The culture was the diagnosis

Over the last decade the NHS has seen quite a bit of me and my insides for one reason or another, all pretty routine, don't worry. The thing that has always stood out is that every single person who has treated me through all this has been excellent. They've been skilled, caring, and unhurried even when it's clear from the pressures all around that they aren't unhurried at all. My mother spent her whole working life in the NHS, and I don't think I've ever met anyone who cared more about other people's wellbeing. So nothing in what follows is about individual clinicians or carers. It's about what happens to good people inside a system that isn't looking after them properly.

As someone who works in trying to improve workplace culture, the Ockenden Review into maternity services at Nottingham University Hospitals, published last month, makes for difficult reading. Over two and a half thousand family cases were reviewed. More than 500 families and 830 current and former staff were interviewed individually. Nearly 90% of staff surveyed said they didn't have enough people to do the job safely. More than four in ten said they had witnessed or personally experienced bullying from managers or colleagues on a regular basis.

Donna Ockenden didn't mince her words. This is what happens, she said, when leadership fails, when governance fails, when a culture develops in which bullying is tolerated, concerns are suppressed, incidents are downgraded, and the voices of women, particularly the most vulnerable, are systematically dismissed. Tellingly, the review doesn't lay the blame at the door of individual midwives or doctors. It points at leadership, governance, and culture, the same three words I'd use. Astonishingly, clinical negligence is costing the NHS almost the same in legal compensation as it spends on the delivery of maternity care itself but the report also highlights underfunding and understaffing as factors too. So the funds are there if they could only be invested in the right places.

Since I started publishing content on workplace culture on YouTube, it's been striking to me how many comments I get from people who work in health and social care sharing terrible experiences. The Ockenden Review publication last month inspired me to look back through the comments. They come from people working in nursing, midwifery, domiciliary care, both in the NHS and the private sector, here in the UK and all around the world. A nurse with twenty five years experience said things had got worse and worse, that she now works in a "climate of fear" where managers "crucify you when it suits them." Another described being called into a meeting after a night shift, three hours' sleep, sixty clients on her books, and being told she'd failed the company. Someone described a "holy trinity" of colleagues who made a workplace hell for anyone outside their clique. One said she'd raised concerns about how a vulnerable client was being treated and watched the culture simply absorb it and move on.

Nobody (I hope) sets out to build a culture where a care worker running on three hours' sleep gets told she's failed, or where a review panel gets described as intimidating and dismissive of anyone who isn't a senior clinician. It happens over time, through a thousand moments where someone with power chose control over transparency, and nobody senior enough was willing to bring poor behaviour into the light and change it.

I get impatient with the idea that workplace culture is a soft subject, something for the away day, something you can only make time for once the "real" tasks of meeting targets is sorted. Culture is the real work of every single day. It is part of the system through which safety either happens or doesn't. A workforce that is frightened to speak does not produce safe care, however skilled the individual workers are. It is good that Ockenden, and the families that fought to be heard, have brought all of this into the light and I hope that change will now come.

What am I reading? 📚

JRCT has hired Professor Keon West to lead its work on reparations. I'm reading his book, The Science of Racism, which systematically provides proof that racism exists (for those that question this).

What am I watching? 👀

Cape Fear and Cape Fear (we did go back and watch the old ones and now I want to do a road trip in the USA's Deep South!)

What am I listening to?👂

The Democratic Republic of the Congo is Africa's fourth largest nation and I would guess many of the England football fans watching what was a tough match against them in the World Cup don't know much about its history. I don't know much but I do know a little of what was a very dark stain among the world of stains that make up colonialism. I thought I'd listen to some history to educate myself some more.

Joy-giving things 😍

OK - onto some joy.

We've invested in a night vision camera to see whether we can spot our nocturnal visitors. We were hoping for hedgehogs but so far we've spotted our own cats, a neighbour's cat playing with a young fox, something in the distance which could be a badger but might also be a squirrel, and a muntjac deer!

Have a great weekend everyone

Lucy

I've been writing regular blogs since 2020. If you want to go back and look, they are all here.

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