16th February 2015

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Health-Chat with Roy Lilley 

Dr Sarah Wollaston MP Chair Health Select Committee

11th March - King's Fund 5.30.  Details here.  Some tickets left.

Fix the system
News and Comment from Roy Lilley

Robert Francis has pronounced. It's official; whistle blowing is now somebody else's job.


As we have come to expect from a Francis report, his latest is full of bone breaking examples of eye watering bad practice... confirming what we all know already. WB is bad.


My advice; skip the report, it's too depressing. What we really want to know is how to fix it. Go to page 7 for the executive summary. Prepare yourself it is 14 pages + 20 recommendations! Francis is a lawyer, he can't help himself!


I come at this from never understanding why bosses don't crawl on bended knee, from one end of the organisation to the other, begging staff to tell them what they need to know.


Add to that, I'm convinced 'managing-up' is at the heart of the problem. The idea that the boss must never be embarrassed and only hear good news, means bad news is stifled, supressed and bullied out of the system.


WB is a middle management issue. They buffer, terrorise, oppress and frighten people stiff, to deliver; so that they don't have to pass bad news upwards; knowing, if they do, they will be batted, terrorised, oppressed and frightened stiff by their boss. Bully bosses have bully bosses.


The trail goes up the line culminating in PMQ's where Cameron would rather poke his eyes out with a rusty stick than admit anything is less than perfect.


Francis? Predictable... He admits; he is recommending we do what we should be doing anyhow.  Better; culture, leadership, valuing people, reflective practice, reporting, structures, prompt responses, training. He gives us confusion over formal and informal reporting and says; resolve conflict, move staff to another job, everyone is accountable.


There's one new, bad idea. 'Whistle Blowing Guardians' parachuted into Trusts, plus a toothless Independent National Officer, paid for by the two organisations at the epicentre of more bullying than a Chinese sweat-shop; Monitor and the CQC. Francis is a NED at the CQC... by the way.


Thus, WB is now the job of 'Guardians' who will create their own bureaucracy and join the game of pass the parcel.


So, let's think about a young nurse on a ward at 8pm on a Sunday. Elderly patients with high needs arrive, unexpectedly. The nurse patient ratio is set at NICE's daft 1:8. It is unsafe; patients can't be toileted or have their drugs on time 'someone' should wave a 'red flag'.


The 'someone' is our nurse who 'waves the flag'. She is at the end of her tether, there are never enough nurses on the wards at weekends.


She calls the duty manager who says; 'Where am I supposed to get more nurses from at this time of night. We're choc-a-bloc... soldier on. The agency budget is overspent'. The nurse returns from the phone call to discover Mrs Brown has fallen out of bed, has a black-eye and a broken wrist. The relatives create hell. The nurse does what...


Our nurse gets to see the WB Guardian on Tuesday to discuss staffing levels. The Guardian says thanks; she'll look into it and speaks to the duty manager.


On Thursday the manager, in a quiet corridor, whispers to the nurse; 'Thanks for dropping me in it. I look forward to returning the favour'. The nurse reports the encounter to the WBG. Dismissively, the manager says she's misunderstood and he was 'genuinely thanking the nurse for her intervention'...


Who is to blame? Manager, nurse? Or: Primary care for not doing their bit? Social services for leaving hospitals choc-a-bloc? The finance department, oppressed by Monitor, to balance the budget? The nurse director for not having enough courage or clout? The CEx, terrorised by the CQC or the non-exec's for not knowing what's happening?


We know, don't we; the nurse will be suspended and the NMC will strike her off for neglect and not preventing the fall. Proving, once again, a whistle is still the most dangerous piece of equipment in the NHS.


At the heart of whistle blowing is system failure. Failures that end up creating unbearable front-line pressures and culminate in people doing desperate and daft things.


Francis has given us all he can; more bureaucracy, reports, letters, layers, legal stuff, process, management and 'clunky'. The responsibility for WB becomes 'someone else's job', when it should be all our concerns.


Answer? Fix the system.


'What is the point of a select committee' come and join me in conversation with Dr Sarah Wollaston MP, chair of the Health Select Committee.

 Kings Fund 11th March - details here. 



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