Empower us to make a change: Perspectives from the frontline

Some may mistakenly misconstrue the purpose of this commission to replace and improve the negative aspects of the NHS; ‘out with the old, in with the new’. Instead we have chosen to find ways to bolster and support what is great about the NHS, and a major aspect of this is the workforce of the NHS. Recently the extreme working conditions of healthcare staff have been under scrutiny, as shown by the Junior Doctor Strike, and the Scrap the Cap campaign,  and highlighted previously by my colleague Haider. And yet despite these conditions as well as the negativity construed by the media about the future of the NHS, the staff continue to work tirelessly to continually triumph by doing what they do best; delivering care to the UK.

photocredit: cartoonstock.com

This is why we conducted a survey for frontline staff, a survey designed by us to be both user-friendly and constructively gain insight into aspects of the jobs of frontline staff, or soon-to-be, which currently seem to cause extreme effort. We want to know how we can enable frontline staff to improve their jobs and the care they deliver; so the purpose of many of our questions is to gain insight into current perspectives. Questions such as ‘Have you ever had an idea to change an aspect of your workplace?’ ‘If yes, what did you do with the idea?’ to assess the ease of implementing innovation within the NHS, whilst questions like ‘Do you think your working place culture supports innovation and adapts to change easily?’ evaluate the receptiveness of the NHS to change.

photo credit: http://blog.stickytickets.com.au/event-organisation/tips-on-increasing-participation-at-your-fundraising-event/

The survey was shared through social media, forums and physically distributing hard copies in order to capture results from the widest possible audience. The ethical process was laborious, and the survey is in no means robust form possible which is unfortunately outside the scope of this commission, but it has been worth the effort to yield results which demonstrate the current situation.

Our survey showed that 85% of frontline staff had had an idea or an innovation. However, there was a multitude of responses which showed that the implementation of these ideas was hindered due to lack of funding, which may be expected, but also by lack of time and low workforce morale. Reflecting on the responses it was clear there was a lack of willingness to adapt the workplace to accommodate innovations from the frontline staff, which I feel is nicely summarised by a responder: ‘Nobody on the frontline feels they have the power to make change’. The survey opened my eyes to the NHS’ current receptiveness to ideas directly from the people who work tirelessly, and highlighted that in order to address barriers to innovation, we, as a Commission, must also address workforce conditions. The survey has been instrumental in directing our report, it is our hope that we can find ways to address these problems so that the NHS workforce can be supported to continue their work that Great Britain has experienced for the last 70 years.

photo credit: https://www.americannursetoday.com/facts-nursing-career/

Grace Pinn is currently a nursing student at King’s College London who is interested in using her nursing degree to implement effective health policy later down the line. Edited by the Social Media Team. 

New avenues for creativity

As I write this blog, the world has just entered into 2018. Reflecting on 2017 and my personal experiences with the Student-led- commission, one word comes to mind: WOW!

What a year 2017 has been. I entered medical school with an idea to better health for everyone by improving the healthy living standard of those disadvantaged in society. I never thought this process would need a great deal of creativity, something I felt I lacked but realised came naturally once trained to do so. So, this blog will focus mainly on applying creativity and change in the NHS, and health in general.

Commissioners in training (from left: Sonali Nundoochan, Osama Suwar)

The NHS is an outstanding institution with well-renowned achievements and was described as “one of civilisation’s greatest achievements,” by the Chair of the British medical association in 2013.  However, at the same time it can be argued that the NHS has not adapted to the fast-changing environment that defined the present and future generations i.e. technology and social networking., In my opinion, it hasn’t adapted to the new world that we live in today.  Although considerable effort has been made to design tools which improve patient involvement and feedback in the NHS, such as patient participation groups in GP practices, decisions are still dictated from above. In simple terms; it is run by those whose perspectives do not reflect the average service user, in my opinion at least.

This is why creative ideas and strategies that challenge the status quo need to take effect in the NHS. In a way, the structure of the NHS needs to flip on its’ head, and becoming a bottom-up service that relies more heavily on people on the front line. By this, I mean patients and front-line staff alike. A more democratic National Health Service. The public need to have trust that decisions that are made on their health are made by people that understand their situation.

The world has changed. The NHS needs to look for solutions and employ a different way of thinking, by moving its’ entire service to one that is based around prevention of disease. To do that end, we need a more proactive and robust health service that understands that understands its’ service users and what makes them tick. And this is where creativity and technology that has advanced our society in so many ways need to be deployed in the NHS.

At one policy lab, participants used fictional scenarios to find creative solutions to help ‘Sharon’ manage her depression.

We need to change how everything is structured and support individuals to take control of their health by mobilising communities and enhance their social and health capital. This can be done by creating platforms or networking opportunities for patients, which provide space for innovative ideas.  There are some signs the NHS is targeting solutions for specific groups, but not at a quick enough pace, such as devolving powers back to the community where patients can have more of a say and input locally. This way the NHS becomes more resourceful by using the social/health capital of communities to help advance good care.

Osama Suwar is a medical student at King’s College London with an interest in health policy. Edited by the social media team. 

The promise of tomorrow’s NHS

During our school days, I think we can all remember the countless research we spent looking at various degrees and universities; all to determine the career path we would eventually take. For myself, choosing a career in which I could give something back to the community, particularly the National Health Service was very important. We should be honoured to represent such an amazing organisation; however it is only natural that we also contemplate; “What does the NHS offer us, the healthcare professionals, in return?”

We should be asking these questions – I know I do.

“What is the promise of tomorrow’s NHS?”

An enthusiastic, yet unaware, Haider Sheikh is pondering how to navigate the challenges of his future working career (shown on left). credited:https://pbs.twimg.com/media/BRPd2EWCEAAkvAO.jpg

Whilst it is selfish to ask these uncomfortable questions, and YES – we remain considerate of the challenges that our NHS has to cope with – it faces perilous times ahead; evolving healthcare needs of ageing and growing population, reduced funding and lack of staffing. The healthcare system persistently rallies on, both night and day, to ensure the public receives the best possible hospital care, A&E and GP services. The fuel required for running the NHS; pooled blood, sweat and tears of NHS workforce, will only last for so long.

credited: https://www.garybarker.co.uk/images/George-Osborne-NHS-cartoon.jpg

As with other areas of employment, it is important to feel valued and enabled to remain enthusiastic in our jobs. It seems these criteria’s are not deemed important enough to instil within the NHS; after all, it is our ‘job’ to care for others health with under-resourced, over-worked and under-staffed conditions. But what is often missed is the emotional stress we endure; the human instinct for experiencing emotion is all but the same.

credited: http://forumdermedizin.com/blog/images/Stressful%20medical%20jobs.jpg

The sooner that we acknowledge the health of the very people, I repeat people – that look after our health, it will become more apparent as to why problems on-going with the NHS affect them. The impact of having an effective and well-run healthcare system gets more glaring when our loved ones, or ourselves, are at their most vulnerable; seeking relief, treatment or wellbeing of some sort. This is when we expect the healthcare professionals to be near infallible, to not make mistakes that, in any shape or form, could prove detrimental to their care. Whilst errors should always be minimised, to expect an error-free healthcare from tired professionals is absolutely unfair – no one had signed on for this!

But yet it is difficult to continue thinking selfishly; we are selfless people and care far too much about NHS to see it crumble. We want the issues tackled.

credited: https://davelordanwriterdotcom.files.wordpress.com/2015/11/nhs-last-as-long.jpg

The promise of tomorrow’s NHS will always be job satisfaction and self-fulfilment – but it is time to deliver on these promises and make them a reality for both the current and upcoming workforce.

Haider Ali Sheikh is a Medical Student at GKT School of Medical Education (King’s College London), with previous BSc honours in Biomedical Science, and has interests in Policy making, medical research and surgical medicine. Haider Sheikh is dedicated to promote and advocate community-wide health, physical and psychological, to eliminate disparities that exist within communities. Edited by the social media team. 

“NHS Doctor” – Noun – Diplomat, Businessman, Lawyer, Doctor

We seldom recall modern medicine fondly – the pre-20th century paternalistic doctors who enjoyed unqualified authority in the medical consultation and characterised by an age of empiricism, laboratory medicine, diagnosing disease and the silent patient. Unchecked modern medicine, after all, was responsible for the scandalous events over the 20th century. Internationally we saw the horrors of modern science through the high-tech warfare of the world wars, the disfigured remains of thalidomide during the 1950s, the revulsions of human experimentation in the Tuskegee syphilis studies between the 1930s and 1970s. Domestically we feel more recent scars: the retention of children’s organs in the 1980s and 1990s, the Dr Death serial-killer of over 200 patients, the terrifying care of Mid-Staffs in the late 2000s.

Instead we celebrate the age of postmodern medicine. An enlightened age where everyone is entitled to their own ideas and everyone has a seat in the consultation room. The patient has been welcomed back with open arms and shares the decision-making seat with the doctor. With postmodern patients armed with google and a prioritisation of waiting times, bedside manner and 24-hour services over health outcomes, today’s doctor-diplomat must balance treating disease with dispelling myths and customer service.

cartoon

The politicians and financial stakeholders take a few seats besides the patient and eavesdrop closely. After all, having funded the NHS through taxpayer’s money they must ensure the system is run efficiently and effectively to get the best value for money. Inefficiencies must be pointed out; solutions must be introduced. Trusts need to hit their targets; CCG’s need to properly budget primary care; NICE needs to pick the cheapest drugs. Today’s doctor-businessman must have an eye for efficiency and rationalisation and a penchant for protocols and audits; *Doctor Bloggs to patient line seven please*.

Finally, we have the lawyers, legislators and regulators, taking their places in the corner ready to pounce to the defence of the patient. Dr Death? Never again – GMC Good Medical Practice. Using children for research?! Fear no more – Human Tissue Act 2004. “I wasn’t told about the side effects!” Do not worry – informed consent. “I was scared off by the side effects and now I’m going to die if I don’t take the treatment!” Do not fear – the postmodern doctor-lawyer will know how much to tell you.

While we should not return to modern age, the protective pendulum has swung too far and the consultation room has become too crowded. “Please can everyone step outside; the doctor can see you now.”

Alex Lee is a medical student at King’s College London, who is interested in service delivery, the influence of digital advances on NHS practices, and personalised medicine. Edited by the social media team. 

Can Digitalised Healthcare Data Ever Be Secure?

A little-known fact is how secure traditional paper-based records of patient medical data were compared to current digitalized versions. Paper records were held in limited copies and storage could be tracked easily. The time to contemplate the benefits is long gone however, with the deluge of healthcare-related information technology advancements.

The digital era provided an answer to the challenge of meeting the demands of quality community care on a tight NHS budget. The volume of data and ease in anonymizing it created immense potential for clinical research. Unfortunately, the availability of digital records also gave rise to a data market where electronic health records became valued commodity worth hundreds of pounds. This in turn gives birth to concerns over security breaches and data leakage. A recent study by Egress notes that between 2014 to 2016, 43% of reported data breaches across economy sectors came from the healthcare industry. Interestingly, the biggest cause for the security breaches was human error.

(credited: https://securityintelligence.com/how-to-reduce-human-error-in-information-security-incidents/)

Specifically, these concerns are two-fold: firstly, there’s the fear that identifiable data held by individual organisations may be intentionally or unintentionally leaked and made public. A second concern is the free flow of information intra-organization and inter-organisation to third parties. For example, earlier this year it was discovered that an error on the SystmOne clinical IT software meant that GPs who switched on “enhanced data sharing” to grant access of patient records to the local hospital unknowingly also allowed hundreds of NHS employees access to confidential patient information without medical reason.

The cost of security breaches includes not only system repair but victim compensation under and fines by the Information Commissioner’s Office. This ought to persuade the NHS to seriously look into viable solutions to fortify its cybersecurity measures. As evidenced during the ‘care data fiasco’, there is a lack of public trust when it comes to the handling of sensitive data by a large organization such as NHS even when framed altruistically as supporting research.

With the new Data Protection Bill currently in its report stage at the House of Lords, it is more important than ever for the NHS to tighten cybersecurity. The new bill gives data subjects such as NHS patients sweeping control over use and storage of personal data as well as imposing larger fines for breaches. A first step in this direction is via tighter cybersecurity measures equipped to manage large volumes of data on the small NHS budget. One solution is to use public cloud services provided by organisations that possess large budget allocations to maintain tight security like Microsoft or Google. Naturally this will have to be supplemented as the features that make public cloud access convenient will have to be managed using other third-party apps. Whatever the solutions the NHS considers, it will have to work towards gaining public trust in order to keep providing quality care using the incredibly useful data it collects, the NHS will have to gain public trust.

presenting ‘NHS in a box’ (from left: Maria Carla Hartescu, Grace Pinn, Haider Ali Sheikh, Jeevitha T Thurai Rathnam)

Jeevitha T Thrai Rathnam graduates from King’s College London with a Masters of Laws (LL.M. Trasnational Law). She is generally interested in how effective use of technology can increase value delivery and efficiency. You can read more of her work on the Policy Institute website here. Edited by the social media team.