Tuesday, March 10, 2015

NHS Change Day...the good, bad and...

Be honest...you have started reading the blog with a degree of intrigue or trepidation- depending on whether you believe in the principle of NHS Change Day..or not- right? It's not unknown that I am a cynic to a degree though my past blogs have tried taking the route of friendly criticism rather than disdain. So let me ask you to be a bit disappointed- this blog isn't to rabble rouse but an opinion from someone who has been a Consultant for 7 years, someone who works both in acute and  community providers, someone who has traveled the breadth of the country talking about "working differently" ...so a bit of experience of change.

Th debate has raged...why this tag, this label in a climate when Kirkup and Francis exposes the NHS warts and all, why this initiative when whistle-blowers are yet to be given their just due..why even pledge to do things when we should be doing some of those pledges as part of our usual work? It's been fascinating to see both sides of the spectrum as the proponents have said this is exactly what the NHS needs- something to help it heal.

So how has it been over the last 12 months? Let me give you a personal perspective, my experiences, my dealings with NHS Change Day...

The Good:  There has actually been a lot of good. It would be wrong to doubt the commitment of those who have volunteered their time to do this, it inherently comes from a desire to improve things- and that, in my view, should not be sneered at. 
I appreciate I have been provocative but among all the people involved, I know a few, don't know quite a few too- but there burns, unquestionably a desire to improve things. It comes through in blogs, their willingness to engage on twitter and a fierce willingness to stand for the value of the NHS. So yes, there has been good- there has been a collective of the willing to "make it happen".As eloquently as ever, Damian makes his point- and indeed is a good one, a balanced one. It gives you, perhaps an insight into what NHS Change Day should be- a force for good, maybe not to the taste of all- but most certainly an ally for all of us who want to improve care- albeit in our own way

The Bad: However, as ever, every initiative will have its drawbacks- and the biggest one - which has been picked up, time and again, has been the "with us or against us" view- shown up on twitter or otherwise. 
It is getting better but efforts to engage or question has met with varying degrees of defensiveness or surliness. Recently when I asked "convince me" one of the answers was "why do you think we need to convince you?"...well, for starters, I am a Consultant in the NHS who is trying darned hard to improve diabetes care- so do, please try. 
It made me smile but that is exactly what has switched off a lot of folks too. You want to be inclusive, do it properly- not by surly thoughts in 140 characters.  Finally, for this category- a huge play has been made of volunteering- the NHS is surviving on good will and volunteering-it has been ever thus- and will ever be.Someone on twitter said.."we all find time, so should you"...a retort to that would be simply juvenile

The Ugly:  Actually there is no "Ugly"- when you have a group of people trying to improve good- there can't be anything "ugly" about it. But there is one thing- its' called the "Hijack". Last year, in my blog, I had mentioned the importance of the original founders holding on to this concept- right now, it's now an NHS IQ project- or at least that's the perception. That makes it all shiny, official, pretty but also laced with words and jargon most people can't understand or switch off to. Some of the biggest workforce in this country or at least the spearheads are Consultants and GPs. How many do you see actively engaged in this? Is it because they don't care, don't have time or simply have had enough of NHS speak jargon which means little-as per their past experience with NHS IQ and the ilk?  Is NHS Change Day now simply a project run by official body which has hijacked anothers concept? Is it alienating people or drawing more to it? That's the question that the organisers need to think about or consider. Do the "hubbies" believe this is their project anymore- or as one of them asked me  not too long ago- "should I stay with it anymore-as it feels like being taken over"?

In the world of twitter, NHS Change Day is a big thing- in the real world, it perhaps isn't. I have done a snapshot of 50 staff recently- inclusive of medical students, Consultants, nurses (senior and junior), pharmacists..total number of folks who had even heard of it? 3. Twitter is NOT  a reflection of the broader world- if it were, the HSCA would have been repealed, the Liverpool Care Pathway would have stayed, the NHA party would have been in Downing Street and oh yes, Madonna would have retired. Mutual backslapping or tweet chats may convince yourselves, not the broader world you need to convince

So, pause, think and see how you can take things forward. Try this simple example. Where you work- can you, hand on heart, stand up and raise patient safety concerns without concern of reprisal? Are all the modalities of safety for patients covered? If not, charity begins at home. Hold fire on changing the whole NHS. Just change 1 thing where you work- let that be openness regards patient safety. 

The day you can do that, you can call that day NHS Change Day. Till the day we can prevent the James Titcombe's from losing their loved ones, a clever tag will remain only that. So feedback from a Consultant? A good project which has legs but needs to be more inclusive, a bit less jargon-fuelled and perhaps even less centrally driven by a national body- try that and you may, just, win some of the doubters over.Doing good doesn't have to be done in any one particular way but it wouldn't be a bad idea for all those forces to at least have a loose alliance - the endgame seems to be the same- would make sense to do it together. 


  1. The people you see on Twitter are more likely to be like you... activists. The people you see in the rest of your life are maybe less activist. So what to do- try and get the debates that you see happening on Twitter happening offline too if you think they are important enough.
    I've never thought that NHS Change Day is about changing the whole of the NHS. It's exactly as you state- about starting to make small differences- about developing and supporting a culture where it is OK to speak up, to be seen to want to make a difference. NHS consultants and GPs have a lot of power already. Maybe they don't feel that they need an initiative like NHS Change Day to get on with changing things. But perhaps they should get involved to show that they believe that this is everybody's job,
    For me the NHS is about social justice. I passionately want to see sustainable health care. I believe that we all have a part to play in making that happen.

  2. I'm not an NHS worker, but I can totally identify with what is being said here.

    It is the same in any massive organisation, like steering that metaphorical oil tanker....you spin the wheel for what seems like an eternity and the ship slowly steers a different path, might not feel like it's changing direction, but slowly it does. I work for Royal Mail, so very large in its own right, though not as big as the NHS, and you can only ever focus in on your own area and demonstrate what change you can do there, and hope this enthusiasm spreads, which it will. Put your efforts into what you can change, rather than set your sights on changing the world....that would be too exhausting! Plus people don't always recognise change, they need to be reminded sometimes of all the great things that are happening in an organisation.

    If you pick the right subject, pull the right lever, everyone is an activist in something. Get them on-board, and they'll help you steer that oil tanker and maybe it will change direction just that bit quicker :-)