NHS London: A vision for health?
By The Team 09 Apr 2010.
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"The health of the people is really the foundation upon which all their happiness and all their powers as a state depend." (Benjamin Disraeli)
Last year, 142 years after Disraeli's Public Health Act of 1867, the Department of Health published the NHS Constitution, bringing together for the first time in one place, what staff, patients and public can expect from their national health service. The Constitution supports an overall vision that the NHS "belongs to the people", there to improve health and well being, support our mental and physical wellness to the end of our lives.
Seven key principles guide the NHS in all it does, and they are underpinned by six core values; These values were informed by an extensive consultation with public, patients and staff. Local health organisations were tasked to develop their own values.
We recently visited directors and heads of comms in over half the primary care trusts in London, and looked closely at their strategic plans to see how they were tailoring the Constitution's values of: respect and dignity, commitment to quality of care, compassion, improving lives, working together for patients and everyone counts, to meet their "local needs".
And, whether their workforces were being engaged and empowered to uphold the values in their jobs.
Only 4 PCTs embraced the values without developing them further; Westminster, Hammersmith & Fulham, Croydon, Bromley. It was interesting to see, from the remaining primary, acute and foundation trusts which values remained and which were thrown out.
Every trust (bar North West London Hospitals and Barking, Havering and Redbridge Hospitals) removed "compassion" from its own value statement. What do we read from this? To what end did the public put compassion down the list compared to other values such as respect and quality, or did the workshop teams feel that compassion was not relevant to the needs of their local area?
In terms of vision, teaching hospitals and foundation trusts have visions of pioneering excellence and leading research. Community hospitals place an emphasis on quality of services and to become the hospital of choice for the local residents. Their visions are realistic and specifically related to the provision of services, which can be measured within the frameworks of quality and clinical outcomes.
Some visions, however, are unrealistic. Maybe carried away with Olympian aspirations, Newham PCT's vision is that the health of Newham's residents is "better that all other Londoners by 2020". Newham would see better results from developing Specific Measurable Achieveable Realistic and Timely (SMART) objectives that it can work towards.
We're now interested in how far throughout each organisation have the values been embedded? Do managers, use values to guide their day to day decisions? Are clinical staff, who deliver frontline services, trained to work to these values?
Apart from in a few examples where we could find no published vision and values, every trust had done what was asked. We hope there is an opportunity to make the exercise useful and meaningful, especially in a climate where every single trust is expected to deliver higher quality care more efficiently.
