Care by Design understands the fundamentals of organisational development, service management and leadership for the 21st century public sector organisation and communities.

Post Francis Enquiry and Report can we now lead the NHS to the Future of Positive Patient Partnership?

I haven’t read the full Francis report in all its volumes. For me the fact that so much harm was done to so many and the impact not only for them but for their loved ones left with the memories of what happened is enough for me to know things have to change.

I know from personal experience. 

My Dad died of the complications of MRSA in 2000 following routine Prostate surgery; I felt I served his memory and vindicated his suffering (he suffered terribly and so did we helpless to make him better) by co-authoring Saving Lives – the Programme to Reduce Health Care Acquired Infection in 2005.

My Mum had bowel cancer that took 3 years to diagnose and when they did her Liver secondaries were too many to operate. I have written before about the continuum in quality of care she received being from excellent (Nottingham Blood Transfusion Team) to you wouldn’t treat a dog that way. She died at home with so much grace on June 25th 2011, courageous to the end and telling us all when she knew she was going how much she loved us.

We (The NHS) know what we need to do… we have known for years. The problem is that we do not implement it. We do not have the right leaders in key management positions (with some exceptions) who understand the complex system that health (and social care) are… complex systems where there are different parts all interdependent to deliver a whole service. Over the years (since 1999) more and more layers of bureaucracy have been added; breaking up organisations and moving the same people around to make new ones with more layers of management and death by committee required to get anything done. 

I had the great privilege on March 7th to attend a House of Commons Conference on Ghandian Values and the Modern NHS. This conference was the brainchild of Professor Narinder Kapur, himself penalised for raising concerns on poor care (classed as a Whistle-blower) Narinder bravely undertook a 5 day hunger strike outside the Department of Health in October last year . The conference was amazing with some of the best clinical minds in the country in attendance including Professor Sir Brain Jarman – the NHS’s leading Statistician, and Dr Kim Holt, Chair of Patients First established December 2011 and the Paediatrician victimised for raising concerns on staffing levels in Haringey a year before Baby Peter died in August 2007.

Julie Bailey, leader of Cure the NHS gave an eloquent and emotional account of the things she saw and her Mum experienced over an 8 week period at Mid Staffordshire NHS Foundation Trust. How she and others have and are campaigning for the return of compassionate dignified care in the NHS. A few weeks ago I sent Julie a paper that I wrote for the BMJ post the Darzi Review in 2008 re its implementation. I was pleased to hear Julie mention aspects of the leadership approach I talked about of ’looking out to the patient and not up to the boss’ approach and front line empowerment to take ownership for improving the service.

There are clinicians leading the way. Dr Gordon Caldwell at Worthing Hospital with his approach to ward rounds and Bookmarks for Better Care; Dr Umesh Prabhu, Medical Director at Wigan Leigh NHSTrust who has transformed medical care at the hospital; Dr Ron Daniels leading the national campaign for Sepsis awareness (see my home page). We have to take their lead and do something now… Leadership is a choice and behaviour and should be one of doing good and what is right.

Ghandi’s principles are based on Compassion (action based on goodness); Harmony (working through our differences to achieve goodness) through Dialogue (openness: talking through our different perspectives to achieve goodness).

Ghandi said ‘It is not our patient who is dependent on us, but we who are dependent on him. By serving him, we are not obliging him; rather by giving us the privilege to serve him, he is obliging us.’

Published 1st November 2018