Successful trusts must not let their stories be overshadowed

3 December 2009 | By Richard Vize

The past week has seen the NHS endure its worst reputational battering since the Mid Staffordshire scandal in March.

The blows just kept coming. The Care Quality Commission report exposing filthy conditions at Basildon was leaked. Then Monitor intervened at Colchester and sacked the chair. Finally, Dr Foster claimed its patient safety ratings showed 27 trusts had an unusually high death rate.

The mix of stories was the perfect media cocktail for a health scare - fear and ignorance

The Dr Foster ratings were the most damning story, with some of the scores wildly at variance with those compiled by the CQC. Predictably the good news was obscured by the bad. University College London Hospitals, Cambridge University Hospitals and South Tees were among those with a near perfect score, while Wrightington, Wigan and Leigh was just one trust that had delivered a dramatic improvement in its mortality rate - the sort of performance jump that can only be achieved by first class managers working with talented and dedicated clinicians determined to improve.

There were vehement denials from some of those ranked near the bottom, and the lowest score - zero out of 100 for Basildon and Thurrock University Hospitals - could not be taken seriously. The public, unaware of the peculiarities of Dr Foster’s statistics, could be forgiven for thinking the staff were all but smothering patients in their beds.

The mix of stories was the perfect media cocktail for a health scare - fear and ignorance. Fear of dangerous services mixed with ignorance of arcane issues such as regulation and standardised mortality ratios allowed newspapers to let rip with headlines such as “National horror story”.

Those managers from trusts and regulators hauled up before the court of public opinion had limited options in trying to get their message across. There were some valiant efforts, but in such circumstances damage limitation is the best that can usually be achieved. Often it wasn’t.

But it is not just the public who are confused. NHS staff given one message by their local leadership and conflicting ones by the CQC, Monitor and Dr Foster must wonder who they should believe. Over the weekend the CQC was outmanoeuvred by the provisional wing of the health data world. This miasma of statistics, inspection and commentary undermines confidence in the NHS.

The commission must get itself out in front in this debate. Health policy junkies know the organisation has achieved a great deal in just a few months and has ambitious plans for improvement - next year it will publish better data faster. But it needs to work harder at getting its messages out to the NHS itself and the public.

Reflecting on these bruising events on Monday, NHS medical director Sir Bruce Keogh came to the annual HSJ Leadership Forum with two messages.

The first was that the NHS has to reorder - and be seen to reorder - its priorities. Quality must drive finance. Finance must not drive quality.

But this was not a plea for quality to be pursued at any cost. On the contrary, the message was that clinical excellence was locked in with financial and managerial excellence. All three are required to deliver first class services. The Dr Foster revelation that one in 10 trust boards still do not routinely discuss clinical outcomes and safety indicates a significant number of trust management teams have forgotten why they are there.

The second message was that the NHS should wean itself off its obsession with apologising, and focus on promoting its achievements.

This should not become a recipe for deception or self-delusion, but for self-confidence. Well led trusts have a narrative of improvement which unites the organisation and communicates a simple, meaningful message to the public which is backed up by demonstrable values, quick wins to build momentum and a trajectory of improvement. Seeing managers constantly on their knees begging for forgiveness rather than celebrating success is unhelpful.

Readers' comments (3)

Murray Anderson-Wallace | 4-Dec-2009 12:50 pm
Making the safety of patients everyone’s highest priority is the primary cause of Patient Safety First, the national campaign for patient safety improvement. It is the basic pledge that underpins the huge amount of work that more than 270 Trusts across the country have been driving at a local level since the campaign began in 2008.

We therefore welcome the many public statements made by Trusts, the CQC, the Department of Health and the Secretary of State that firmly underline this commitment.

In our view it is highly regrettable but as Richard points out, entirely predictable that the recent media coverage has almost completely overlooked the widespread improvements in patient safety that have been achieved across the NHS over the past 18 months.

Anyone involved in patient safety improvement work at a local, regional or national level will be more than aware of this as a journey of continuous improvement. There is still a great deal to achieve in terms of improving adoption of evidence-based practice and thus reducing variation and reliability.

Patient Safety First as a voluntary campaign believes that improvement is best achieved through local action as part of a national movement using peer to peer support and influence and the best available evidence to drive change. Inevitably organisations will be at different stages of their journey and will require different types of support and guidance.

No doubt the debate about how best to assess patient safety will continue, but in the meantime we need to ensure that the enormous commitment and dedication of hundreds of teams of frontline NHS staff, senior clinicians and managers who are already working together to make care, safer and more reliable is not overlooked or publicly degraded.

Murray Anderson-Wallace
Head of Field Strategy & Communication
Patient Safety First
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George Webb | 4-Dec-2009 9:42 pm
A quote from "Freakanomics" by Peter Sandman.
Risk = Hazard + outrage.
When hazard is high and outrage is low, people underreact.
When hazard is low and outrage is high, people overreact.
He concedes that that hazard & risk do not carry equal weight.
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Peter West | 5-Dec-2009 2:14 pm
Sorry, Richard, at a time when the statistical methods and data of Dr Foster are being discussed on the BBC by experts such as Nick Black and David Speigelhalter, you cannot claim that improving hospitals can only have obtained a big improvement through first class managers and dedicated clinicians. They might be getting a better performance score due to the data and methods, just as has occurred in the past with the Annual Health Check by the Healthcare Commission and CQC.
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