Courtesy, respect and dignity need to be restored in the Health Service in order to build trust from patients, according to the Northern Ireland Ombudsman. Tom Frawley gives a frank assessment of how patients view the service and the pressures on staff.
Health professionals are facing “impossible circumstances” in a politicised atmosphere. He finds it interesting that while survey answers suggest that the overall quality of the service is deteriorating, people report that their own experience is quite good: “What happens to individuals bears no relation to how the service is presented.”
It is, though, not accurate to say that all was well. As Ombudsman since 2000, he has never received so many complaints about the Health Service, the volume of which was “escalating on a scale that we’ve never seen”.
When sitting in an outpatients’ department recently, he noticed the disengagement of staff but appreciated that it was “very difficult” to stay engaged when so many people were moving through a hospital. Engagement with patients, though, is very important because people know what it is like to be treated with dignity, respect and courtesy – and know when that is not happening.
The Ombudsman’s office finds that patients want holistic treatment and are, for example, frustrated when they are sent back for one test after another. Clinical professionals need to acknowledge genuine criticism from the public e.g. regarding a perceived tolerance of poor practice, secrecy about performance, poor communication and paternalism.
In the past, Health Service professionals gave their time and expertise and expected to get deference, respect and job security in return. Nowadays, there is greater accountability, patients are more assertive and better informed, and there is a fundamental need to collaborate between professions. Health professionals also face constant evaluations (perhaps too many), inspections, audits and regular reviews of their competence to practice – and they sometimes feel that they had “no energy left” to care for patients.
Communication is central, with a real need to listen to patients, respect their views and give them relevant information in way that they can understand. Information should be shared with partners, close relatives and carers provided that the patient has granted his or her consent.
Frawley recalls the Royal Commission on the NHS in 1976 when the only group to stand up for the service was the patients: “It still has that standing and status with the public but can it retain that if it continues to be seen to fail their expectation?”
As a manager in the Health Service, he had been disappointed to see doctors lobby for a particular piece of equipment and then find it sitting in its box three months later. There are still “real issues about value, efficiency and getting the best value out of our resources.”
Frawley encourages staff to “live and breathe” their values every day, demonstrate leadership for the whole system, build patient engagement and communicate well. Staff also need to care for each other: “If all we do is dump more and more things on the same people over and over again, they do run out of capacity and goodwill and energy, and they get difficult and bad-tempered and mistakes get made.”
Frawley’s career in healthcare included leading the Western Health and Social Services Board, based in Derry. Back in 1982, he saw a need to find ways that gather information on a patient’s experience and sent a records officer around the clinics in Altnagelvin Hospital with a handheld voice recorder to talk to patients. Frawley reflects: “It’s incredibly more powerful to have an authentic real voice telling you their frustrations than to actually be counting sheets with scores up because it actually impacts more directly.”
Frawley also understands the scope for cross-border services (e.g. in paediatric cardiology) as Northern Ireland could not run every service on a regional basis: “The idea that we can sustain – in some sort of autonomous ‘independent state’ model – every possible healthcare element that anyone could possibly need is naïve in the extreme.”