As part of a conference jointly run by The King’s Fund and PHSO, a panel of esteemed speakers shared their reflections on the importance of learning from the COVID-19 pandemic. This is especially relevant now, as public services work out how to operate again under very changed circumstances. The panel included Saffron Cordery, Deputy Chief Executive at NHS Providers, Charlotte Augst, Chief Executive of National Voices, and was chaired by Abi Howarth, PHSO’s Director of Operations and Quality.
Balancing needs across the NHS
The panel recognised that the approach taken by the NHS in the first wave of the pandemic was necessary to protect frontline staff and services. However, as COVID-19 rumbles on, the health service must find different ways of working. Ways that can balance emergency demands with ‘business as usual’ care. Ways that recognise how connected different local services are.
We heard that existing ‘fault lines’ in the NHS – issues that existed before COVID-19 – have become more strained during the crisis. Both speakers recognised the challenge of supporting NHS staff who have worked under enormous pressure, and at the same time addressing the ongoing challenges for patients in being listened to by NHS organisations. This situation existed before the pandemic but was made more difficult when in-person appointments were dramatically reduced.
A culture of listening
So much of the discussion was about listening. We were reminded that most patient feedback is offered positively – to help organisations improve and rarely with the intention of seeing someone punished. And yet, the reaction to this feedback often lacks compassion. The NHS was challenged to be more curious about feedback.
Staff working under extreme pressure can become closed to feedback. They may be fearful of the consequences of accepting responsibility for mistakes. Openness, transparency, and support for staff wellbeing and psychological safety must be top priorities if this is to change.
Supporting NHS staff and creating the right conditions for patients to provide feedback are two sides of the same coin. But it is an organisation’s culture which enables these to flourish. A culture that supports staff to flag concerns, so that they can be put right, is also one that is more likely to seek the learning from patient feedback and complaints.
Developing a just culture
In many ways the experiences of NHS staff and patients are similar – speaking up can take real courage on both sides. Patients may be scared to ‘take on’ the NHS and express their concerns when they are worried about how it could affect their care, and staff may fear that speaking freely could impact their career.
While the experience of patients and staff are related, it is the organisations and their leaders that hold much of the power. COVID-19 has shown us the value that organisational culture can bring in enabling staff and patients to relate to each other on an equal footing. We have more in common than that which divides us.
The panel reflected that the people most affected by COVID-19 are often the ones least likely to complain. This suggests that those most in need are less likely to be heard and receive the care they need. Inequality like this is tragic, and the responsibility for addressing it lies with organisations and their leaders. Patients know what they want and need. Leaders can and must do more to consider what gets in the way of listening.
The panel agreed that it is important to learn quickly from mistakes made during the pandemic and to make improvements sooner, rather than later. We must not wait for the public inquiry to reach a conclusion, as there is work to be done now. An approach that puts people at its heart and creates a culture of mutual understanding and respect is one of the immediate ways in which the NHS can build on the learning from the pandemic.
Sorry needn't be the hardest word.