Posted by: ayrshirehealth | December 11, 2013

Food for thought by @ptupdate

Food for thought

During the summer a good friend who had been suffering chronic stomach pain for some time was diagnosed with kidney cancer.  Not yet 40, this came as something of a surprise: to her, to her GP, and to her family and many pals. Summer sunCaught early, it was operated on, and her prognosis is good. But her experience has been illuminating, and inspires much food for thought.

For my friend, the process has been impressive – her GP, unable to get to the root of her symptoms, made a referral to a gastro-specialist in a large teaching hospital; that specialist had the skill to spot that he wasn’t the right person to investigate further, and passed her on to a kidney specialist; scans revealed a tumour, and just on the right side of the waiting time limit, the operation took place.

Of all the many health professionals that she encountered, there were only two who fell short of expectation on the patient experience front – a radiographer, whose shock on discovering the lump was palpable and scarily infectious, and a nurse in HDU who snapped ‘shut up ’ when pain control wasn’t working.

Luck won’t have to come into it

My friend is now on the road to recovery. She’s forgetting the post-op pain and the wound-repair niggles, but she can’t get over how many people – including her GP – who have told her just how ‘lucky’ she is.

My friend was indeed lucky: Lucky to have a family doctor willing to refer her on, lucky to have been referred to a specialist (she calls him ‘the miracle man’) who spotted where her problem really lay, and then lucky to be handed on to a crack surgical team. It shocks her – and me – to consider what would have happened if good fortune hadn’t gone her way.  Maybe I am being naïve, but I sincerely hope that the herculean efforts that are being made to continually drive up quality in our wonderful NHS will one day mean that luck won’t have to come into it.

Twitter

TwitterSo, when I was scrolling though Twitter as this was all unfolding, and I came across this Tweet – “Did a GP out of hours shift tonight. The NHS can be incredibly good…

– I felt the urge to respond. In reply, I wrote: “Is ‘can be’ good enough, though? Needs to be reliably amazing… can be that!”

The responses – from people who weren’t the original Tweep – took me by surprise. Basically, I was wrist-slapped for not appreciating the positive, and reminded that the “#assetsbasedapproach has a lot going 4 it”.

Do you know, I thought that I was accentuating the positive by acknowledging the capacity of Scottish General Practice to be amazing for even more people, even more of the time. Must have been the way I said it that came across as off-message.

Are rose-tinted glasses now an essential?

Since then, it has occurred to me there may have been a directive issued, stating that rose-tinted glasses are now an essential part of the NHS kit. Rose tinted glassesI have been testing this hypothesis by the medium of Tweet, and it seems there can be no public statement made these days that implies room for improvement, or challenges the prevailing group-think, without an ensuing ticking-off accompanied by a hashtag along the lines of #positivethinking.

Now, I know that I am particularly sensitive to spin, but this strikes me as slightly disconcerting.  I am all for recognising and applauding the great work that our wonderful NHS in Scotland delivers day-on-day in communities up and down our land.  I hope my track record is testament to that.  But I also think it is vitally important that we are all (members of the public, patients and their carers, health staff and yes, even journalists) able to call it as we see it, and thereby support the national push for improvement in our own sweet way.

Accepting that there may be things our NHS can do better does not mean trashing the vast majority of activity that goes so very well. Indeed, there is a danger that the other approach can backfire. Take the apparent presumption that everyone working in health and social care needs to brush up on person centred care: in my experience, and that of my friends and acquaintances (and that’s as scientific as my evidence-gathering gets) it is the minority that lets everyone else down, and it is they who need to be taken aside and worked with intensively. By not acknowledging that, there is a danger that all staff are smeared with the suspicion that they too don’t care, and have to be taught how. I know quite a few who find that deeply insulting and demoralising.

The experts in identifying those whose inter-personal skills need to be improved are the service users who feel it first-hand. And we have been making real strides in gathering their views, and giving them confidence that they are being listened to. Part of that trust-building involves embracing room for improvement, and publicly.

Honesty and openness.. might be uncomfortable at times

The Francis report, Keogh and Berwick, all promote the pursuit of unvarnished honesty and openness, and want the culture of organisational paternalism to be consigned to history. Not to act – in spirit and in deed – on their recommendations is to betray the trust of all the people who want to believe the NHS can shift from being self-protective, and demonstrate that it is really putting consistently high-quality care at the top of the priority list.

Francis wants openness and constant scrutiny from all perspectives. Sure, that might be uncomfortable at times but so be it, in the interests of driving up standards of care. Instead, though, there are parts of our health service apparently closing ranks and preparing to repel outsiders, no matter how well-intentioned.

Patient Opinion

patient opinionTake the online feedback service Patient Opinion: accessible, open, carefully moderated, with a track-record of using experience to shape change, it can only be a good thing, no? Not, it seems, for all: NHS England, and some Scottish health boards, seem hell-bent on developing copycat in-house systems that cannot hope to deliver the independence and impartiality that underpins the Patient Opinion model. Never mind the wasted costs associated with duplication. Once again, the system acts to exercise control.

Deep frustration with the media

There is also a deep frustration with the media being expressed within the service, and allegedly unfair treatment meted out by journalists. But is that a case of shooting the messenger? The coverage I see is very often informative and positive, and I would personally like some proper analysis of the proportion of the good and the bad, along with forensic investigation of what goes wrong when that does happen. Knee-jerk assumption that the media is out to get you is just not good enough.

There are empires within some NHS organisations whose survival depends on maintaining an impression of us-and-them.  Macho types like it to be thought that they practice dark arts to trip up troublesome hacks.  Indeed, I have heard the tough times that our news organisations are suffering being greeted with glee  – even by former journalists who ought to know better. That causes me alarm. A healthy media is indicative of a healthy society, and while any inaccuracies must be corrected, reasonable comment and responsible scrutiny ought to be actively supported. Indeed, if anything, the NHS should join in the debate more openly and more effectively – not be tempted to appoint costly lobbyists to spin things even harder, as I understand is being mooted by at least one Scottish health board right now.

Think of every major NHS scandal you know – action has only been taken when the media has doggedly exposed it. It’s scary to think what might happen if that particular watchdog was muzzled for good.

Our health service is constantly evolving and, yes, growing stronger. And so is the voice of the people who use it, love it, and rely on it. In the past, they may have had no choice but to wait to be invited to share what they think. But those days have gone. Now, you just have to scroll through the Twitter feeds or scan the stories posted on Patient Opinion, to monitor the experience of an increasingly informed and sometimes pesky public.

Instead of reacting defensively, a confident NHS would embrace all discussion about how it delivers its services. And if it was truly person centred, it would allow me to express myself in any way I choose – not attempt to tell me what to think, and how to think it. #Justsaying.

This week’s blogger @ptudate (Pennie Taylor) is an experienced journalist and health communications specialist. Pennie is a renowned champion of public and staff involvement in Scotland’s health and care services, former Health Correspondent for BBC Scotland and Health Correspondent (and Associate Editor) at the Sunday Herald newspaper.

Comment

Comments on the blog are very welcome, either by adding them directly onto the blog itself (click the ‘leave a reply’ icon below): or via Twitter by including @ptudate #ayrshirehealth in your tweet.

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Responses

  1. Have just read Pennies very salient words and had to leave a comment from the train, so true. We do need to be able put on our rose tinted specs to survive with emboldened souls what would be a relentless and very dark place, to motivate and engage to harness positivity and appetite for continual change or more importantly continual improvement. We do also need however the confidence and bravery to be honest in its purest unvarnished variety and to recognise this as opportunities where we are duty bound to improve . Yes, our NHS is wonderful and full of commited, skilled staff but we also recognise it can be so much better.getting the balance between helpful and unconstructuve positions is the key.

    Well done Pennie for a thought provoking piece

    • Thank you for your kind comments. Great to have you join the discussion… need to keep talking about it!

  2. Agree with the previous comment – a well written and thoughtful piece form Penny

  3. Pennie

    I enjoyed your blog and the challenges within it, the very fundamentals of our NHS journey of improvement are in your blog, including the elements we struggle with. However I wonder if the ‘rose coloured glasses’ is a two way street and is depending on where you are standing. I have no doubt there are some within the NHS who are less than open and less than transparent in their approach, they may indeed “practice dark arts to trip up troublesome hacks” – I wish it were not so. However, perhaps some in the land of journalism need to adjust their ‘rose coloured glasses’ with regard to their colleagues, a fact we see clearly played out in Levisson.

    I have been on a conference panel being quizzed by you, I have seen you chairing numerous other conferences and NHS events, I’ve heard you being interviewed – to my mind you challenge where it is required and praise where it is due. Perhaps your own inherent professionalism and fairness impacts on how you see some of your colleagues?

    I have no doubt that ethical, investigative journalism has been responsible for exposing some horrendous and indefensible events; for that we as a nation and individuals within it should be grateful. I fear however that there is a cohort of your colleagues who aren’t interest in exposing truth, or uncovering injustice, they are simply looking to grab the next sensationalist headline. As an example I’d cite the recent Sun headline related to mental health – neither balanced, fair or accurate, simply stigma being stoked for sales.

    Perhaps we have much to learn together, and perhaps you and I are reading the same book, if not quite on the same page – how we will get others to join the library?

  4. Great to share your perspective, Derek. I am not an apologist for the worst journalistic excesses, but genuinely believe Leveson-type approaches to be vanishingly rare – a bit like Mid-Staffs doesn’t represent all care, no? However, I am deeply intrigued about the perceptual gulf that exists between many working in healthcare and the media… why is there such suspicion? How can we bridge the gap, and gain a better and more productive understanding of each other’s roles? Clearly, there will always be a challenge posed to health providers by the media – that, after all, is the news role. And as you say, used properly, it is an important role in a healthy society. The scrutinised have to be able to justify their actions honestly and openly – there ought not to be anything to hide, or spin for that matter.
    I am not naive about the anxiety that exists – I was, after all, a Head of Comms in the NHS for a couple of exciting years. But in terms of developing a new and hopefully more mutually-respectful and better-informed relationship between the NHS in Scotland and the media, I think there is serious work to be done. For a start I would like to see some proper investigation of assumptions that it’s all ‘bad news’. Could some of the reaction be over-sensitivity to fair comment, and the non-clinical language that is used? How much of the criticised coverage is down to badness, and how much to misinformation or misunderstanding…? Or is it just a difference of opinion about how to put things and what to focus on?
    I know what you mean about Sun headlines, etc. – and it is absolutely right that we each respond to anything that we find offensive. In the SM age, that sort of protest really works. But when it comes to differences of interpretation, things get much more tricky. That doesn’t mean we ought to give up on exploring it all, though.
    So far, I have had one response to my blog accusing me of being a sensationalist journalist… that doesn’t take the conversation very far. How can we keep it going, for the benefit of our NHS and those who depend upon it?

    • Speaking as a citizen and someone who works in the NHS, my view is informed by my perception of lack of balance in reporting. News, by its nature can be good and bad, it is significantly less common to hear a front page story of where the NHS has done a great job – presumably because that’s why we are there anyway, and of course it’s likely to be far less dramatic.

      Almost every morning I listen to BBC GMS on my way to work, I hear a story, sometimes someone being interviewed and then a few minutes later the headline that is attached to it, and I think ‘I just listened to that interview, how did you twist that negative headline from it?’ It seems they can’t help themselves, it’s a rush to reduce it to a dramatic sound bite.

      When this is applied to an NHS story I get even more disappointed as it diminishes people’s perceptions and beliefs in our NHS (the unintended consequence?), perhaps the day before they are admitted for a life saving operation, or a relative has been rushed into hospital.

      The excellent investigative journalism that truly uncovers injust and wrongdoing, that asks probing and difficult questions is a invaluable asset in our society – I’m just not sure we see it very often on a day to day basis.

      I have not (personally) seen overreaction to fair comment, however perhaps it is our understanding of what ‘fair’ is that differs. I think it would be a great idea to get into a room and explore these perceptions, we’ve done it with the police and now understand each other more (but don’t always agree) and the Fire & Rescue Service – could this really work with journalists?

      • There’s an old newsroom adage ‘good news is no news’. And ‘good news is what you should be doing…’, ergo bad news is about highlighting failures, or perceived failures. I agree that it is important that there is proper balance, but that might mean different things to different people. Fairness, ditto. Again, I would like to be talking about real examples of news coverage that NHS insiders find problematic, so that we can explore different perspectives. And I do think (hope?) that there would be an appetite among journalists to engage in the discussion, if the right approach was taken. Do you reckon there would be inside NHSS?

  5. Thank you for writing this blog post Pennie. I have a particular interest in this topic so I thoroughly enjoyed reading it (a few times). I have quite strong views about this which I have presented below. These are however, my own views and therefore I am happy for them to be challenged. They have not been made to cause any offence.

    Firstly, I want to agree with you and the other comments that we do have a fabulous NHS and some very dedicated and skilled staff – and I have experienced this as a healthcare professional and also as a patient (on a number of occasions). On the flip side, unfortunately there are also some not-so dedicated and skilled staff – which I have also experienced as a healthcare professional and a patient. This is also true in relation to journalism, as Derek pointed out. I offer no excuse for this.

    However, I couldn’t agree more with the statement “knee-jerk assumption that the media is out to get you is just not good enough”. When I was an infection prevention and control practitioner before coming into academia, my opinion would have likely differed. I was fairly anti-media and was often frustrated by dramatic headlines such as ‘superbug kills 8 ’ or ‘dirty hospitals and killer bugs’, which I saw only as an attempt to crucify the NHS, our good work and create mass public panic. As a result, requests for media interviews were often ignored.

    My views however, have changed significantly. This has been largely influenced by speaking to a diverse range of local, regional and national newspaper journalists and editors not only about their roles, responsibilities but also about their challenges and barriers of reporting health-related risk stories. My view is that all too often (although not always) reactions to media coverage of adverse events is a case of shooting the messenger. The public have a right to know what is happening in their NHS and the risks that they or their families may potentially face. If something was happening in my local hospital I would certainly want to know in case I needed to take specific action to protect myself or my family if exposed to a particular risk.

    The media is and will remain a key source of information for the public. Viewing the media as the enemy and trying to fight against them is not only a dangerous game to play but also full of missed opportunities. Working with the media on the other hand can create unique opportunities to engage with people in an open, honest and transparent way so that the right messages are provided to the right people at the right time. If healthcare professionals do not fully engage with the media, then naturally journalists will seek information from perhaps less informed sources. Consequently, this can result in a less than accurate representation.

    I have no doubt that such engagement is not straightforward. To help achieve this, in my view, healthcare professionals need to have a greater understanding of the role and responsibilities of the media, and also their challenges. Additionally, an understanding of what their role is not. Their job I believe, is not simply to echo policy maker’s advice or become health educators. At the most basic level, it is to communicate to their readers (in a way that is easy to understand), what is going on around them.

    Media coverage we know, plays an important part in influencing public and political agendas and can be crucial in helping drive forward change and improvement. Yes, we would be naive to say that dramatic and sensationalist headline/stories can be prevented – we need to accept that this will continue to occur. The public will also interpret media coverage as they want to (based on a whole host of other variables). What we can also do is understand how the media represent an adverse healthcare-related event and use that to challenge potentially unwarranted assumptions and to inform further communication strategies.

    Apologies, I still can’t get the hang of brevity 🙂

  6. Emma, you write beautifully and powerfully. And I find it so refreshing to read your views on this. I wish more people could access this blog, and more importantly, the responses to it… how do we go about engaging more folk on both ‘sides’ in this important debate? Food for thought indeed!

  7. Thank you for your kind words Pennie. I totally agree that this is such an important issue which warrants much more engagement and healthy debate from a wide range of individuals/organisations. Will continue to promote and think about other ways in which this can be achieved.

  8. […] Taylor provided Food for thought on the Ayrshirehealth blog about attitudes to standards in the National Health Service, looking […]


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