Wednesday, September 13, 2023

Bullshit in NHS Foundation Trusts

As Dave Pilgrim writes in British psychology in crisis:-

‘Management speak’ with confident terminology and phrases abound, and many employees now simply expect their managers to talk bullshit. Clichés are offered, as and when required, to mollify the public. When the latter are assured about probity, transparency, or safety in a press release, then there are often good grounds for healthy suspicion from the ordinary citizen.

In the NHS, for example, this means that managers can spend their time bullshitting to protect the organisation rather than improving patient care. Non-executive directors in Foundation Trusts, who are supposed to ensure that patient care is improving, fail to challenge executives, leaving sceptical members of the Trust and the public in general without confidence, even in their elected Council of Governors.

Norfolk and Suffolk NHS Foundation Trust, where I used to work and was a governor for 7 years, has been found inadequate four times by the Care Quality Commission. I could see the fourth inadequate coming and publicly called for the resignation of the Chair (who was going anyway), the two vice Chairs, the Senior Independent Director (SID) and the lead governor. This wasn’t because of personal antagonism to the people in post, all of whom I knew through working as a governor and keeping in touch subsequently as a member.

Of course this did not happen! The Chair designate came into post and has helped to get the CQC rating improved to ‘Needs improvement’ rather than ‘Inadequate’. The SID has moved on and one of the vice-Chairs is also due to come to the end of his term soon. Still, I thought the better way for the Trust to manage its difficulties was to accept accountability by these public resignations. 

The Trust still, therefore, lurches from scandal to crisis and back, most recently with a BBC Newsnight investigation (see BBC report). This was partly about the Trust’s handling of its mortality data, but also about the need for an open and honest debate about the state of mental health services in Norfolk and Suffolk. I still don’t fully understand what the Trust is saying about how it has handled, is handling and will handle its mortality data. The concern about the state and quality of services is due to the fact that the Trust has still not properly recovered from its first CQC inadequate rating due to the disastrous implementation of its radical redesign before that first inadequate rating. 

There are of course national issues also about the state of mental health services in this country. NHS England seems to be leaving Trusts to sort out their own messes, so there still needs to be an open and honest discussion about the state of mental health services in Norfolk and Suffolk. If non-executive directors are not willing to facilitate this discussion, they should resign and be held to account by the Trust Governors.

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