The imbalance between the number of negative and positive stories about the NHS is stark and there are potentially damaging consequences, says Karen Castille
Pick up any newspaper, listen to the radio, or watch TV and it is not hard to find another negative NHS story.
‘How much does a constant barrage of negative NHS stories damage our feelings about our heritage, society and country?’
Worse still, we frequently see a named and blamed villain (or villains) responsible for the reported debacle. The imbalance between the number of negative and positive stories about the NHS is stark.
Is this a fair reflection of what is happening in thr NHS, and are there any potentially damaging consequences?
Good stories ignored
The NHS spends billions of taxpayers’ money and there is a good reason for it to be publically exposed and held to account for any failings.
But why are the majority of publicised stories negative and what is the ripple effect of this? All too often good stories are neither published nor promulgated.
The media assert that they are simply “giving the public what it wants”. Indeed, history is littered with examples of people luxuriating in debase and scurrilous remarks but, for the NHS, this is not without repercussions.
A recent Ipsos MORI survey reported that it is the NHS that makes people most proud to be British.
This begs a societal question about how much a constant barrage of negative NHS stories could damage our feelings about our heritage, our society and our country.
But perhaps my disquiet is unfounded because, paradoxically recent research from the NHS Alliance found that over half of adults (53 per cent) said their feelings about the NHS were no different to a year ago and that people still trust the NHS to look after them. This is despite the fact that one in five reported that they trusted the NHS less than they did a year ago.
‘The temptation to find villains and attribute blame for failure or system gridlock must cease’
Contrast this with views about politicians and the media’s portrayal of the NHS and we find that in the same survey less than one in 10 people believe politicians portray the NHS in a balanced light (11 per cent reported that they believed the media’s portrayal is balanced). It is not surprising we are confused.
You could argue that it is right and proper that there is open and frank criticism of the NHS relating to system failures as exemplified by the challenges faced in emergency care. But it seems unfair when this is not reported alongside the context of austerity, inadequate technology, workforce shortages and a relentless increasing demand on services driven by demographic changes.
It should come as no surprise that the NHS is overwhelmed.
New leadership paradigm
To solve these seemly intractable problems requires leadership vision and will. This must be executed through a new leadership paradigm based on wholehearted collaborative working.
‘We need to respect and trust our staff and partners across the health and social care arena’
No single leader or organisation can sort this out. The fact of the matter is that the problems the NHS faces today are highly complex. It is no longer within the gift of individuals or single organisations to solve these problems; a whole system approach is prerequisite to success and necessitates mutual trust and respect.
The temptation to find villains and attribute blame to individuals or organisations for target failure or system gridlock across the local health and social care economy must cease.
We need to respect and trust our staff and partners across the health and social care arena.
Negative stories in the press − especially when told with the intent of exposing a “villain” − work against trust. They damage confidence in individuals, staff groups and organisations and create a culture of fear and defensiveness.
Blame serves no useful purpose.
Professor Don Berwick urged us to leave fear, blame, recrimination and demoralisation behind and move forward with energy and optimism, in his review of patient safety.
Staff wellbeing affects care
Frequent media reports that make sweeping statements blaming “callous and uncaring NHS staff” turn staff into villains and risk damaging their sense of wellbeing and feeling valued and safe. Consequently, we know that this also affects patient safety and care. We even see instances where patients are portrayed as the villains.
Examples include patients being accused of abusing or overusing services, or worse still when they are referred to as “bed blockers”.
Changing the culture from one of blame to one of openness, honesty and transparency requires new leadership behaviour.
Great healthcare organisations across the world, in the private or public sector, understand the benefits of creating a trusting environment which values and supports staff and actively listens to and acts on staff and patient feedback. NHS staff know this too.
‘The leadership challenge in the NHS is to build trust and change our leadership model to one of distributive leadership’
A participant in a recent Guardian online debate about staff engagement said: “If concerns raised are acted on and those raising them are thanked and praised, that sets an example, a mood, the culture.”
Hence the leadership challenge we face in the NHS, in this most testing of environments, is to build trust and change our leadership model to one of distributive leadership.
This requires a conscious shift in our own behaviour by ceasing to pursue and appoint single “hero” leaders to save the day. We must role model what we wish to see in others by personally welcoming and encouraging criticism of ourselves and making it safe and normal for staff and patients to do so.
But if the search for heroes and villains continues it will perpetuate a culture of dependency and fear, placing immense pressure on staff, especially those who work in organisations under the microscope.
A negative atmosphere diminishes our ability to engage fully in our work and, ultimately, affects staff morale and patient care. It’s not rocket science.
‘Talking up the NHS is important because it is what is needed to give the service a chance to meet the challenges it faces’
I have always believed that engaged staff are happy, and happy staff lead to happy, well cared for patients.
Evidence for this has been steadily increasing over recent years such that there is a convincing correlation between staff engagement and a range of performance indicators.
In short, where staff are engaged, happy and feel valued, quality and safety improve.
Talking up the NHS is important. Not because it makes us feel good but because it is what is needed to give the service a chance to meet the challenges it faces. It creates trust, confidence and discretionary effort, just at the point when it is needed.
This year could be a turning point for the future of the NHS as we approach the next election.
The NHS Confederation has thrown down the gauntlet to all political parties to help the NHS create the space for change as part of our 2015 Challenge.
We can all play our part by making sure that for every negative story we hear about the NHS we tell two positive ones. We must also stop shying away from the leadership challenge and resist the temptation to hide behind heroes and villains.
Dr Karen Castille is an associate director at the NHS Confederation and chair of its urgent and emergency care forum