Wednesday, 9 January 2013

The NHS needs to be more open with the people it belongs to | Jeremy Taylor

The NHS needs to be more open with the people it belongs to | Jeremy Taylor: The biggest challenge for the NHS in 2013 is to change its culture of secrecy, cover-up and authoritarian management

The health reforms in England will continue to generate a war of words this year. The major reorganisation of structures is causing great upheaval. The government's embrace of private providers is highly controversial and many people fear it will lead to worse access and poorer services.
Holding NHS budgets flat year on year is unprecedented and will put services under huge pressure as demand and costs grow. But the biggest challenge for the NHS in 2013 is not the reorganisations or even budgets, but the need to change its culture.
The results of staff surveys often make grim reading, revealing management cultures that are authoritarian, secretive and unsupportive. That is why the health secretary, Jeremy Hunt, has declared quality of care as one of his top priorities, why the chief nursing officer has launched a new drive for quality and compassion in nursing, and why health organisations have recently felt the need to sign a voluntary compact to protect NHS whistleblowers (though whistleblowers already enjoy legal protections).
In the next few weeks we should finally get to see the much-delayed report by Robert Francis QC on the failings at Mid Staffordshire NHS foundation trust. It is essential that his report marks a turning point for the NHS. Above all, there needs to be a concerted drive by NHS organisations and the people who work in them to involve and listen to patients and carers.
The new NHS commissioning board has been asked to ensure that the NHS becomes "dramatically better" at doing this. There are plans to publish much more data about the safety and quality of doctors, and the government wants all patients to be asked whether they would "recommend this service to a friend or family member" and to reward organisations that do well on this test.
These measures might help to nudge the culture of the NHS in the right direction, but they are not sufficient. Indeed, the "friends and families test" may be too crude to do much either to inform patients or spur improvements.
There needs to be a much sharper focus on ensuring that NHS organisations have excellent leadership, that staff are recruited for their values as well as competence, and that patients, families and local communities are able to participate in a continuous dialogue about the quality and shape of local services.
However, the culture of secrecy, cover-up and authoritarian management within the NHS is so entrenched that a change in the law is also essential. Patients need a statutory "duty of candour" that obliges health organisations to be open with them and their families if things go wrong. Many people would rightly be shocked to find out that if they are harmed while in the care of the NHS there is no obligation for them to be told. No one can guarantee to prevent another Mid Staffs, but a statutory duty of candour would provide an important safeguard.
In the words of the NHS constitution: the NHS belongs to the people. It is time for it to start being more open with us and to involve us much more in our own care and the services in our local area.
• Jeremy Taylor is chief executive of National Voices, the coalition of health and social care charities in England The Guardian

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