Ken Lownds on Curing the NHS

Ken Lownds

Born in Longton the most southerly of the six Potteries towns and attending secondary school in next door Newcastle–under–Lyme Ken left the Midlands to read Classics at King’s College London.  His career splits into two phases, first a twenty year spell in ground operations roles in the airline industry, and then a similar period running, with his wife, a management consultancy specialising in and organisational change.  Warren Lownds Limited has worked for a wide range of organisations in a variety of sectors.  In 1997 the company helped its client BAA plc to win the prestigious “People Management Award” for extraordinary efforts of teamwork during the construction of the Heathrow Express railway.

As a child Ken had strong family links with the former North Staffs Royal Infirmary now part of the University Hospital of North Staffordshire (UHNS); as a coalminer his grandfather was appointed to its management committee to represent the interests of local workers when it was absorbed into the NHS in 1948.  Returning to live in Staffordshire Ken joined the Patients and Public Involvement Forum for UHNS in 2004 which led to his joining Julie Bailey’s group Cure the NHS in 2008.  After the death of her mother Bella in Stafford Hospital in 2007, Julie started the campaign for the Public Inquiry and for drastic improvement in standards of care in the NHS.  Ken has devoted much of his life to this campaign and will continue to do so until change is achieved

Here’s the test of a speech Ken Lownds, of Cure the NHS, gave at the Association of Surgeons of Great Britain and Ireland conference, May 2011

 

While I’m a member of Cure the NHS the ideas I’m presenting here today are mine and not necessarily those of the group as a whole.  Cure the NHS is non party political so we don’t care which party does the curing, we just wish they’d get on with it.

In much of what I say I’m referring to the NHS as an institution.

And of course I’m talking about acute care in NHS hospitals, just one element of NHS activity.

I speak respectfully of course.  I’m sure none of you would dream of treating patients the way they were treated at Stafford.

What proportion of our much-loved NHS is as rotten as I describe I don’t know but I suspect from the tens of thousands of complaints it receives every year, and from the many campaigning groups there are now, from staff surveys, from the behaviour we see on secretly – filmed TV programmes such as the recent Dispatches, and from Stafford of course that it’s substantial.  But it’s an indictment of the NHS that it cannot tell from hard evidence from minute to minute how well it’s doing.

The Nursing and Midwifery Council has a backlog of three thousand complaints.  A nurse talking about one of her patients as a twat.  How low have we sunk as a society when that can happen?  Who took the nursing out of nurses?  They and their leaders.  From the antics I saw at the RCN conference a few weeks ago neither they nor their leaders realise it yet.

Today’s session – early warning signs of a failing trust – let’s not have any failing trusts – or hospitals as I prefer to call them.  Look back in anger – well anger, despair, disappointment, grief, rage – I became involved in cure the NHS in October 2008 and since then with the other group members I’ve undergone every human emotion.  The dawning realisation of just how bad the NHS can be was the worst emotion.  The NHS in reality is not what we want and need.

I hope today I’m calm and ready to listen.  Life is a learning journey after all.

A community in crisis – a community that doesn’t know whether it has a safe hospital, it still doesn’t – it will certainly never be the same again – largely an adjunct of the University Hospital of North Staffordshire in Stoke.  Mckinsey are working on it as we speak.  We now know that UHNS itself was a whisker away from an investigation.  Saved by Cynthia Bower, not a fan of investigating failures.

The other alarming community aspect is how many people colluded with the hospital board to deny the problems, even the local MPs failed to respond to their constituents’ pleas, how many still attack our group and the idea of us, how many still deny the scale of the problem, and the scale of the excess deaths.

I’m a lay person.  I’m amazed and humbled by the technical side of your conference.  Papers about advanced techniques for repairing parts of the body I didn’t even know I’d got.

Definitely not lay when it comes to seeing how badly the NHS can do.  In Stafford it was awful.  I dare to hope it is now a little better.

I want you to turn your hospital the RIGHT way up again, unless it’s a private hospital, your hospital is not a business, its patients and the public generally don’t want it to be.  But of course it must be run in a businesslike manner.  Within the constraints of finance you and your frontline colleagues must shape and lead all that it does for patients, for their safety, for the quality of care delivered to cure them.

What upside down?  This.  This is a hospital as a tool of the Government, an institution, a bureaucracy.  Front line staff near the bottom.  Patients at the bottom of the heap.  Without doubt our NHS has been politicised and over the last decade became a political tool with politicians wanting to suppress any bad news.  The evidence is at the Public Inquiry.

This is the right way up.  Patients in the most prominent place.  Politicians at the bottom.

The triangle the right way up need two other vital elements to support it,

One.  The professional commitment of everyone on the front line of care.

Two.  The systems for safety and quality that have been part of so many other sectors.  Designed by you, enabling you and your colleagues to deliver the highest quality of care safely.

Getting the managers, executives, and non executives back in their proper role, supporting you, not creating a bureaucracy that serves only itself..

In fact all care always right first time.  This approach, this mindset is so well established across so many sectors I’m surprised it’s not come to the NHS long before now.  Well it may have come in your operating theatre but it is not part of the fundamental principles on which the NHS works.  High time it was.

Always zero harm, not zero incidents, not zero errors.  But zero harm.  The same applies as with right first time.  Zero defects was established in many sectors many years ago.  In the NHS it’s a moral issue as well as a technical one.

Executives and mangers cannot do it, Andrew Lansley cannot do it, David Nicholson cannot do it, David Cameron and his Future Forum cannot do it.

Only you and your colleagues can.

Only you can do it, with the help of your front line colleagues.

We need the professional commitment that is so evident in the hundreds of wonderful technical improvements being discussed in this conference applying to turning the NHS the right way up as well.

A fundamental change of behaviour across the NHS, focused on high quality care.  An end to the command and control style so familiar in the NHS with its attendant bullying and humiliation of whistleblowers, with its torturing of any patient or loved ones who complains with years of prevarication and procrastination has crushed the culture of care.

How do you make a start next Monday morning?

I suggest waiting for your board might be somewhat frustrating.

If you work in a team bring these ideas to your team.  What errors does the team make?  Is it individuals?  Is it the system that the team uses?  Is it the system imposed on you?  How good are you at feedback in the team?  To other members?  To the whole team?  Review all complaints, errors, incidents, and near misses.   Agree with your team that you will be fully open and honest with patients and their loved ones when errors are made.  Hopefully you’ll come out with some actions only your team need to take, and some you’ll need to take to other teams.

It’s vital that you take capability into account.  Capability of skills, capability of resources.

Get all the teams across the hospital to do the same and to begin to fix the problems you find within your teams and between your teams.

This is really starting what’s often called a “culture change”.  In reality it’s just fixing things that have been festering for years.

Start to get that zero harm and right first time language used all day every day.

Get the focus back to care of the highest quality for every patient.

Get a movement started across your hospital and start a staff side safety and quality group.  Feed into the formal governance structure.

Then tell the Board that you’ve changed your part of the culture and that they will be supporting what you’ve done.  At the same time implement two key changes.

First an end to the use of the word governance for what is really safety and quality.

Then ensure that there is a safety and quality manager, general, manager, or director with no line responsibility.  No line responsibility is key.

So this is a major influencing exercise.

Why should you engage in this?

Because it will deliver safer better care for your patients, so it’s good for them, that must be good for you, for your team, for the hospital, for the community, for the NHS.

Get out into the community as soon as you can and explain all of this to them.  We the public know so little about acute care and what you do to us.

share with your community your mortality ratios, explain to them how it work.  Take them through any serious complaints you’ve received, anonymised of course, and what action you’ve taken to ensure they will never happen again.  The same with serious incidents that have harmed or killed.

Hopefully this refocus on quality and safety should put an end to something I simply don’t understand.

You and your team make a first class job of an operation.  The prognosis is a speedy recovery.  A few days later the patient is in an awful state with bed sores and suffering from the effects of all the inept, unprofessional, uncaring, incompetent care which characterised Stafford.  Lying in faeces and urine, with infections, with bedsores, hungry, thirsty, crying out in pain, medication completely wrong, notes all in a mess, loved ones being told all sorts of nonsense.

Any hospital which treats any patients like that is a bad hospital with bad systems, bad staff, and bad leadership.

Could that be your hospital ?  Could it be one small part of your hospital?

If it is please get started on changing it.

May I remind you that it was just one one woman stood up to Stafford Hospital and gathered a small group round her who have challenged the whole of the NHS and the Government.

If the NHS is not for treating all patients without harm then it’s nothing.

Who if it is not you is your patients’ guardian, their champion during their stay?

A couple of systems are needed to support the change of behaviour.

One, a patient safety management system to set out accountability from the front line to the top of the NHS and to set the whole framework and philosophy for safety improvement and everything that goes with it.

Two; a quality of care system to ensure that we draw together all of the standards, protocols, processes, procedures, frameworks, and pathways, that enable every patient to receive the best and the same wherever they are in the NHS.

Finally I suggest a code of conduct for every staff member along these lines:-

“The whole objective of the NHS is to heal people, therefore my first thought at every instant should be how can I do this RIGHT first time, how can I do it without harming my patient?”

I understand that as a human I do make errors and in complex NHS care may do so from time to time.  But I will always make proper preparation in case they do and focusing my whole attention on my patients all of the time will eliminate most of them.  I will think through in advance the risks of every treatment action and I will ensure error avoidance routines are in place.  I will ensure action plans are in place in case I or a colleague does make an error.  I also understand that every patient is different and I will prepare for all robable reactions as assiduously as for my own or my colleagues’ potential errors.

I understand that this way of working has to be applied every second that I am on duty.

I understand that lack of attention and focus, sloppy and unprofessional working, treating patients without dignity or respecting, harming them in any way, being rude to them or their relatives is no part of the NHS.

I understand that if I act in such a manner I will be removed from the service.

I understand that the only way is to do everything “RIGHT first time”.

I understand that my prime objective as an NHS staff member and the prime objective of the whole NHS is to do no harm.

I understand that being a staff member in the NHS makes me very special because I am entrusted with the lives of my patients.  It therefore makes my job different from any other; it makes my workplace very different from any other.

I understand that when I come on shift I must behave very differently from the way I may outside the hospital.  The hospital is a very special place.

I will be special.”

I will ensure my patients are special”

Thank you.

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5 Responses to Ken Lownds on Curing the NHS

  1. Dee Speers says:

    A Code of Conduct is great if workable and of course we already have a statutory Code of Conduct for NHS managers http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4097226 (mainly ignored!) also Monitor has a Code of Accountability I am informed and Mandatory Guidance http://www.monitor-nhsft.gov.uk/home/our-publications/browse-category/guidance-foundation-trusts/mandatory-guidance-0 (is this being implemented?
    PHSO Has published Principles (which are endorsed by most public bodies) but mainly ignored!
    We already have Whistleblower policy which allegedly offers protection…mainly ignored too!
    Like a teacher with unruly students, maybe we need to help the learning by strict statutory guidance …..implement the rules keep the focus let the learning of lessons begin!
    Only other option I fear is “do what we keep doing and get what we always get”

  2. j.ooms says:

    Fantastic speech and good work Ken, but it is a dream. It is like saying to people “You must not steal” or “You must not kill”. Yes, codes of conduct or changes in attitude or culture are ideal aims but we still require laws, rules, and regulations because, despite our education and religion and training and philosophies and ethics, people still lie, deceive, and cover-up wrong doing no matter who they are and what experience or qualifications they have. It is the NHS Complaint Procedures that should identify errors and negligence and be able to ensure that improvements/corrections are made. Unfortunately, there is too much latitude within these procedures allowing for cover-up. There is no enforcement for staff to be open, transparent, and honest about revealing evidence, and no accountability for those who are complicit in cover-ups. And the politicians who approved and maintain these procedures seem indifferent to those complainants who are denied truth and justice by those procedures. Yes, I am all in favour of a change in culture in the NHS but until that happens let us start with having a legalised duty of candour in the NHS and public (state-financed) prosecution for those who are complicit in covering up negligence and thereby preventing neccessary improvements/corrections from being made and denying patients and complainants from obtaining justice.

  3. Ken, to quote: “Loved ones being told all sorts of nonsense”. Not that many members of the public realise that this is and has been the routine mode of conduct within the NHS for many years. Possibly derived from the outset when there were more snake oil salesmen and quacks about than true medics.
    The public is very gullible, and more so when they are motivated by fear. Fear of a loved one being not looked after properly if they ‘rock the boat’ is a powerful incentive toward beleiving any rubbish spouted at them.
    The medical profession as a whole has to change and change fast. We have the information to hand now. If things go wrong we enquire. We discover. We become incensed when we discover we were lied to. Clearly unequivocally knowingly lied to. That is why we must have a Legal Duty of Candour in statute. Everyone would then know that fiddling medical notes ‘for the best’ is wrong. Standards would rise as adverse events are properly documented. Avoidance of harm would then rightly take priority over ‘clever’ avoidance of discovery.
    We have had this discussion before. My perspective is clear, uneqivocal and understandable by all. Let us make it so for the future.

  4. David Gilchrist says:

    Ken, spot on!
    As a safety and human performance expert working in a high hazard industry (nuclear!) I was struck by Julie Baileys interview on the BBC this morning and your speech above.
    The issues, arguments, dismissals and objections are all entirely familiar to those of us working in the field. What I find utterly shocking is hat he NHS does not seem even to have started on the safety/quality/excellence journey – thirty years after it first hit most other sectors.
    Some of the reactions on this page are also evident of a lack of awareness of the very simple and well proven pathways to excellence.
    From your cv it seems you know of all this from the aviation industry.
    As you will be aware, what is needed at these first stages is evangelism by champions, it occurs to me that this could be facilitated by bringing in experience from other sectors where the journey to excellence has already been travelled.
    This might be achieved by partnering arrangements between NHS institutions and industry. For example, there are nuclear, gas, aviation and chemical installations all around the UK, a plant could partner with its local NHS Trust and provide speakers, case studies, even human performance training (error prevention tools are totally generic).
    What do you think?
    DG

  5. T.Rashell says:

    This for me captures all the many concerns that face the NHS today. My father was a patient at East Surrey hospital after having a stroke. He had Parkinsons also. We placed our trust in the staff on the general ward he was eventually admitted to. Concerned about the distressed state he was in & reassurances he had been given his meds/fed he was bullied/starved to death and passed away on the 4th of December 2010. His experience is the one mentioned in this speech on the C4 Dispatches programme, concerned we placed camera by his bedside, later we saw evidence of bullying and contempt for vulnerable patients. Our worst fears confirmed. The culture in parts of the NHS is highlighted in many cases still but a fundamental change in leadership is still needed. Again Kens speech reflects our own thoughts/feelings after our fathers death.

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