Introduction by Marcus Longley, Director of WHSC and Professor of Applied Health Policy
This week’s blog in our ’20 blogs for 20 years’ series is by Dr John Bullivant, one of the UK’s leading experts on governance in public services. Drawing on both his professional and personal experience, he reminds us of some uncomfortable home truths about how the NHS is – and should be – run, and asks why problems take so long to be resolved. We have worked with John since our foundation in 1995 (and some of us before that!), and he is a Senior Visiting Fellow on governance at the Institute.
It’s not my fault
Why do inquiries and reviews take so long? The Mid-Staffs problems were long standing, emerging in the press in 2009, but the final reports and flurry of activity across the country to avoid another Mid-Staffs took until 2013.
Dr Kirkup’s 2015 report investigating the Furness General Hospital maternity ward of University Hospitals of Morecambe Bay NHS Foundation Trust covered problems which started in 2004. By early 2009, there was ‘clearly knowledge of the dysfunctional nature of the FGH maternity unit at Trust level, but the response was flawed’, and the new Chief Executive is still saying sorry.
We have only recently seen the full report on Vale of Leven, where Clostridium difficile Infection problems started in 2007; an inquiry was launched in 2009 and only reported in November 2014.
The problems in Betsi Cadwaladr from the previous regime are still emerging with the Health Board being put in special measures for events that occurred in 2013 before the present top team were in post.
None of this is to say that the treatment of patients and the oversight by senior clinicians, management and boards was not appallingly lax, and similarly, there are some serious problems in the UK NHS, but shooting the new sheriff who is trying to clean up the town is not the answer.
Some simple points:
- Any enquiry still running two years after the events took place has lost the plot. The organisation will have fixed itself or will be in serious terminal decline if still awaiting the diagnosis and treatment.
- The regulators cannot possibly give assurance all is well, nor should we expect that to be their job. They should be able to assess if the board has a grip on what is going on.
- Boards should know when to undertake their own deep dives: they should be clear about when a non-executive director should intervene, what assurance they are looking for and equally importantly how to get out again, not staying micro-managing the business.
- Boards have to stop wallowing in the past and concentrate on the future; on setting ambitious goals and then focusing on the risks of not achieving their goals without fear of being criticised when they achieve less.
Since Sir Liam Donaldson told us in 2009 it was alright to say sorry, our clinicians, managers and chairmen have become more humble in accepting they have let patients down. What, often, they actually mean is that their predecessors got it wrong but they now own the problem of promptly putting things right. I know from my own personal loss that our main concern was that someone else did not have to go through the torturous process of trying to find out what went wrong, and also that we had confidence that in the future no one else would suffer the same problem.Back in 1995 when the Welsh Institute for Health and Social Care (WIHSC) was born, we were about to establish the eight new health authorities and I recall writing with Mike Ponton and David Pritchard about the critical success factors for the new authorities. One of the key ones was ‘easy to do business with’. Twenty years on, have we learnt how to do that?
Dr John Bullivant is a Senior Visiting Fellow on governance at WIHSC and Chairman of GGI, and author of the Good Governance Handbook (HQIP & GGI, 2015)