Six Cs

As I was driving into work today I was listening to the Today programme and our Chief Nurse Jane Cummings talking about the new  nursing strategy which focuses on the 6 Cs :

care, compassion, competence, communication, courage and commitment.

I have never really liked catchy headlines and feel sometimes we spend too much time thinking them up rather than doing anything about them but these words struck a chord.

I found myself thinking that these should be true for everyone working in the NHS not just nurses, but doctors, managers, porters, receptionists everyone. It needs to be the culture of the NHS not just for nursing.

Sadly there are many many stories where care got lost in “management”. We all have our own stories. I do. My Mum, My daughter. Contacts with the NHS at time of acute personal stress and vulnerability when nothing terribly bad happened but that vital human acknowledgement of the needs concerns and values of person inside the medical problem are ignored, brushed aside. Working in the NHS myself hearing these stories makes me feel embarrassed and apologetic. And there are worse of course. WE await the Francis Report which we know will be as hard to read and the previous reports have been.

Those 6 Cs seem so obvious don’t they? The blindingly obvious. Why do we need to spell them out?  

To many outside the NHS it may seem strange to have “courage” in there but to those of us who work within it…we understand. It is the courage to stand for what is right, to always keep the patient at the centre of everything we do even when the pressure is on. . It is wrong though to focus on individual alone. Yes everyone who works in health care has a responsibility to do their best but It is about growing systems that support people to work to do just that.  And pressures come from many different places.

 Organisational cultures can sap personal strength make staff feel powerless and even bullied  Front line  staff working with patients every day need to work in supportive environments. In fact the environments need to have those same 6Cs as their guiding principles. We all work best when we are treated with care, and compassion, by a competent management team who communicate well and lead with courage and commitment.

I hope things can change. There mustn’t be  about a tick box approach to implementation of change. We have lived through “named nurses” who were never there, lip service to individual care plans. This needs to be deep fundamental cultural change through the NHS from top to bottom and side to side… where everyone believes this is more important than short term financial issues and process targets.What could be more important than this?

Logs and Bricks

It is too long since I last blogged… my excuse well time and pressure. Lots going on and it is so easy to get drawn into the day to day and lose sight of the bigger picture. We have been busy of course and all of it is important. Busy doing what? Well… getting the CCG authorised ( a national process that measures us against a set of criteria laid down to test that we can do the job we need to do once PCTs finally go in April next year.. so they cover everything from how we talk to our public and patients to how we are managing our finances and whether we  have robust processes for safeguarding)…  continuing with our on going work around the paediatric and maternity services at the Friarage, trying to get a handle on the finances for our locality and developing and implementing new pathways of care to make our health system work better… and then sometimes I find myself wondering if we are making a difference.

 As a GP at the end of each day I can look back and measure what I have achieved that day….. number of patients seen, referral written, path results actioned, hospital letters read, patients phoned, prescriptions signed. A pile of neatly chopped wood, evidence of decision making and action. More importantly I can go home thinking that  somewhere in that list of jobs I have made a difference to someone.. Helped someone.

 At the CCG it isn’t so easy. Days are full of a mix of meetings big and small, phone calls and emails. Some of it is about fire fighting situations that just come our way out of the blue, much is about developing a new organisation.. working on culture , values… supporting staff…but at the end of each day it is harder to measure change. I still find I measure success in  terms of people: individual interactions, a good conversation, finding common ground when none seemed possible,  sorting out an issue about a service that was reported to us by a GP or patient, but I am learning that the other more architectural stuff is important too…it is more like building a house brick by brick than chopping wood, each brick laid doesn’t seem to amount to much and at the end of each day it doesn’t always look much different to the day before… and until you get the roof on it is pretty useless really…but together as long as each follows the blueprint we have all agreed upon we can build something and once we have got our “authorisation roof “on we can begin to take shape …. Sometimes we make mistakes and have to take a few bricks out and put them back differently. We are still an apprentice team although we each bring skills to the job in hand and we learn from each other day by day. Why do I like doing this? Because it is fun to work with such a great team of people who care passionately about what we do and I sincerely believe we can make a difference to those same people I worked with as a GP. WE can make the services we all use here better, higher quality, more efficient and effective.