Turning complaints into 'gifts'

I missed my last blog as I was on annual leave - practising what I preach and pushing the pause button - with Henry, our medical director, stepping in with a fabulous guest blog. Perfect timing as it was also an opportunity for him to say goodbye before he retires. 

I thought I’d come back from holiday to more information about the refresh of national mental health framework and financial framework, so I could then update you on our own business plan in this blog.  But this national steer, which we need to guide and refresh our own plans, is still delayed.

So although we’ve got a sense of what’s going to be in it, we still don’t know what money we will have to focus on our priorities going forwards. Once we get clarity we’ll let you know, so please bear with us and watch this space as they say.

Anyway, the weather was rubbish on my week off, so I binge-watched a drama mini-series called Safe. Created by crime author Harlan Coben, a lot of it was filmed in Manchester and, after his 16-year-old daughter goes missing, it’s about a father uncovering a web of secrets as he frantically searches for her.

The central theme of this drama is about the devastating impact of keeping secrets. They’re like a cancer in the soul, eating away and leaving destruction behind. The drama highlights that hiding them causes so much more damage than their disclosure. 

And so, when I came back to work to hear about our results from the national Freedom to Speak Up index, the negative consequences of not bringing things into the light was strongly on my mind. This index is based on a number of questions in the annual staff survey that show how well trusts are encouraging and supporting people to raise concerns and speak up about poor practice.

Don’t get me wrong, our overall results aren’t bad, in that we’re just above the national average for NHS Trusts. They show that nearly all of you know how to report poor care (95%) and a significant majority feel that we encourage you to report errors, near misses and incidents (85%).  We also have a fairly reasonable majority who feel able to raise concerns (nearly 72%). What worries me is that less than 60% of you feel we treat staff fairly when a concern is raised or an error is made.

So, basically we’ve got a mismatch between you feeling you can raise a concern, and then how we manage it.

Our Freedom to Speak up Guardian always says it’s not just about supporting people to speak up, but really listening with curiosity and an open mind to what they have to say. 

Compassionate leadership is about showing empathy, but without positive and supportive action it simply isn’t enough. So we need to put a lot more effort into handling and concluding things, as it must be frustrating when people have spoken up and feel it’s not been satisfactorily concluded or that they have not been treated fairly. We’ve got a couple of cases, for example, which have already had multiple reviews, so we do need to focus on improving this. 

People want to feel that they have been listened to and understood, and that their concerns have been taken seriously, and very importantly, people need to feel that they don’t suffer as a result of speaking up and highlighting poor care and practices. It’s about responsiveness, fairness and timeliness.

We’re still progressing our Just Culture work, but there’s lots more to do. The pandemic forced us to cancel our second Just Culture conference a few months ago and so we’re now looking at how we can set it back up. We need to push forward on building an open culture that learns and grows from mistakes, not brushes them under the carpet.

If we don’t listen then we’ll eventually be surrounded by people with nothing to say.

There is a popular philosophy in business that says complaints are a ‘gift’ because they offer an opportunity to improve. When we are open to criticism, what we get is good information and advice about how to change things for the better.

I know that dealing with concerns and complaints can be challenging, emotionally demanding and at times frustrating. It is hard not to take things personally. But we want all our leaders to see them as valuable insight into what is not working as well as it might be, and as an opportunity to put things right and improve practice. There are often common themes which are of wider relevance and an awareness of these themes can inform approaches and help prevent issues arising in the first place.

On the subject of leaders, it’s positive that we’re strengthening the clinical and professional voice in our new leadership structure. All the evidence shows that clinicians from the different professional backgrounds have so much to offer as leaders. You will have seen the recent announcements about posts appointed to, and we are hoping to appoint to all posts in tier 2 by early September.

And talking of good leaders, we say goodbye to two of our executive directors, Dr Henry Ticehurst and Suzanne Robinson next week. As you know, Henry is retiring after ten years as medical director and many more as a consultant, and Suzanne is joining Greater Manchester Mental Health Trust as their new finance director. Suzanne has been our whirlwind romance, sweeping us off our feet for a short period of time as she wowed us with her energy, ideas and sparkle. And Henry has been the long-term relationship that has totally enriched and changed our lives.

Henry leaves a legacy of his unique style and impact. He has a superb perspective on life, which is worth its weight in gold in the difficult moments. He’s been a great support to me, as well as to the medics and many others, and we appreciated him staying on during the covid crisis. We will really miss his fantastic sense of humour and fun and his great warmth.

Thank you Henry and Suzanne. We’ll be cheering you on all the way.

Best wishes

Claire

You can follow me on social media @ClaireMolloy2

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A few weeks ago it was wonderful to have Muhammad Khan, a resident at one of our rehabilitation units, contribute to my guest blog.

I’m delighted to see he now has his own blog, which you can read here: http://inmywords.co.uk/

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Guest blog from Henry Ticehurst, medical director

Dr Henry Ticehurst

I’m on holiday this week so I've asked Henry, our medical director, to do a guest blog. It’s only a few weeks before his retirement, so it makes this one all the more special.

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Dr Henry Ticehurst, medical director:

I’m sat in Stepping Hill Hospital about to see some of my last patients, trying to write a few paragraphs about my time at Pennine Care.

It’s not easy – trying to distil some 20 years in to a blend of anecdote and reflection. In the words of Vinny Jones – it’s been emotional!

The best bit of advice I got, when I was looking for a consultant job, was that colleagues were the most important factor. That still holds true.

My early years in Rochdale, when it was still part of Rochdale Infirmary and pre-Pennine Care, where (and I struggle to believe that I remember this correctly) we had a consultants dining room and the ring of the bell would herald in the next course. I think we live in slightly more egalitarian times now. The dining room went many years ago, probably about the same time as we entered the 21^st century, and the hospital farm was derelict before I came along, along with the insulin coma therapy room and the industrial therapy unit.

Times change but, by and large, people don’t. The sense of all being in it together for a common purpose, having colleagues you know you can turn to and a team which will support you, and which in your way you can support. These are all the intangibles, the absolutes which keep us going, and which I hope define how Pennine Care works.

I have worked in Rochdale, Bury, Tameside, HQ and Stockport, in various roles – in community mental health teams, inpatients, early intervention team, rehab and high support, psychiatric intensive care, access, home treatment, and of course as medical director. And at every juncture I have met with individuals and teams who have really helped me to understand my role, and to be fair have been incredibly patient as I have driven them mad (professional term) with my own disorganised way of doing things. I remember driving to HQ from Birch Hill Hospital for my appraisal, only for the then medical director to phone me to ask where I was as she was sat in my office waiting for me at Birch Hill Hospital. A career limiting move you would have thought, but something that for those of you who know me will come as no surprise!

Perhaps this would be a good time to thank those who have supported me and put up with me through this. With a special thanks for everything you have done these last few months.

I have been so immensely proud with the collective spirit and response to covid. I can’t help but think that the NHS I joined back in the day is the one I see responding to the pandemic with humanity and a sense of collective purpose – and, really importantly, a sense of recognition from the outside world.

These have truly been interesting times, where we have had to seek certainty where none is given, to live with a degree of uncertainty amidst the confusion, and somehow portray a sense of carrying on regardless. It’s the collective spirit that will stick with me, the sense that we are all in it together – from the covid dance in the corridor as we try to maintain that distance, to the mutual moans about face masks and hand sanitisers.

We’ve done things differently, and we’ve done them in a way that we haven’t been able to in the past. A mixture of permission giving and a lack of what is absolutely right has been a fertile ground for improvement and innovation. The key is surely how we don’t lose that spirit of innovation, of shared accountability, as we move on to what is now generally described as the ‘new normal’.

And I think, as the ‘novelty’ of the pandemic wears thin and the collective spirit runs low, we need to remember what we have achieved. It has been amazing and we can’t allow the collective behaviours to be forgotten, nor the means by which we have achieved these things be extinguished. That’s why we’re really keen to learn and not lose either the great achievements and innovations, or the means by which they came about.

As we enter the next phase, I think it’s right that we have a new leadership structure, with Nihal as our new medical director helping to forge a new clinically led model. The focus on mental health and learning disability has brought our organisation back to its natural home, where we are the expert at what we do, and where our voice is now loudest. Loudest to act on behalf of those whose needs we represent. Nationally, mental health has a voice and a presence which it has lacked over the years, and mental health is also seen as a top priority within Greater Manchester.

My plan for now is to have no plan (again, no surprise there), take some time to unwind a bit and reassess. I have always loved natural history and so I will immerse myself in walking, bird watching, fishing and gardening and await inspiration or opportunity. I suspect that working in public service doesn’t let you off the hook that easy and so, in some guise or other, I will reappear. But in the meantime, if you should happen to see an odd figure walking along with a fishing rod and binoculars, say hi.

Thank you for allowing me the opportunity to be part of this journey. I truly wish Pennine Care and all those who sail in her a bright and happy future.

I need to go and don my PPE for clinic now. Goodbye and thank you so much.

Best wishes

Henry