of NHS Change Day and put it at the heart of everyday NHS culture through more systematic staff involvement.

Or as Francis put it (paragraph 1.118 of his report): “The patient must be first in everything that is done: there must be no tolerance of substandard care; frontline staff must be empowered with responsibility and freedom to act in this way under strong and stable leadership in stable organisations.”

That is why Public World is proud to have produced for Unite the Union a special edition of our Duty of Care handbook, Putting Patients First, which offers practical guidance to staff about how to assert their right to do just that.

And it is also why we are introducing into health and social care in Britain the Best Workplace methodology of staff involvement — developed, tried and tested over 20 years by our Swedish partner, Alamanco.

NHS Change Day shows that NHS staff are up for it. The question is, are their national and Trust leaders as determined as they are?

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