Nick Summerton: Sickly health service in need of proper cure

FOR five years I ran a single-handed practice in West Yorkshire. One of the things that I shall always be most proud of was that the staff I recruited when I started were all still there long after I had departed. Without realising it, I had built a highly motivated and committed team.

When we all arrived at Skelmanthope in May 1989, the records system was inadequate, the dispensing and prescribing of medicines was chaotic and there was a complete absence of any equipment including an ECG machine or a computer. By 1994 the practice rivalled some of the best across the area. It has gone from strength to strength ever since.

Back then, as a team, we all knew what we were trying to achieve for our patients, and what I also learnt as a very young GP has stood me in good stead every since. It seems to me that motivating staff is about trust, understanding and listening as well as actively responding to suggestions, ideas and concerns.

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People also have feelings and everyone likes to be appreciated. Consequently the importance of simply saying thank you can never be underestimated.

I have never been particularly adept at organising social events or choosing expensive Christmas presents for staff but this has always seemed to be less important than doing a good job for the people I have worked with.

Nowadays it really saddens me to see how de-motivated many clinical colleagues within the NHS have become. According to this week’s report from the King’s Fund, even NHS Trust finance directors are now becoming concerned about staff morale.

Working in healthcare ought to be rewarding and interesting; yet, all too often doctors and nurses feel overworked and under-appreciated. In 2013, over a third of NHS staff had reported being unwell as a result of work-related stress. Amongst nurses, the figure was 55 per cent.

The way staff feel about their NHS workplace matters as this also has impacts on the quality of patient care. Recent research has demonstrated a correlation between staff satisfaction and death rates in addition to a clear link between staff experience and patient experience.

Sadly many middle-ranking NHS managers have little direct experience of patient care and, consequently, do not seem to understand how to motivate their clinical colleagues. Part of this problem seems to be a lack of any genuine appreciation as to what the NHS is actually there for – to care for patients.

For example, I was invited by some of our local NHS managers to become involved in a ‘communications and involvement’ initiative. However, when I suggested that it might be a better idea to spend the time and resources improving some of our local clinical services, I was accused of holding ‘very negative views’.

In another report published by the Point of Care Foundation they highlighted an intriguing dissonance between clinical and managerial views about communications. Although only one-third of doctors and nurses thought that communications with senior mangers were effective, the NHS managers reported a far more positive outlook. The latter group cited clinical engagement as one of their top priorities.

I believe that the time has come for doctors and nurses within the NHS to be freed from managerial constraints to be allowed to exercise common sense and to use their clinical intelligence.

One model for how this might work is provided by Hinchingbrooke Hospital near Huntington. Within this hospital, the executive board is now dominated by doctors and nurses and the chief executive is an obstetrician. Only three of the 14 board members have non-clinical backgrounds. Nurses and doctors have been permitted to innovate and run things with improvements in patient wellbeing. For example, a senior clinical nurse on one of the elderly care wards has done away with the nurses’ station as she felt it made the nurses too remote.

NHS managers and management processes have effectively turned the NHS into a sick organisation – the time has come for doctors and nurses to cure it before the decline becomes terminal.

• Dr Nick Summerton is a GP in East Yorkshire.