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David Pencheon: Don’t always put patients first.

26 Jul, 12 | by BMJ

David PencheonPatient health, patient experience, and health outcomes for individuals and populations should always be at the heart of the NHS. But the best way to actually achieve this most effectively might be to address it more obliquely.


Do you remember when some cabinet ministers (and their papers) emerged from 10 Downing Street and were caught on camera? One of the ministers had scribbled words to the effect of “we must put people first.” I thought this was rather good until Ian Hislop rightly pointed out that one really shouldn’t need to be reminded of this after so many years in public service and elected office. Similarly, although I can understand why we must strive towards a genuinely patient-centred health service (where the needs of patients should always come first), I wonder if that constant reminder doesn’t come at the cost of many staff feeling as though their needs come necessarily second. I heard the previous chair of the John Lewis Partnership, Sir Stuart Hampson, speaking recently at the NHS Confederation’s Annual Conference say much the same thing. (Some people in our family have a close association with said partnership and some with the NHS, and one works for both, so I am always keen to exploit this at the supper table.) Sir Stuart told countless inspiring stories of customer service; but when he was was asked how staff were trained to do all these outstanding tasks, he said they weren’t actually trained to do them. He ascribed such behaviour to a strong value base and culture in the staff and to deep seated “employee engagement;” all clearly borne out of the fact that the enterprise is genuinely a partnership.

Now, other than faith groups, there cannot be many organisations in the UK who have such a socially minded and ethically based set of values as the good ship NHS (despite the fact that such values are easier to espouse ritually than to deliver 24/7). I wonder therefore if there are some better ways towards improving patient care. Not by blindly putting the needs of patients above the needs of staff, but by acknowledging that meeting staff needs is an integral part of meeting the needs of patients—in fact we should acknowledge it is an essential part of high quality patient care.

This is an especially fertile time for re-establishing values: with the NHS Mandate at the consultation stage, the NHS Constitution being reviewed, and the establishment of numerous other national and local bodies, from Health Education England to local Clinical Commissioning Groups. Crises are far too good to waste, especially if one is interested in change for good. We could perhaps improve patient care most by investing more in staff needs and staff development.

None of this is new of course. Angela Coulter, perhaps one of the most perceptive observers, commentators, and actors on the stage of healthcare policy and practice has long espoused the fact that happy staff make happy patients. We should therefore reconsider trying to attain our goals too directly, and take counsel from the like of John Kay (of Obliquity fame) and remember that some of the most important goals in life (and perhaps of the health service) can be reached more efficiently, more ethically, more sustainably, and more fairly, by taking the more indirect approach.

David Pencheon is a UK trained public health doctor and is currently director of the NHS Sustainable Development Unit (England).

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  • I’m convinced we need to support healthcare staff. If we want compassionate healthcare we must ensure there is compassion for those who are at the front line. See – champions for compassionate care. 

  • DiJames

    David Pencheon is right to exploit a crisis. Who cares for carers? Support to those who try.  This is  a profession steeped  in a history of military and religious tradition. Discipline and self sacrifice has been exploited out of all proportion to the needs of today. Some balance is required to address modern expectations against time honoured ways.Some oblique thinking as he suggests  could well  result in refreshing  creative change. 

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