Preparing for hard times: Safer staff

Abstract

I was struck by an item on the radio recently reporting on the world of ‘preppers’, perhaps better known as survivalists. Usually associated with America, these are people who prepare for a major disaster, whether a collapse of government, failure of banking or information technology systems or a natural catastrophic event. There are now many people in Britain preparing (or ‘prepping’) for man-made, or natural, Armageddon. The more extreme envisage a need for knives and crossbows to defend their families against marauding looters and other competitors for dwindling resources. Perhaps, the more realistic ones stock up on food and other supplies in the event that they will need to be self-sufficient. The aftermath of Hurricane Katrina in the southern states of America has been cited by some as a very real example of the necessity of such an approach. While I would not suggest that we face total shut down in the NHS at the moment, the concept of improving self-sufficiency is an interesting one in the current financial climate. One of the fundamental recommendations from the Francis inquiry into care at Mid Staffordshire NHS Foundation Trust was to set mandatory safe staffing levels at a national level. The attempts to implement this have foundered due to a combination of complexity and expedience. In June this year, the government suspended NICE (the National Institute for Clinical Excellence) from working further on issuing safe staffing guidance, announcing that it would instead incorporate nurse workforce planning into its forward plans. Now, the alarm over the high level of deficits in trusts seems to have forced the pendulum away from a focus on improving staffing ratios and filling posts (with a concomitant rise in agency and other costs) back towards the need to balance the books at all costs. If not a catastrophe for patient safety, this is surely a crisis. The analogy with ‘preppers’ and their self-reliance becomes particularly interesting if we interpret the ‘self’ for the NHS as our staff. The NHS has a range of armory to reduce the threats posed to good clinical care by suboptimal or unsafe conditions. Examples include early warning system; professional codes of conduct; guidelines; protocols; patient safety metrics; training; audit; communications; whistleblowing. However, I would argue that each of these depends on the quality, health and well-being of their much vaunted biggest asset: staff. In my experience of talking to a range of NHS staff about their organisations, there is a palpable feeling of optimism only in those where the senior clinicians and managers have truly managed to prove that they wish to engage with front-line staff. Even when people are under-staffed and working in difficult, pressurised circumstances, they will be heartened and inspired by leaders who are visible to them, who communicate personally with them and who make the effort to find out what they can do to make front-line working lives more comfortable. Lucien Leape has pointed out in his 2013 white paper that organisations need to care for staff to enable safe working. He sets out a range of helpful recommendations on supporting continuous learning, improvement, teamwork and transparency. Perhaps the most critical point he makes is concerning the confidence, trust and belief that staff have in the organisation: ‘The workforce needs to know that their safety is an enduring and non-negotiable priority for the governing board, CEO, and organization’. In September this year, NHS England Chief Executive Simon Stevens announced a drive to improve and support the health and well-being of 1.3 million health service staff. The £5 million initiative is based around three ‘pillars’: