Steve Turner

• Is it time to change the way England's healthcare system is funded? 
• Is the English system in need of radical structural change at the top?

I've been prompted to think about this by the article about the German public health system on the BBC website: https://www.bbc.co.uk/news/health-62986347.amp 

There are no quick fixes, however we all need to look at this closely. I believe that really 'modernising' / 'transforming' our health & #socialcare systems could 'save the #NHS'. Both for #patients through improved safety, efficiency & accountability, and by making the #NHS an attractive place to work again, providing the NHS Constitution for England is at the heart of changes and is kept up to date.

In my experience, having worked in healthcare for the private sector and the NHS, and lived and worked in other countries, we need to open our eyes.

At present it could be argued that we have the worst of both worlds in England. A partially privatised health system and a fully privatised social care system. All strung together by poor commissioning and artificial and toxic barriers, such as the need for continuing care assessments. In my view a change, for example to a German-style system, could improve patient safety through empowering the great managers and leaders we have in the NHS. These key people are held back by the current hierarchical crony-ridden system, and we are at risk of losing them.

In England we have a system which all too often punishes those who speak out for patients and hides failings behind a web of denial, obfuscation and secrecy, and in doing this fails to learn. Vast swathes of unnecessary bureaucracy and duplication could be eliminated, gaps more easily identified, and greater focus given to deeply involving patients in the delivery of their own care.

This is a contentious subject as people have such reverence for the NHS. I respect the values of the NHS and want to keep them; to do this effectively we need much more open discussion on how it is organised and funded.
 

What are people's views?

This potentially looks very helpful. Preventable deaths tracker: 

This work has so much potential for improvements in patient safety. Will it link to Coroners prevention of future deaths reports?

It's such a complex area, with so many threads and possibilities for learning. I used to work in a Mental Health Assertive Outreach Team and was greatly saddened by the high mortality rate from deaths through neglect or undetected (and treatable) physical illnesses. 

The West Suffolk Independent Review published yesterday indicates that safety concerns were ignored and the hunt for an anonymous whistleblower was "flawed" and "ill-judged".

https://www.england.nhs.uk/east-of-england/wp-content/uploads/sites/47/2021/12/west-suffolk-review-081221.pdf

This Review was commissioned following widely reported events arising from an anonymous letter that was sent in October 2018 to the relative of a patient who had died at the West Suffolk NHS Foundation Trust (the Trust). 

The 225 page report contains important learning and highlights the need for an open culture in the NHS and an end to a culture of avoidance, denial and victimisation of those who speak out for patient safety.

This report highlights the need for cultural change and raises several key points:

• The importance of real and empowered clinical leadership.
• The importance of NHS leaders being self-questioning, open to criticism and to listen to staff.
• The importance of leaders understand the value of dissent and disagreement. 
• Where concerns and criticisms appear or do turn out to be misguided, the need for NHS leaders to avoid jumping to any conclusion that the individual raising them is simply making trouble.

I am so sorry to hear of your experience Dom.

As a mental health nurse who trained in the 1980s I have witnessed a shocking decline in the NHS. The NHS being an institution which, like you, I support and want to see thrive and become world class.

The NHS, and indeed all services commissioned by health & social care, has fallen victim to a culture of avoidance, a rise of cronyism (based on self-interest) and exclusion of those who speak out. That includes appalling treatment of patients and relatives who speak out. This has to change.

In order to change this problem has to be fully recognised, independently scrutinised,  and spoken about openly at the top, not avoided and skirted around, as is currently happening for example through the weak implementation of the Francis Review recommendations and stigmatisation of many who who speak out.

That would be good.

I wonder how common experiences of bouncing, delayed or lost referrals are are. There is so much learning to be had. Including simple changes that can be made right now to improve communication and the safety of referral processes.

Thank you.

I have a family member who had a similar experience to the one you describe Helen.

This involved an urgent  tertiary referral that would have been bounced back to the patient had they not kept their own notes.

As he had the notes my relative was able to show copies of all the letters, scans, EEGs and reports that indicated the referral was potentially life saving.

In his case I believe his GP would have intervened, however the GP did not have all the notes and was missing a key echo-cardiogram, that showed definitively an urgent intervention was needed.

My recommendation to all patients is to keep a copy of your notes in real-time. Insist that everything is copied to you. Most clinicians are more than happy to do this. (They all should be!) Then, if your referral goes in to a faceless 'referral management system', it is less likely  to be lost or the priority to be missed.

My worry is that this is fine for articulate, English speaking, reasonably IT literate, middle class white people like me. What about those who slip through the net? Who helps them? Who advocates for them? We may never hear of this.

Thank you for your comments Clive. I am so sorry to hear what is happening to you. I'd like to say it's an unusual situation but I know many have experienced the same treatment.

Patient complaints are an opportunity not a threat. Sadly the NHS largely fails to recognise this, and fails to provide the right training for staff (at all levels) so that we can all learn and improve.

I remain optimistic that this can and will change. There are some good signs of this in some trusts.

About 1000 angry nurses and doctors have rallied outside Perth Children’s Hospital in Australia following the death of seven-year-old Aishwarya Aswath, demanding vital improvements to the state’s struggling health system.

The Australian Nurses Federation was joined by the Australian Medical Association for the rally, with staff from hospitals across Perth attending. Many people held signs that read “We care about Aishwarya”, “Listen to frontline staff”, “Report the executive — not us” and “Please don’t throw me under the bus”.

Aishwarya developed a fever on Good Friday and was taken to Perth Children’s Hospital the next day, but had to wait about two hours in the emergency department before she received treatment. She died soon after from a bacterial infection.

An internal report into the tragedy made 11 recommendations — including improvement to the triage process, a clear way for parents to escalate concerns and a review of cultural awareness for staff — but Aishwarya’s parents said the report raised more questions than it answered. The family wants a broader independent inquiry to look at all 21 near-misses in the past 15 months – not just their daughter’s case.

Some people have been referred to medical authorities, while Child and Adolescent Health Service chair Debbie Karasinski resigned after the report.'

I am encouraged to see the way healthcare staff reacted to this tragedy.

Imagine a similar event in England, would nurses protest outside the hospital and stand up to authority like this? I doubt it very much, which is very sad reflection on the prevailing culture and health leadership in England.

What do others think?

Source: The Australian. 9 July 2021

Picture: Picture: 9 News

In the UK there is a Prescribing Competency Framework which applies to ALL prescribers. This has been in place since 2012.

In my blog I use examples of, what I believe to be, fundamental prescribing failings to discuss its impact and the extent to which it has been adopted.

1. Do the prescribers in your team use the competency framework?

2. Is the competency framework part of the prescribing CPD in your organisation?

3. Is the competency framework used as part of prescribers’ annual appraisals?

4. How is prescribing competency monitored in your organisation, and is the competency framework included in clinical supervision?

5. Does your organisation use the prescribing competency framework in clinical governance sessions?

6. Is the prescribing competency framework referred to in incident investigation reports?

Link to blog: 

The recent press release from the UK Government outlines a White Paper which contains the reforms:

"Major reform of Mental Health Act will empower individuals to have more control over their treatment and deliver on a key manifesto commitment.

Reforms will deliver parity between mental and physical health services and put patients’ views at the centre of their care.

Plan will tackle mental health inequalities including disproportionate detention of people from black, Asian and minority ethnic (BAME) communities, the use of the act to detain people with learning disabilities and autism, and improve care for patients within the criminal justice system..."

The report covers:

"A package of reforms has been set out in a wide-ranging new Reforming the Mental Health Act white paper, which builds on the recommendations made by Sir Simon Wessely’s Independent Review of the Mental Health Act in 2018.

At the heart of the proposed reforms to the Mental Health Act is greater choice and autonomy for patients in a mental health crisis, ensuring the act’s powers are used in the least restrictive way, that patients receive the care they need to help them recover and all patients are viewed and treated as individuals.

These reforms aim to tackle the racial disparities in mental health services, better meet the needs of people with learning disabilities and autism and ensure appropriate care for people with serious mental illness within the criminal justice system."

Do you work for Mental Health services?

Are you someone who uses Mental Health services?

What are your views?

Some years ago I stopped writing for journals, in favour of blogging & volgging. My reasons were:

1. I specialise in patient involvement and inclusion, so I want the work of me and my colleagues to be easily found by everyone
2. We didn't want our work to end up behind a paywall
3. We work across disciplines and try to bypass hierarchies, especially in promoting action learning and patient led care

I can see there are some really good Open Access Journals around. So my question for us all is:

Which are the best Open Access Journals?

Here a link to my digital profile: https://linktr.ee/stevemedgov

This is our developing model of working, a away of working in healthcare that all use and participate in: 

I'm hoping that the Long COVID clinics link up with all initiatives for people with long term conditions. We started looking at medicines and expanded this to include ALL treatments and approaches.

We're looking at how our work can link with this.  Here's an early video on our work:

More here:

 https://medicinegovorgmedlearn-innovation-event-nhs.blog/patient-education-support-sessions-helping-you-manage-your-own-care/

Thanks Derek, I think you have hit on a critical issue and a solution. As a community nurse, someone who is keen on interdisciplinary working & patient empowerment I'd like to see ways in which this approach can be adapted and adopted to work outside hospitals. I'm sure it can be.

Time for the #NHS to truly modernise and focus on patients safety, and patient involvement,  in IT projects.

This looks good. I hope the #NHS I.T. will catch up with this. It shows that health is not 'unique' when it comes to safety and human error. I particularly like the way the patient is an equal part of this solution. 

I agree...'The system would have saved 450 Gosport patients 30-years ago, and currently under live investigation by Police (Operation Magenta).'

Thank you.

Thank you. I agree.

I think it's sometimes forgotten that when staff fail to speak out, are unable to speak out or are silenced & victimised for speaking, out it falls on patients, careers and relatives to do this. At great cost, because by this time someone has usually been harmed.

It's #SpeakUpMonth in the #NHS so why isn't the National Guardian Office using the word whistleblowing?

After all it was the Francis Review into whistleblowing that led to the recommendation for Speak Up Guardians.

I believe that if we don't talk about it openly and use the word 'WHISTLEBLOWING' we will be unable to learn and change.

Whistleblowing isn’t a problem to be solved or managed, it’s an opportunity to learn and improve. So many genuine healthcare whistleblowers seem to be excluded from contributing to the debate, and yes not all those who claim to be whistleblowers are genuine. The more we move away for labelling and stereotyping, and look at what's happening from all angles, the more we will learn.

Regardless of our position, role or perceived status, we all need to address this much more openly and explicitly, in a spirit of truth and with a genuine desire to learn and change.

I've been posting advice to patients advising them to personally follow up on referrals. Good advice I believe, which could save lives. I'm interested in people's views on this.

This is the message I'm sharing:

**Important message for patients relating to clinical referrals in England**

We need a specific effort to ensure ALL referrals are followed up. Some are getting 'lost'.

I urge all patients to check your referral has been received, ensure your GP and the clinical team you have been referred to have the referral.

Make sure you have a copy yourself too.

Things are difficult and we accept there are waits. Having information on the progress of your referral, and an assurance that is is being clinically prioritised is vital.

If patients are fully informed and assured of the progress of their referrals in real-time it could save time and effort in fielding enquiries and prevent them going missing or 'falling into a black hole', which is a reality for some people. It would also prevent clinical priorities being missed.

Maybe this is happening, and patients are being kept fully informed in real-time of the progress of their referrals. It would be good to hear examples of best practice.

On 07/09/2020 at 11:45, Steve Turner said:

For me the top 3 are:

1. An individual duty of candour enshrined in law. The current DoC holds institutions not individuals to account.

2. Prescribers held to account for failure to follow the RPS Prescribing Competency Framework. This is a competency framework for ALL prescribers.

3. More education on the implementation of the Mental Capacity Act, and holding to account those who do not follow it.

I've chosen these three areas because they are measurable and link directly to high profile failings including:

* The alleged cover up of the death of Robbie Powell ( a Police Report suggested 35 criminal charges & the case is with the CPS).

* The case of Oliver McGowan where prescribing a medicine he had previously reacted badly too contribuited to his death.

* The Gosport Hospital scandal where in June 2018, the Gosport independent panel reported that there was “a disregard for human life and a culture of shortening lives of a large number of patients” at the hospital.

I believe staff are unsafe if patients are unsafe. The two things go together.

The other thing is that when staff see bad practice going unchecked and are victimised for speaking out they leave if they can. Leading to a wide variation across orgnaisations.

This is behind many large scale failings in healthcare & part of a worldwide cultural and societal problem.

For me the top 3 are:

1. An individual duty of candour enshrined in law. The current DoC holds institutions not individuals to account.

2. Prescribers held to account for failure to follow the RPS Prescribing Competency Framework. This is a competency framework for ALL prescribers.

3. More education on the implementation of the Mental Capacity Act, and holding to account those who do not follow it.

I've chosen these three areas because they are measurable and link directly to high profile failings including:

* The alleged cover up of the death of Robbie Powell ( a Police Report suggested 35 criminal charges & the case is with the CPS).

* The case of Oliver McGowan where prescribing a medicine he had previously reacted badly too contribuited to his death.

* The Gosport Hospital scandal where in June 2018, the Gosport independent panel reported that there was “a disregard for human life and a culture of shortening lives of a large number of patients” at the hospital.

Good question, I don't know. Some suggestions:

I tried setting up the Turn Up The Volume! movement and we held two sucessful national workshops. This, I believe, helped bring together the main themes, involve patients (who are often not involved in these type of  forums)  and link people together who would not have met otherwise. The workshops were attended by senior NHS people, and then shunned by the NHS. http://www.carerightnow.co.uk/turn-up-the-volume-resources-2/

I have been commissioned to conduct a few workshops on whistleblowing (looking at the situation for all angles and encouraging reflection) in NHS trusts, and once in a University. They were well received locally.

The NHS Whsitleblowing Support Scheme commissioned a study by Liverpool John Moores University in 2019 'Final evaluation survey - NHS whistleblowers support scheme'  I have asked several times when this is to be published but received no reply. This may shed some light on the situation. Realted NHS web page: https://improvement.nhs.uk/resources/whistleblowers-support-scheme/

It's a tough one to crack and very senior people just won't talk about the deep seated problems of victimisation and blacklisting of staff and patients, and have unlimited resources to try and keep a lid on it. As exemplified by the National Guardian's Office, which as you know I believe is a dangerously (some say deliberately) flawed initiative.

Good points Helen and Anton02. Thank you both.

I did raise an FOI on the CQC's role, which revealed that they had incorrectly dismissed my 2012 concerns as 'all third hand'. The CQC also said they had lost the report that they asked to be commissioned in response to my concerns. A report I never saw.

I think there's a lot more I could 'FOI'. I've chosen not to as it would take up so much time and probably be little help.

Most of the blacklisting I experienced is informal and can't be proven. In fact I could be wrong on some of it. The loss of a contract which I was awarded, and which was taken from me the day after the award without a valid reason being given, is a different matter. I chose not to take formal action on this as I didn't want to get involved in legal wrangling.

I've never applied for NHS employment since leaving Assertive Outreach in 2006 (except to apply help out short-term as a covid returner, without success). Fortunately I've been lucky as I had other alternatives. I do some teaching, and support 20 Community Pharmacies on Information Governance & do clinical assessment work.

It's been tough financially, but I don't regret my decision to leave and to speak out. After all, as I see it, I was just trying to do my job properly.

Thanks Helen. This is such an emotive subject and people (staff and patients) are victimised & blacklisted for speaking out in subtle, and not so subtle, ways all the time.

I appreciate your reply. I wasn't expecting any. Maybe someone will comment anomyously. Also, I welcome criticism and questions on my views & experiences, that's how we can all learn.

Way back in March I applied to re-join the NHS to help with COVID-19.

I am a mental health nurse prescriber with an unblemished clinical record. I have had an unusual career which includes working in senior management before returning to clinical work in 2002. I have also helped deliver several projects that achieved nation recognition, including one that was highly commented by NICE in 2015, and one that was presented at the NICE Annual Conference in 2018. Several examples of my work can be found on the NICE Shared Learning resource pages.

Since applying as an NHS returner. I have been interviewed online 6 times by 3 different organisations, all repeating the same questions. I was told that the area of work I felt best suited to working in - primary care/ community / mental health , specialising in prescribing and multi-morbidity - was in demand.

A reference has been taken up and my DBS check eventually came through. I also received several (mostly duplicated) emails. On 29th June I received a call from the acute trust in Cornwall about returning. I explained that I had specified community / primary care as I have no recent acute hospital experience. The caller said they would pass me over to NHS Kernow, an organisation I had mentioned in my application. I have heard nothing since.

I can only assume the backlisting I have suffered for speaking out for patients, is still in place. If this is true (and I am always open to being corrected) it is an appalling reflection on the NHS culture in my view.

Here is my story:

http://www.carerightnow.co.uk/i-dont-want-to-hear-anything-bad-whistleblowing-in-health-social-care/