Practical measures to heal the NHS in Scotland
Pressure on the health service is growing, while the fact that funding is not keeping up with demand is well documented and reported by Audit Scotland. But who can help to heal the NHS?
It is complicated. At the very least, this ménage à quatre of politicians, managers, clinicians (doctors and nurses) and the patient public bring different contributions to the table.
The distribution of power, authority, knowledge/skill and worried expectation does not facilitate solutions. But, after 40 years in the NHS, I do believe that meaningful change can only come about with a different contribution from each of these four groups.
And, although not discussed, I acknowledge with profound gratitude the crucial input from secretaries, porters, pharmacists, laboratory and radiology staff, laundry and catering workers, volunteers and many others without whom the service would rapidly grind to a halt.
So, what can politicians do?
The rising demands are exacerbated by underfunding, which contributes to understaffing, which in turn drives poor morale and rising sickness absence.
Targets, the stuff of short ministerial soundbytes, are useful if used in a discriminating and judicious manner. At present, this is not the case and their widespread use necessitates large numbers of staff to collect, analyse, submit and verify the data. Funding, and the use of targets, need to change.
What can managers do?
There is no gentle way to put this. We need less of them.
Surely, the task of management is to help clinicians deliver an excellent service. We should, therefore, be united in a common goal.
One of the reasons we are not is that much of management is focused on seeking solutions to the funding, staffing, complaints (often arising from the first two) and the targets I referred to above.
Both clinicians and managers need to come together over the questions “How can I give the best service to my patients?” and “How can I best help you to do that?”
That requires a level of dialogue and mutual respect which is often missing.
What can clinicians do?
We need to rebuild our clinical teams, work better together and listen more effectively to our patients. For a variety of reasons, there are now a number of areas of acute clinical care where doctors and nurses work in parallel rather than as one.
In a piece I wrote for the Journal of the Royal College of Physicians of Edinburgh, I have described how we might improve this, but one of the most important changes would be to enable and empower the Charge Nurse.
He or she needs more administrative support and a recognition from management that the place of the Charge Nurse is almost exclusively on the ward or clinical area, and not in endless meetings.
This pivotal role should be reflected in salary, pension, calibre and kudos. Only the very best should be appointed to, and wish to remain in, these posts.
What can patients do?
Requests for feedback accost us at every turn in today’s society.
Nowhere, however, could feedback have greater importance and power to inform improvement than in the NHS.
At present we have a plethora of mechanisms across the UK. Care Opinion, widely used in Scotland, is close to pointless as it mostly provides a channel for praise.
Of course, it gives a little boost to morale to know the service was appreciated but, much more than that, we need to know where we most need to improve from the point of view of the service user.
I therefore put forward the following idea in the hope that it might gain some traction: every patient leaving hospital should be asked one question by a trained staff member (preferably a nurse): “What is the one thing we could have done that would have most improved your journey?”.
Ten patients might well give ten different answers, but ten thousand answers (which most hospitals could easily generate in a year) could give some very powerful indicators.
The cost of such an initiative would be a small fraction of the cost of targets and might, actually, give us more meaningful information.
The hospital could announce the plan through local media in advance, and commit to addressing the top three concerns each year, reporting back through the same media on what was achieved – “you said, we did”.
This could well powerfully and positively strengthen the bond between hospital and community.
If some of these ideas sound too speculative to implement, why not try a pilot? We certainly have enough data on performance to know if they make a difference.
In my experience, patients look for four things from the service they have placed their trust in – competence, communication, continuity and compassion.
Who can help to heal the NHS? We all can, and we all must.
Dr John Wilson is a consultant gastroenterologist at NHS Fife and former vice president of the Royal College of Physicians of Edinburgh