Civil servants are too remote from the reality of life and work in the health service, says DH permanent secretary Una O’Brien. That is why they are being asked to spend four weeks every year on the NHS front line
February was a humbling time for everyone in the Department of Health and the NHS. The publication of the Francis inquiry’s report into the horrific events at Mid Staffordshire Foundation Trust was a moment to reflect on some deep and enduring issues – how we all listen to patients and service users, understand the work of staff and truly appreciate the experiences of illness, care and recovery.
As Robert Francis QC highlighted, this was not just about hospitals, doctors, nurses, carers and health service managers. It was also about civil servants like me who work in the Department of Health.
‘Some DH staff are too remote and detached from the reality of the front line
His report asked for major changes, and that change starts with the culture in our own organisations. The Department of Health needs to connect more with the everyday realities of health and care. Our staff are committed to the health service’s values, but we must accept this uncomfortable reading: that some of us are too remote and detached from the reality of the front line.
Tea and sympathy
For our decisions on policies to be shaped around the needs of patients and staff – to make us better at what we do – we must nurture this direct connection with the places and people on which they impact. That is why I want every civil servant working for the Department of Health to have frontline experience as part of their professional life.
I know some will dismiss this commitment as tokenism, as some likely short-lived PR exercise. This will not be the case – this is not just what the Francis inquiry report recommended, but also what we need to do to help us be good at our jobs.
It won’t just be the odd day of experience in our careers, but four weeks a year, and starting with our senior civil servants.
And it will not be about sending our staff to clog up hospital hallways or get under the feet of busy health and care staff. We are working very hard on the practicalities of this programme to ensure this does not happen. It is being structured so that it helps us think differently about how we do our jobs, so real connections can be made that don’t inconvenience people or put patients, or our staff, at risk. And already the support from the NHS, social care and voluntary organisations has been incredibly positive, with offers coming in to assist with the programme.
This is about creating a lasting change for the civil service – we will be the first department in Whitehall to make such a commitment – that improves fundamentally how we do our jobs.
I know how important such experiences can be. I joined the civil service in the late 1980s after spending three years working on a project providing hospice and homecare support for people with AIDS – an experience that shaped the way I felt about health and care and my subsequent career. More recently I worked for four years as director of clinical governance at University College London Hospitals Foundation Trust. Safety and quality in acute settings was my priority, and it gave me invaluable insight into the issues which matter to patients.
‘Those civil servants who have already started their experiences have been incredibly humbled and inspired by the courage and dedication of patients and staff’
Many civil servants have frontline experience already, and we have an established programme of volunteering and visits to the NHS, third sector and care organisations. I want to build on the sense that we all have of wanting to make a difference. Those civil servants who have already started their experiences have been incredibly humbled and inspired by the courage and dedication of those patients and staff at the heart of our health service.
I am confident our programme will greatly enhance their understanding and appreciation of the health and care system. To see how everyone contributes to the high quality care of our patients at their times of need and worry – from a calm receptionist and reassuring nurse to the porter putting a person at ease with small talk and the healthcare assistant who makes them a cup of tea and helps them wash.
Behind the evidence
The Department of Health is an organisation that prizes evidence. Evidence derived from data, analysis and research, such as performance information, surveys and patient insight, is critical to good policy making. But the truth is that in complex systems such as health and care, we need a broad base of real life experiences to be able to better interpret this evidence. I firmly believe our policies will improve further if we collectively have a broader grasp of how things work in practice and how people feel about their health and care.
That is why, as civil servants prepare to leave their offices to experience life on the front line, I am in no doubt how inspirational, rewarding and above all valuable this programme will be.
Una O’Brien is permanent secretary at the Department of Health