'The greatest advocates for the NHS are GP receptionists while the worst are GPs. This is about culture, not money'
The NHS Confederation's annual conference is fast approaching. So it's a good time to take a step back and look at the current state of the NHS. I have been wondering how things would appear to someone landing from another planet. A 'man from Mars' may be rather confused if he picked up a newspaper.
He would quite rightly ask how a service with such high levels of patient satisfaction gets such bad press. How it is that a service that has paid staff extremely well in recent years now has regular threats of industrial action? And why is a service normally delivered in the community or hospital creating enough paperwork for an individual trust to fill a novel every day?
Patient satisfaction is very high. The recent Healthcare Commission survey of hospital inpatients revealed that 92 per cent rated their overall care as excellent, very good or good. With over 8 million patients staying overnight in an NHS hospital each year, this is a big achievement and a credit to NHS staff. Any other industry on Earth, Mars or Venus would wave its arms or tentacles in pleasure yet it is hardly worth a mention in the national press.
The NHS has delivered significantly lower waiting times. In 2000 the number of outpatients waiting more than three months for a procedure was 393,000. Today that figure is just 126 people. The number of people waiting more than six months for treatment fell from 269,000 in 2000 to just 144 today. Yet the public does not recognise or celebrate this improvement in its health services.
Despite these significant improvements, opinion polling shows that the public consistently rates NHS services much more negatively than the people who use them. The NHS Confederation's recent report Lost in Translation analysed this phenomenon and concluded that persistently hostile reporting and anecdotes have resulted in the public becoming increasingly distrustful about evidence of NHS improvement.
It would seem disenchantment with the government translates into scepticism about the service. Health service leaders as well as the government have failed to effectively communicate the reasons for health reforms to the public and NHS staff.
NHS staff are not good advocates and only the police force has lower staff satisfaction. Every manager, board and leader has a role in turning this poor perception around. The 1.3 million staff should be our greatest allies, not our worst critics. Intriguingly, the greatest advocates for the NHS are GP receptionists while the worst are GPs. This is about culture, not money.
At this point the rather assertive 'woman from Venus' would point out that in order to get the best from people, they need to feel valued, in control and able to influence their own destinies. For the NHS, this means a system where boards and the public set their own priorities within overall strategic objectives. Problem-solving, innovation and responsiveness all improve when people feel in control.
Devolution of power must be responsible; it is about collaboration and a passion for improvement, rather than barriers, boundaries and declarations of independence. Performance must be judged against clear outcomes for patients as well as a focus on the way we treat patients to show they are respected and valued. I remember the hand which held mine as much as the needle that took away the pain.
Every board must ensure services they provide or commission are those they would be proud to use themselves. Targets must be superseded by passion to improve. This will only happen if we work with staff and patients to design services that make real differences to health status or quality of life.
Customer service and sensitivity is as important as measurable targets. We must aim to have patients who speak highly of our services as well as staff that are proud to work with us. I hope I will never again have to listen to professionals saying they don't have time to treat patients with dignity.
With this new approach will come trust. There would be fewer forms to fill in that do not add one iota to the task of improving patients' safety or experience. NHS boards must be strengthened to take this responsibility for their own actions and rely less on external scrutiny. This is appropriate autonomy with the proper counterweight of true accountability.
Excessive bureaucracy must be cut back. It's ironic that we take so much criticism as managers for being bureaucrats, when it's bureaucracy we hate the most. In The Bureaucratic Burden in the NHS, we calculated that over 56 different inspection and regulatory organisations are scrutinising the NHS at any one time.
But the burden of bureaucracy goes much wider and deeper than regulation. The feedback we get from members is that the burden does not just lie in the number of visits or inspections - the overwhelming and primary cause of bureaucracy is duplication of activity by assessors.
We must see a review of all the inspections and data collections, with a view to streamlining these and reducing the impact they currently have on the NHS.
As we approach the dawn of a Gordon Brown premiership, the NHS Confederation believes there are some key principles that must be applied regardless of structures or politics.
First, we must have devolution of power within a truly collaborative system. Second, we must strengthen boards. And third, we must see greater autonomy across the NHS. Finally, we strongly believe the only way to create Gordon Brown's responsive, patient-focused NHS is through empowering the service to do the right thing.
Then I will be able to give good answers to the questions from Mars and Venus.