Changing Healthcare – are there more legitimate questions than answers?

Is transformative change unfolding in the UK’s healthcare sector? Is it being driven by a new government after a prolonged period in opposition, or public frustration? Will examining our publicly funded NHS be beneficial? Is radical change needed before we can expect any improvements in key performance areas?

Asking these questions is undoubtedly positive, provided it isn’t a diversion from more urgent issues. In the search for answers, it is key to ensure that it doesn’t create unintended negative outcomes and that the aims foster a genuine cultural shift. We might be witnessing a rare, once-in-a-generation opportunity for profound change.

Could resignation to accept dysfunctional norms of normality and fairness be the root cause of the current issues in the UK healthcare system? Behind every serious systemic shortfall in care, there will be clinical staff who have flagged it – perhaps even becoming whistle-blowers. Those who speak out can face negative reactions ranging from being ignored, to more severe responses, often with serious repercussions. Those who persist in trying to highlight problems can be marginalised and risk professional consequences. Each day brings new stories of inadequate care and suffering patients—tragic for those receiving care and for those professionals providing it.

Is this article about heaping more opprobrium on a struggling institution? No, because I need the NHS – we all do. It is about considering root causes, the better to inform solutions. Can we identify and then expand the best parts of the system while using the worst performing units as case studies for ‘good change’? This is not about re-organising the whole service.

The Role of Frontline Staff: Key Voices in Identifying Systemic Issues

Front-line healthcare providers – nurses, doctors, and allied healthcare professionals – are the indispensable eyes and ears of healthcare organisations. They directly interact with patients, manage treatments, and handle the day-to-day challenges of healthcare delivery. Their firsthand experiences and insights are crucial to understanding the realities of patient care, identifying systemic problems, and informing improvements in service provision.

For managers and administrators who may be several levels removed from direct patient care, properly engaging with front-line staff through regular feedback mechanisms is essential. This engagement keeps management informed and helps develop practical and effective solutions for improvement. Feedback from those working in units with poorer outcomes is particularly valuable, as it identifies critical areas that require attention and intervention.

Transparency and Clinical Leadership: Building a Culture of Accountability and Safety

Strong clinical leadership within healthcare is vital. Effective leaders can inspire their teams, drive positive change, and ensure that the highest standards are consistently met. By fostering an environment where feedback is encouraged and acted upon, and where strong, principled clinical leadership is in place, healthcare organisations can better navigate the complexities of delivering high quality patient care.

This includes developing effective methods for listening and responding constructively when issues arise. Comprehensive training, expert oversight, continuous monitoring, and adequate resourcing is required by struggling units, and the whole NHS needs compassionate leaders who are well-supported, skilled and motivated by the right reasons, to make the service safe, sustainable and a good place to work.

For those who have not witnessed the detrimental impact on healthcare workers who raise serious patient safety concerns — be aware — it is a sad and shameful phenomenon. It seems counterintuitive that any organisation with ‘care’ at its core would not respond positively and directly to issues of patient safety. However, hospitals reacting in the negative way they often do, do so because acknowledging and addressing flagged issues would reveal wider and more serious systemic flaws within their organization.

Organisations often resort to unhelpful solutions to governance issues. The frequent use of NDAs in compensation settlements is a clear indicator of underlying problems within any institution raising immediate red flags for those responsible for overseeing financial governance.

The departure of highly skilled staff from the healthcare sector when they flag poor clinical governance practices is a significant loss. Such individuals are often clinically competent and deeply committed to patient safety. Their loss is particularly tragic, given the current shortage of trained personnel, the backlog of activities post-COVID, the limited public funds available and the frequent emergence of NHS healthcare malfeasance. Institutions often have short memories, and when a poor culture prevails, identical incidents tend to recur at the same hospitals over the years. This perpetuates a toxic environment that compromises staff wellbeing and reinforces ineffective governance.

Within healthcare institutions, those charged with safeguarding standards should direct their influence to support the integrity of the entire system. Patients trust healthcare professionals and institutions with their lives, and breaches – whether through active malpractice or passive negligence — undermine public confidence and endanger patient safety. The lack of adequate support and protection for clinical staff when they raise issues of patient safety, highlights the need for robust, transparent, and independent mechanisms to handle and address safety concerns within healthcare, ensuring that those who speak out do so in an environment where the primary focus remains the well-being of patients.

So, where does this leave us? Is this issue too complex to address effectively?

Can we have an NHS that is characterised by transparency and fairness in governance, the frequent promotion of committed individuals to top positions, staff recruitment and retention, and institutional acceptance of gold standard care? Strong leadership and exceptional wisdom are required to deliver this and should be at the heart of a publicly funded healthcare system.

Are there still more questions than answers?  The answer is here …Let us all work towards and promote a culture that will foster openness, prioritise quality, support patient safety, and deliver good clinical outcomes. It is time for all stakeholders – NHS managers, clinical leaders and staff – to recognise that transparency around incidents, accidents and clinical errors, will lead to better care, better patient outcomes and a happier workforce. The need for change is not coming…the time for ‘good change’ in the UK’s NHS is Now.

References

https://www.bbc.co.uk/news/uk-england-merseyside-66668023
https://www.bbc.co.uk/news/articles/ckgvl8l5q0xo