A thought provoking meet-up this week got me thinking about tribalism in the NHS and how that impacts on day to day culture, staff and patient care. Also this week: can the CQC stay true to its mission? 

Everything you need to stay up to date on patient safety and workforce, plus my take on the most important under-the-radar stories. From patient safety correspondent Shaun Lintern

A thought provoking meet-up this week got me thinking about tribalism in the NHS and how that impacts on day to day culture, staff and patient care. Also this week: can the CQC stay true to its mission? Contact me in confidence here.

Shaun Lintern, patient safety correspondent

We must overcome NHS tribalism

The Oxford English Dictionary defines a tribe in modern usage as “a distinctive or close-knit group.” But when referring to indigenous populations like Native Americans it describes a tribe as “a social division in a traditional society consisting of families or communities linked by social, economic, religious, or blood ties, with a common culture and dialect, typically having a recognised leader”.

Keep this in mind, as I think the NHS and its many tribes are closer to the latter than the former.

Last week I attended an interesting gathering of people from across health and social care brought together by consultancy group Thought Space, who are organising a series of “melting pot” lunches. On the agenda at last week’s event was the issue of fear and love in the NHS.

The discussion focused on the issues around tribalism. One clinician described in detail their fear at being viewed by colleagues as having left the tribe by changing their clothes and wearing make-up and heels during their fellowship year. Others shared similar stories of how different teams within the NHS view members of their tribe, versus colleagues who are from another – and most strikingly how the views of different groups affected how they worked together.

What was notable was the genuine desire to conform combined with a fear of being ostracised by the tribe – being left to wander the badlands of the NHS without a group to look after you. I was genuinely surprised at how prevalent this was among people around the table and more at how it affected the way people work.

Inevitably when groups feel under attack, alienated by others around them, their level of willingness to cooperate with other tribes will reduce and open hostility might break out. As we know from the work of Michael West from the King’s Fund, culture, staff engagement and motivation have a very real impact on care quality.

Do you recognise this tribalism in your workplace? How can it be overcome? Surely one method must be ensuring staff and teams work together, but also spend time understanding what the other group is aiming for and the pressures on them. Health Education England has a plan to roll out multidisciplinary training between groups of healthcare professionals but this will take years to filter through the service. Barriers need to be broken down within the workplace.

All this brings to mind the apocryphal story of the janitor working at the NASA space centre in the 1960s who, when asked what his role was, replied that he “helped put a man on the moon”.

Time for CQC to stop playing good cop?

Have any NHS trusts been prosecuted for breaking the law under the fundamental standards of care (which are more than a year old)? Have any been fined? Has anyone been removed for being an unfit director?

The answer is no to all three – and while that may not necessarily be a bad thing, there is disquiet among some patient safety campaigners and charities that despite being handed new powers following the Mid Staffs inquiry, the CQC has balked at actually using them.

A report by the charity Action Against Medical Accidents underlines this with an analysis of the so far lacklustre approach of the CQC to regulating the duty of candour regulations – a breach of which is a criminal offence.

Many people will say that the CQC must not be heavy handed, that the NHS is under immense pressure and is doing all it can, and a regulator waving around its heavy stick is the last thing it needs. There is some value to this.

But consider the fundamental standards again. These are supposed to be standards below which care never falls. They are the line in the sand that cannot be crossed. Yet the CQC appears to be looking the other way.

Either patients are at the heart of the system or they’re not. Either the CQC is prepared to tackle failures of care or it is not. No one would argue for mass prosecutions, but the AvMA report raises questions about whether the CQC is being too superficial in its approach.

There will be those who argue the culture in the NHS would suffer if the regulator exercised its powers. But the culture of the NHS has stubbornly refused to improve without such action.

Perhaps it is time for the CQC to send a clear signal that it will be the final backstop on quality; that it will not allow the line on safety to be crossed.