Tom Bell: My oodles of unwanted experience as a Patient Safety Partner

Summary

In this blog, author, consultant and patient safety expert Tom Bell shares his story of being approached by an NHS Trust to take up a role as a Patient Safety Partner. He describes how his initial enthusiasm to make a difference was crushed by the Trust’s failure to value his experience and time. Tom describes the Trust’s approach to working with Patient Safety Partners and implementing PSIRF as tokenistic and disjointed. He highlights the gap between the Trust’s stated view about the importance of working with Patient Safety Partners and its disorganised internal systems and unwillingness to manage and compensate Patient Safety Partners for their work.

Content

In the summer of 2022, I was approached by the NHS Leadership Academy to see if I would be willing to make myself available to become a Patient Safety Partner for an NHS Trust that might be seeking one. Shortly thereafter I was asked and encouraged by an NHS Foundation Trust to become one of two Patient Safety Partners they wanted to appoint. My lived experience, former NHS management role, and knowledge of delivering healthcare services in rural areas were deemed useful. 

My role as a Patient Safety Partner started in early autumn 2022. From the beginning I was open in sharing my concerns that not every NHS leader is comfortable hearing what they don’t want to hear. I explained I would not be offended if the Trust felt I was not right for them. I was assured by the Assistant Director for Safety and Quality that my ability to present an alternative perspective would be welcomed. I was delighted. I accepted that the pay was menial in relation to my experience and qualifications, but the improving of patient safety matters deeply to me, as many will know from working with me or hearing me speak at the Annual Patient Safety Congress.  

Having lost a sister to suicide after a period of sexual abuse and cover up in an NHS mental health hospital and then losing my job as a middle manager in the NHS after whistleblowing in an unrelated incident over two decades later, I have been on a journey I would not wish on others. I understand to the very depths of my gut the need for significant culture change in the NHS in a way few could ever comprehend.

I think the Patient Safety Incident Response Framework (PSIRF) is a genuinely well-intentioned initiative. The principles it embodies and the cultural shift it seeks to be the lever for, are massively important. The role of the Patient Safety Partner as outlined by NHS England in helping NHS Trusts successfully and meaningfully implement PSIRF, in form and spirit, is quite rightly held aloft as a significant one. 

For those like me who are fortunate enough to recover from the rage injustice flushes through our veins and make it through the red mists of righteous anger, the truths our experiences reveal are gifts. The hard-earned insights and knowledge we inadvertently find ourselves possessing, are precious and valuable to those willing to hear and hold them with us. I am continually emerging, if never fully, from my journey with a far greater understanding of the many forces that drive and shape individual and organisational behaviour than my academic qualifications and professional experiences could ever give me. And I remain one of the NHS’s greatest supporters. I understand very few people are inherently bad, whatever that may mean, but I also remain acutely aware that many good NHS employees at every level, feel they are working within sub-optimal systems. As W Edwards Deming rightly observed, “The origin of issues can be largely traced back to the system, not blamed on the people within them.”

It will come as no surprise to those who know me that I launched myself proactively into my role as a Patient Safety Partner. I endeavoured to be a well-informed asset to a Trust I thought had placed faith in me. I carried out research and spent a great deal of my own time looking at relevant issues and exploring areas of interest that would add value to my role. Yet instead of the Trust valuing my expertise and input or welcoming the views and information I brought to the table, as well as the positive informed challenge I offered, I found myself being treated incredibly shoddily. 

Despite being told the work I was involved with was important, more than half the scheduled PSIRF meetings planned for the coming year were cancelled, often at short notice. Those meetings that were held were far too short to accommodate the number of agenda items included in them. Meaty and complex topics such as organisational culture, that required in-depth discussion in their own right, were given minor billing on agendas and skipped briskly over in a matter of minutes. The hour-long meetings that did go ahead were held during staff lunchtimes at which many people were distracted, eating while checking emails. The meetings were classically hierarchically dominated by a director. The majority of attendees offered little if any input. Some of those present never spoke other than to introduce themselves at the first meeting. 

There was no space or appetite for discussion during meetings. Progress and actions were presented through the usual RAG rating lenses of red, amber or green. I recall during one meeting I asked about progress on a particular issue, to which the chair of the meeting replied that, “Oodles of work has been done in that area.” They seemed surprised when I asked what “oodles” looked like in practice. I was greeted with a confused silence. I explained politely that were anyone to create a report for a regulator or their colleagues stating that “oodles of work had been done,” they might not be taken seriously. My point was acknowledged, I was promised evidence of the “oodles” and the meeting moved on. Of course, I never received what I had been promised during the meeting, despite my follow up emails asking for it. 

What I find fascinating is that nobody else in the meeting appeared to understand or support my challenge. Why did none of the well-paid presumably well-qualified NHS managers and directors in the room say anything or question the unevidenced assertion their colleague had made? The irony is that I was by many degrees the least well-paid person in the room. To me it seemed the Trust was viewing PSIRF as just another top-down, flavour of the month, centrally-mandated initiative that they needed to demonstrate they were taking seriously by ticking all the right boxes. As anyone with a degree of public sector experience knows, demonstrating you are doing something well is very different to actually doing something well. In my view and based on my experience, the Trust and its directors were simply not making the time to talk about and implement PSIRF meaningfully. As Forrest Gump might say, important is as important does.

As the meetings were frequently cancelled and opportunities for face-to-face (albeit virtual) conversation became more limited, I found myself trying to communicate via emails and phone calls. However, trying to get to speak to people on the phone was a nightmare and over three quarters of the emails (yes, I’ve done the maths) that I sent in relation to my role went unanswered. 

Worryingly, after many months I had not received most of the reimbursement I was owed. I was being bounced around between the NHS Leadership Academy’s and the Trust’s confused and unresponsive admin departments. My requests for an update in relation to the growing amount I was owed, were ignored. I became so frustrated at the lack of responsiveness that I emailed the Trust’s senior leadership team, at which point the Trust actively blocked my email address to stop me contacting them. My access to the Trust was only reinstated when I bypassed the block using another email address and copied in numerous local MPs with whom I shared my concerns. Some of the amounts I was owed related to activity undertaken over nine months previously. I was appalled that an NHS Trust that had approached me for help and assured me my work was important and my input would be valued, was treating me so poorly. It was not the amounts in question that mattered, the reimbursement was essentially tokenistic. It was the principle. 

Trying to correspond and deal with the administrative mess the Trust was creating was getting me nowhere. The Trust’s own admin and finance teams acknowledged to me that the situation was “shambolic.” I eventually contacted the Trust’s newly appointed Chief Executive, and then when nothing happened, I approached NHS England and the Secretary of State for Health and Social Care. Only after I had done this was I eventually contacted by the Trust to finalise and arrange payment of what I was owed. I should never have had to make such waves to be reimbursed for work I was doing at what ultimately amounted to less than the minimum wage.

The Trust published its PSIRF plan and policy in December 2023, at a time when I was in theory still one of its Patient Safety Partners. Despite the many ideas, suggestions, documents and references to useful information I had shared, the Trust did not even let me know they were going to be published. The input I had offered was not used. Early in 2024, the Trust informed me that my services were no longer required, saying they had realised they weren’t yet ready to work with Patient Safety Partners. A classic and deeply ironic cop-out if ever there was one, as well as a shirking of their legislative obligations. 

I was incredibly disappointed at how I was treated. Those who know me know I do not walk away lightly from any challenge. The concern I am left with is that if the Trust I tried to help is this tick-box-entrenched and administratively shambolic and unresponsive in how it treats its Patient Safety Partners, where else is dysfunctionality occurring in that Trust and the wider NHS? I worry that the involvement of Patient Safety Partners in the creation of many PSIRF related plans and policies has been little more than a tick-box exercise. 

Having raised my concerns with NHS England, in May 2024 I received a reply. The letter negates any concerns raised using the kind of classic public sector assertion highlighted most recently by the Post Office Scandal. It opens with the statement, “Your experience and the issues you raised are not what we have heard from other Patient Safety Partners…” (nobody else has a problem with their computer system Mr Bates), a statement which I presume has oodles of evidence to support it. As for me, all I know for a fact is that while some Patient Safety Partners are satisfied, others feel undervalued and underutilised. But what would I know, I’ve only spoken to them…

This is just one Patient Safety Partner's experience but we have also heard many positive experiences too where Patient Safety Partners are able to make an impact. 

Further reading:

• How do Patient Safety Partners feel about their role? Analysis of online survey results
• Patient Safety Partners: examples of impact
• Patient Safety Partners: influencing for safety
• Developing the Patient Safety Partner role: Imperial College Healthcare NHS Trust share their approach
• Patient Safety Spotlight Interview with Mark Smith, National Patient Safety Partner and South West Yorkshire Partnership Foundation Trust Patient Safety Partner
• Patient Safety Partners – lack of role clarity a barrier for impact

We would love to hear your experiences of being a Patient Safety Partner, please add to the comments below (you will need to be a member of the hub and logged in). 

If you are a Patient Safety Partner, you can find out more about the Patient Safety Partner Network, and how to join here.

About the Author

Tom Bell is an author, consultant, educator and speaker who specialises in helping healthcare and public service providers develop safe, open, productive cultures. He provides informed, impactful, intelligent insight built on extensive lived, learned and professional experience. Tom has worked for over four decades at all levels across multiple sectors and is a Fellow of the Chartered Management Institute.