Group mentality and the #NHSChangeDay mafia!

Last night I posted this tweet and what happened next was as surprising to me as it’s content!

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This was after an entire day of media reporting of the #Kirkup report; it’s publication had been imminent for some time. You can download and read The Report of the Morecambe Bay Investigation here. For those of you not in the know it was ‘An independent investigation into the management, delivery and outcomes of care provided by the maternity and neonatal services at the University Hospitals of Morecambe Bay NHS Foundation Trust from January 2004 to June 2013’ where there were three maternal deaths and 16 babies died at or shortly after birth. One of the problems identified was ‘group mentality’ amongst a bunch of midwives, and I’ll come back to that later.

Healthcare is risky business. Childbirth is risky. Mistakes and errors happen everywhere in life, and the NHS is no more exempt from that than any other system. The response to those errors is what increasingly galls me though. The seeming inability to hold hands up, admit mistakes, show humility and compassion. The ever elusive candour, training provided by solicitors, focus on reputational risk. The painting of patients and families as a nuisance, and those who dare to debate or challenge as cynics. It is an absolute testament to the strength and commitment of the families involved at Morecambe Bay that there may be any potential learning. In his introduction Bill Kirkup states:

This Report includes detailed and damning criticisms of the maternity unit, the Trust and the regulatory and supervisory system. In view of the progress that is now undoubtedly being made in all these areas, the necessity for this Investigation to lay bare all of this may perhaps be questioned, both by Trust staff (who undoubtedly feel beleaguered) and by others. There are two reasons to resist this view. First, although the signs of improvement are welcome, they are still at an early stage and there have been previous false dawns in the Trust; this emphasises the importance of understanding fully the extent and depth of the changes necessary. Second, there is a clear sense that neither the Trust nor the wider NHS has yet formally accepted the degree to which things went wrong in the past and admitted it to affected families; until this happens, there is little prospect of those families accepting that progress can be made.

These events have finally been brought to light thanks to the efforts of some diligent and courageous families, who persistently refused to accept what they were being told. Those families deserve great credit. That it needed their efforts over such a prolonged period reflects little credit on any of the NHS organisations concerned. Today, the name of Morecambe Bay has been added to a roll of dishonoured NHS names that stretches from Ely Hospital to Mid Staffordshire.

The statement about signs of improvement and false dawns sent chills down my spine. They were reminiscent of my thoughts around another Trust documented elsewhere on these pages; who seem determined to ‘show’ improvement rather than to truly embody it, to spin rather than to accept. But I digress, I’m not going to get into that here. I’m going to offer a quick reflection on my original tweet. Kirkup’s report is published at a time when my social media channels appear to suggest there is an absolute overload of NHS ‘initiatives’, just one of which is #NHSChangeDay. Again I’m not going to get into those initiatives in any great detail, I had a long phonecall with the awesome Anne Marie Cunningham recently and she made me think quite hard about my almost allergic reaction to them.

I concluded that NHSChangeDay just isn’t for me. It’s not aimed at me. I could never pitch up to work each day and be oppressed, or beleaguered, or demoralised by a system. Without putting too fine a point on it I suspect I’d be dismissed fairly soon after arriving if I was to find myself within the NHS system I hear described, that all of these NHS programmes seek to change. I get that, and I get that many, many (most) people who work in the NHS do so because they want to help people/make a difference/cure/support* (*delete as appropriate).

I’m no stranger to the NHS though, I’ve detailed on my personal blog my experience of my Dad’s life and death, and for the last year I’ve been heavily involved in the JusticeforLB campaign, seeking (amongst other things) to gain accountability for the preventable death of Connor Sparrowhawk. I’ve also blogged here about NHS spending on attending award ceremonies, I’m a committed Patient Opinion fangirl, and I’ve spent many, many hours of my life over the past 6.5 years on twitter discussing and debating healthcare and many aspects of it.

So the response to my tweet last night surprised me a little, what perhaps was intended as a ‘cosy’ nudge felt like a mafia attack. None of the people who replied have ever, as far as I’m aware, tweeted me before (although the people who sent me DMs I know better and I really suspect that I’m not alone in my frustrations), I’m assuming there is some monitoring of the #NHSChangeDay hashtag, but within about 20mins I’d had it suggested no less than three times that it was my responsibility to take action on this….

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That last tweet irked me in particular, there was so little attention paid to the discussion that the assumption was that Dani_ellie had somehow made the link, and what did I need, to be ‘challenged’ to take action. Luckily for us all I was heading out so I did reply asking all of these people why they felt it was my place to take action but I didn’t get into a protracted discussion about that. Mostly because it didn’t feel like there was a very open environment for discussion. I’ve been criticised before for my dissection of twitter conversations, but it’s all publicly available, and I don’t really know how to raise these issues without examples. I get that some may have felt my initial tweet was unfair, or that my challenge was too challenging, but this is the crux of it for me. It appears that these programmes and initiatives are encouraging/ reinforcing/ training/ moulding people to behave in a certain way. It’s like there’s an unwritten code of how to challenge appropriately, my way isn’t it, so I’m somehow expected to put up and shut up, or just follow along like a nice little lemming. The very group mentality that Kirkup highlights as a risk.

A week ago a report was published by the Kings Fund on leadership in healthcare. Written by Michael West, someone whose work appears to be rated quite highly by many of those in the healthcare community. One of his high level findings was as follows:

One observation to come out of this work is that much of what is written about leadership and much effort on leadership development in the NHS is based on fads and fashions rather than hard evidence. Moreover, successive reviews often fail to draw on the evidence base, only adding confusion via strong opinion to the vast body of writing on what constitutes good leadership in health care.

So please, please, please can we have less group mentality, less challenging those who dare to speak up to sort things themselves, less opinion and more evidence, less delusion that initiatives are what matters, less focus on staff morale when the system is failing patients. Can we please embrace candour, really honestly work together to look at what goes wrong and improve things. Focus on evidence not spin, and please stop surveilling/monitoring social media as though it’s a platform for you to demonstrate your worth/protect your reputation/broadcast your reach.

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I’ll leave you with my final thoughts on NHS improvement, that there’s a need to genuinely put patients, their families, carers and advocates at the centre, on an equal footing, and to do that well, you could save some of the money wasted on awards and initiatives and use it to meaningfully reimburse those who are sharing their experiences and learning, and for more on that see this excellent post by David Gilbert.


5 comments on “Group mentality and the #NHSChangeDay mafia!”

Sara says:

Thoughtful post, George. Brilliantly highlighting the faddiness of the change agent/radical/thought diversity stuff. A distraction really from the work at hand. Reminds me of research projects that go full pelt down a certain path answering questions – possibly brilliantly – of no relevance whatsoever to those involved at an everyday level.

The speed of swooping in on the hashtag is an interesting point. I follow a few hashtags and comment liberally. I don’t know if the speed of my comment to tweet varies according to the intensity of my interest in that topic. Maybe it does…

The NHS change stuff has a definite cult feel to it. And a very shiny veneer. Not sure those involved will want to taint their sparkly vision by linking it with distasteful evidence of catastrophic failings so I’m not surprised about the Kirkup cock up. Of course, if they did, I’d be a lot more optimistic about the potential for their efforts to lead to more than self congratulation and relentless jargon production. In a pretty cliquey way.

For now, they remind me of the winged monkeys on the Wizard of Oz, though I ain’t sure who holds the cap of power.

Anniecoops says:

Morning George
A thoughtful blog as ever. We need you telling us these things and keeping us grounded. And I mean that – not just platitudes.
It’s hard because I know some of these people and I guess I see them as positively motivated to try to make things better. But I too sometimes feel affected adversely by almost a group think and an approach that says your are either with us or not with us. And if you are not with us then you must not be good.
I am involved in my personal changeday campaign. I chose to join it as a potential vehicle to do some good. It might not work, I don’t know how to measure it but it’s done with my effort, in my own time. My gut tells me it’s a good thing to do.
Re #kirkup – my pledge (sorry poor choice of words 😉 is that I will read it and think very hard about my work and how I could ever, if faced with something so terrible, try to do good.
Keep writing. X

Hi George,

We’ve already had a good discussion on this via Twitter. From my point of view, I also could never go into work each day feeling oppressed, demoralised or belligered – I would rather face the consequences of speaking up than never speak up at all. But that is based on my own previous experience many years ago. I am lucky that I am in a place where I feel confident to stick to that and will never forget how I felt as a 19 year old nursing assistant witnessing poor care and not knowing where to turn.
My personal motivation for being involved in change day is that I want to enable anyone who feels like my 19 year old self did to know that they have the power to do something. As Anne has said, that might not be something we can measure empirically, but that also doesn’t mean it’s a fad or not valuable.
Change day might not be for you, and that is your decision obviously. As we’ve discussed before, this Twitter exchange was during a tweetchat we were having on the campaigns this year – all of which are working and progressing throughout the whole year. All I would say though, is that no matter how put off you feel you continue to discuss change day and both the positive and negative elements of it as this is the only way we’ll be able to eventually develop something that one day you might feel you would want to be involved in.

Thank you for the fruitful discussion we have had and I look forward to many more.


Eileen Morris says:

It is noy difficult to solve, insist everyone recognizes that they are human and as such capable of human error. I used to work with people and money and it is a fact that the majority of people are honest but the overwhelming majority of people refuse to acknowledge that they are capable of human error and immediately go on the defensive. Being defensive should be banned in all aspects of life. It should actually be taught that each individual should question themselves. I and everyone with whom I worked did this and checked up on each other and it becomes second nature. In the case of births, in my time of giving birth (40 years ago) everyone I met always used to take notice of ‘listen to Mother’ that is the one who is giving birth. Guess where I live and gave birth to my two children – the Furness area of Cumbria. Of course this was before any insistence on natural birth and breast feeding was a choice no one was put under pressure. Stupid idea to put a pregnant woman under pressure. Everyone will make a mistake teach ‘everyone ‘ to have the courage to admit it

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