There is a fragility at the top of the health system, a lack of individual accountability. There is infantilisation of people who have been selected to be expert and dysfunction in the relationships between senior leaders. This has a ripple effect throughout the health system and leads to perverse incentives and behaviours which impact on patient safety. We need empowerment of leaders so that people have permission to make decisions, freeing up people’s time and speeding up processes. Because people are stuck, they do not respond and this comes across as rudeness and poor behaviours, creating a sense of futility to raise matters and damaging relationships as a result.
We need to be proactive and take a long view – a 100-year plan – so that babies born in 2024 have a fantastic life ahead of them. Health is only one part of this but if we make the right decisions now it will help keep the population safe, healthy, and able to life our brilliant ordinary lives.
Let’s begin with the end in mind. From the Government’s role in population health to primary and secondary care, where does patient safety come in? The answer is, everywhere.
So, let’s put first things first. We need everyone to be thinking about the safety of patients, families, and staff. And this needs to start at the top, from Government departments, including DHSC, the Cabinet Office, the Treasury, and the Health and Social Care committee. Then officials, regulators, commissioners, patient groups, health providers and professionals need to work together to put safety at the heart of decisions.
The current system does not make it easy for patients to be heard. Appointments are short, the language and attitudes create epistemic injustice, and the pathways are byzantine and not designed with patients in mind. Worse, patients are blamed! When appointment letters are sent by outdated snail mail and arrive after the appointment date, the patient is told off for not attending and discharged from clinic. When service specification blames patients for ‘failing conservative treatment,’ you know something is truly wrong.
So, what is the difference that makes the difference? If we want to say, ‘In ten years, my healthcare will look like this…’ there are some steps that we need to take. First, a whole system approach is what we need for the win-win. A better understanding of the system by the system and those who use it. Simplification of contracting services, inspecting services and an expectation of high quality, safe and effective patient care.
Second, this is about the people we serve – the S in NHS. We need to seek to understand then be understood. When we include patients and families as true partners in care, wonderful things happen – the care is faster, safer, and everyone feels heard. In trusts across England, I have seen examples of excellence in terms of listening to patients and communities and putting patient safety at the heart of all activities.
This is all about leadership and about people stepping up to serve. As John F Kennedy said: ‘I always thought someone should do something, until, one day I realised I was Someone.’
Finally, we need to take time to lift our head above the horizon, time to sharpen the saw and reflect on how we can become the best at getting better.
These steps, taken together as a health system with patients as partners and organisations working effectively together, will set us on a positive course for the next hundred years.