The surgeon called me 'a snivelling clerk', I stood my ground

The code of conduct for NHS managers (2002) asks managers to “make the care and safety of patients [their] first concern and to act to protect them from risk”. I chaired the group that produced the code and drafted it. I had learned this value and everything else I needed to know, from my first boss Jack Newton at the Royal Hospital in Sheffield in the early 70s.

Crafting the NHS code of conduct

The experience that embedded this value in my heart and mind came later in my career. I had just started a new job and a senior surgeon asked me if I was married. I said that I was and he advised me to make sure that my wife was not referred to one of his colleagues. I asked him why and he replied by shrugging his shoulders and advising me to look at the legal files. I did that and understood the advice! In those days, it would have been very difficult to challenge the surgeon directly and so I set up a review of the service and invited evidence. The surgeon with the issues replied to say that he would not reply to a letter from a “snivelling clerk”. I was the most senior manager in the organisation!

A few weeks later the surgeon who had given me the advice asked me how I was getting on with the review. I told him that I was getting nowhere. He sympathised and said it was very difficult. I could have left it there but somehow found the courage to challenge him. I asked him to look in the mirror when he got home and to ask himself if he could live with what he knew.

He never forgave me for the challenge and it affected my relationship with the consultants as a whole. However, a few days later, the consultant he had warned me about was visited by the three wise men – senior consultants who were responsible for problem doctors – and he resigned on grounds of ill health. The service was transformed by his successor.

I never forgot this lesson and for the rest of my time in the NHS as a manager and chair tried to live the value of making the care and safety of patients my first concern and to act to protect them from risk. When I was asked to produce the code of conduct as part of the government’s response to the Kennedy report on the events in Bristol, I knew where to start.

Sadly, although the code was adopted and NHS organisations were asked to incorporate it into the employment contracts of all senior managers, it was not promoted or enforced.

A candid reflection on NHS challenges

If the code had been a living part of NHS culture, events at Stafford and Chester might have been very different.

The care and safety of patients is much more important than the reputation of the organisation or loyalty to colleagues.

My own commitment to the code was severely tested at the end of my career when I was involved in two service reconfigurations, the second of which was very controversial.

We approached the issue with care and commitment involving the community, patients, carers, colleagues and partners. We had an expert panel of national experts who reviewed every stage of our work. There was a very strong case for change – the creation of stronger, safer services.

However, the timing was difficult politically and I came under sustained personal pressure. Indeed, it was one of the reasons that I retired early from full time work. I will always treasure the supportive emails from the leaders of the campaign opposing our proposals who said that they recognised our “honesty, integrity and professional approach” and the “consistency of our considered opinions”. They recognised that we were trying to put the safety of patients first.

After I retired, the Independent Reconfiguration Panel advised the secretary of state that the proposals should be approved and they were implemented.

A few years later I was treated in the emergency admission unit created as part of our proposals, having been misdiagnosed and discharged by a hospital in another part of the country. I was glad to be in a stronger centralised unit and I was very well looked after.

Patients first.

I know that it is very challenging to live this value and make this choice in today’s NHS with the pressures of demand, staffing and resources and with truth in short supply in the run up to the election.

In my 54 years of involvement with the NHS, I never heard a colleague regret that they had put patients first. I have met many who wished they had made that choice.