Professionalism — what does it mean in 2014?

1. Professionalism — what does it mean in 2014? Niall Dickson — Chief Executive and Registrar General Medical Council 28 February 2014

2. Public perceptions, 2006 – what’s missing? Understanding Public and Patient Attitudes to the NHS, Ipsos MORI, August 2006

3. 2013 — safety and quality Nursing standards and performance 1.14 As a result of poor leadership and staffing policies, a completely inadequate standard of nursing was offered on some wards in Stafford. The complaints heard at both the first inquiry and this one testified not only to inadequate staffing levels, but poor leadership, recruitment and training. This led in turn to a declining professionalism and a tolerance of poor standards. R. Francis QC, Report of the Public Inquiry into the Mid Staffordshire NHS Foundation Trust, Executive Summary 2013

4. Professional disengagement • Weak professional voice in management decisions • Figures preferred to people • Focus on systems not outcomes • Board remote from staff and patients • Absence of clinical governance • ‘Overall, the system that was intended to bring clinical risk to the attention of the board did not function effectively, and the board appeared to be insulated from the realities and problems on the general wards’ • ‘Staff portrayed the executive team as a closely knit inner circle and considered their style of management to be oppressive and intolerant of failure’ R. Francis QC, 2013, Report of the Public Inquiry into the Mid Staffordshire NHS Foundation Trust Healthcare Commission (2007), Investigation into outbreaks of Clostridium difficile at Maidstone and Tunbridge Wells NHS Trust Healthcare Commission (2006) Investigation into outbreaks of Clostridium difficile at Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust, London

5. Moving from the dark side Perceptions of management?

6. The challenges of changing the culture I know how many clinics I’ve been in with a doctor and I will go and wash my hands and then they go ‘Oh’ and go and wash their hands. It’s clearly something that is drummed into us 24/7, but it’s not something that’s always done by them, or maybe they forget. Yes, you can lead by example even to the consultant on the ward. The King’s Fund, 2010, Understanding the doctors of tomorrow http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Understanding-doctors-tomorrow-levenson-atkinson-shepherd-oct10.pdf, page 50

7. A safety critical industry? • An Organisation with a Memory (2000) • To Err is Human (2000) • Bristol Inquiry (2001) • 7 Steps to Patient safety (NPSA)(2004) • The Checklist Manifesto (2009) • ‘Healthcare is a decade or more behind many other high-risk industries in its attention to ensuring basic safety…’ To Err is Human 2000

8. The 2013 assessment ‘Place the quality of patient care, especially patient safety, above all other aims’. • Incorrect priorities damage patients • Blame and fear are toxic • Safety improvement is a science • Listen to patients and their relatives/carers National Advisory Group on the Safety of Patients in England, 2013, A promise to learn — a commitment to act https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/226703/Berwick_Report.pdf

9. The Government response “Putting in place a clear and well-functioning system of accountability in the NHS is a critical condition for creating a culture of safe, compassionate care.”

10. The Government response • Duty of candour on organisations • The responsible clinician • Reinforce professional duty of candour • Criminal offence of wilful neglect

11. Is regulation/increased accountability the answer? • We are requiring those in the public sector and the professions to account in excessive and sometimes irrelevant detail to regulators and inspectors, auditors and examiners. • The very demands of accountability often make it harder for them to serve in the public sector. Baroness Onora O'Neill • We need to free professionals and the public service to serve the public ... to work towards more intelligent forms of accountability ... [and] to rethink a media culture in which spreading suspicion has become a routine activity". A Question of Trust, Reith lectures, BBC 2002

12. After Francis — tensions in the system Openness and transparency Local responsibility More national regulation Quality and safety Aspiration Reality Targets not the answer Tougher accountability Financial pressure Tougher inspection

13. More joined up regulation

14. A new model of regulation More bottom up Less top down Regulator Board Team Individual / professionals Patients

15. A new model of regulation – reaching out

16. A new model of regulation - using data

17. Revalidation – coming soon to a nurse near you The medical model: • Not to catch the next Harold Shipman • Not to pretend all problems go away • Not a panacea for all ills of the NHS • Three clear aims • Bring all doctors into a governed system – Specialist doctors, locums   • Help to identify problems earlier • Encourage self reflection

18. Annual appraisal based on GMP CPD The medical approach to revalidation in UK Quality Improvement Activity Reviewed Complaints & Compliments Reviewed Complaints & Compliments • Designated bodies • Responsible Officer • Annual appraisal • Supporting information • 5-year-cycle • 33,125 doctors revalidated to date since December 2012 Patient Feedback Significant Events For doctors and nurses – how will we know its working? Colleague Feedback

19. What next? • New model of regulation • New awareness of safety • New systems of accountability • But … 1972 South Ockendon Hospital Inquiry 2013Mid Staffordshire Inquiry 1999Alder Hey 1969 Ely Hospital Inquiry 1998 Bristol Inquiry 2000 Shipman Inquiry … just another report or a seminal moment?

20. www.gmc-uk.org niall.dickson@gmc-uk.org Contact Centre 0161 923 6602