In July, the Dash Review of patient safety across the health and care landscape was published and highlighted the messy and overlapping ecosystem surrounding improvement of safety and quality in healthcare. Inevitably there were things that fell between the gaps and plenty of duplication, overlap and a general treading on each other’s toes. Anyone who has scratched the surface of this area will be familiar with this jumbled landscape.
The review recommended that the guardian role continues, and in some ways, it could be seen as being strengthened through a shift towards local oversight by providers and commissioners. However, the effectiveness of this approach will depend on how well the role is supported and resourced locally. Meanwhile, the core functions of the National Guardian’s Office are expected to transition into NHS England and, eventually, the Department of Health and Social Care, though the final arrangements are still being confirmed.
At the heart of these changes is a group of people who are dedicated to making things better. Making what better? The simple answer is: “Anything that gets in the way of doing a good job”, which includes patient safety, staff experience, interactions with colleagues and so forth. Anything that you would ideally speak to those around you and your seniors about if you weren’t happy, but for some reason don’t feel able to.
Without exception, every guardian I have ever met has been motivated and resolute in trying to do support this process. A recent survey across guardians nationwide reported that 9 out of 10 would recommend the role to others. This compares to the NHS Staff Survey where an average 60% would recommend their organisation as a place to work. This difference is impressive. Something must be right about what the guardians are trying to do.
Personally and this is very much a personal belief, I believe that there is an epidemic of learned helplessness in our workforce. The impact of this sense of futility has a huge personal and professional negative impact. I believe that speaking up is part of the solution to this. It is about not just listening but learning and closing the loop. In fact, following up and actioning is not only the theme of this year’s Speak Up Week – but it feels like the key bit of the jigsaw.
At the same time, it is important not to shy away from the criticisms when it comes to listening and learning from concerns – and this includes the Freedom to Speak Up process. Let’s face it it doesn’t work for everyone. Sadly, some people find speaking up totally useless and we must learn from this and not ignore this inconvenient truth.
It is not a one size fits all solution. But, what in healthcare is?
My experience of being a guardian has been two sides of a coin. It has been heartening, rewarding, and part of the solution to a system that is challenged in every single way. It has opened up conversations and dialogue and helped people have hard conversations and be heard. It has also opened up cans of worms left, right and centre and this in its own right can create tensions. But also learning. And this learning includes personal learnings. I can honestly say that every case has taught me lessons and given me new insights.
It is also sometimes stressful, lonely and downright tough.
There is a phrase in the bible, “Physician, heal thyself” (Luke 4:23) highlighting the need to look after oneself in order to do one’s job. And this includes the connection with others doing the role who genuinely inspire me with their sense of purpose and dedication, and provide the support and community to do this work. They also make the stress, the loneliness and the toughness bearable.
If I was to fast-forward to what I think the future state for guardians should look like, I honestly don’t feel strongly as to whose jurisdiction I’ll sit under or who’ll check that I do my training. What matters to me, is that I continue to be given the tools and authority to support those who need the support offered. And alongside this, a degree of connection to others doing this work to not only energise me, but sometimes just to understand how hard it can be. No actions, no closing of the loop, no learning. Just listening. Which is ironic given this is the exact opposite of what guardians do.