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NHS must focus on health, care and compassion
Dr Kate Granger, a Specialist Registrar in Geriatric Medicine currently working at Leeds Teaching Hospitals Trust, is terminally ill with cancer, throws down a challenge to new NHS England Chief Executive Simon Stevens:
If you hadn’t noticed we have a new Chief Executive of NHS England, Simon Stevens.
He’s the new man at the helm with the unenviable task of leading this mammoth organisation, in the challenging post-Francis report era, with no money to spend. But what would I, as both patient and doctor, like Simon to be doing, changing and inspiring?
Firstly, I really think we somehow need to move away from the tick box, target driven culture that we currently have, which in my opinion stifles care and innovation. I would like to see a move towards an NHS where caring is valued more and staff are given more time to care. I want a culture where the little things really matter and are expressed by everyone from hospital porter to Medical Director.
Compassion has become extremely fashionable in recent times and is perhaps most noticeable when it is absent. Creating a compassion friendly environment would, in my opinion, include adequate staffing levels, time for personal development and rewarding positive behaviours.
We saw this for real with the massive boost given to all nominees and winners of the inaugural Compassionate Care Awards which I presented earlier this year.
I have just returned from the International Forum on Quality and Safety in Healthcare, held this year in Paris. One of the most inspiring presentations was given by Don Berwick. He was asking the question “What if we tried for health?” and was suggesting we need to embrace, promote and value health and wellbeing, moving away from the disease focused models that we currently have.
I will admit to being a very disease focused clinician. It is how I was trained; to think of health as merely the ‘absence of disease’. But living with cancer for a significant period of time now has taught me the vital importance of social support, positivity, mindfulness, exercise and eating well alongside traditional models of care to keep me feeling as ‘well’ as I possibly can in difficult circumstances.
I have also massively exceeded my predicted prognosis. So if Simon could steer the NHS towards delivering healthcare which focuses on health rather than disease that would be on my wish list. I realise this is huge, near impossible ask.
My final major desire is improved integration of healthcare systems that really work for the patient. As a doctor I see the consequences of this failing to happen every day I go to work. The Holy Grail of true integration is beginning to be achieved in many places but my own personal experience is that we could do so much better.
Part of the answer to this, which is rarely discussed, will include convincing the public that their care and that of their relatives can be delivered safely in the community rather than the expectation of hospital admission, which is an attitude we often come up against in Medicine for Older People.
We also need to break down the barriers between primary and secondary care in terms of communication. For example we urgently need robust systems to communicate Advance Care Plans to all those involved. If key workers have spent many hours having these difficult discussions with patients and their relatives, it is an absolute disaster if a patient ends up against their wishes dying in an Emergency Department in the middle of the night. This is a recurrent personal nightmare of mine.
So I guess I’m asking Simon for a more compassionate, health focused and integrated NHS. If those things could be achieved we would move towards becoming a much more effective and patient-centred service. Whether they can be achieved in my lifetime we shall see.
Your story today mirrors our family experience and words fail me. I would love to make a change in how people are conveyed this news but still am traumatised to move on. My Husband, aged 58, totally out of the blue, was delivered the news that he had colon cancer which had spread to the liver and fatty lining of his stomach. He was delivered this news ( myself and son present) by a disgraceful excuse of a human being who made no contact at all. He seemed to “get a kick” out of having 2 young students… both tears streaming down their faces. My Husband ( also a very typical Yorkshire bloke ) asked… how long do I have..? Again, the Consultant made no eye contact and said… “6 weeks – 6 months… who knows! At that point my Husband ended the meeting and said ” I will ot waste any more of your time then!” He never shook his hand, said goodbye or anything. Thankfully, my Husband had the most amazing Oncologist in Leicester, Prof. Anne-Louise Thomas, who was the most inspiring person. That meeting where we were told left me in total trauma for 3 weeks where I could not eat, wash or function and when I should have been there for my Husband, I failed him as I was in total shock. I am not ashamed to say that 18 months on I still get extremely anxious, a, physically sick when thoughts of that dreadful day creep in. If I could spare just one person experiencing what we did that day I would feel like I had made a difference. Any pointers would be very gratefully received as I could channel all my copious spare hours in a positive way. Finally, your books, updates are so very inspiring and I know I speak volumes on behalf of countless others. Thank you.
Mrs. Tina Dicks
I completely agree with Dr Kate Granger regarding the need to focus on positive health when facing any cancer diagnosis/prognosis. I was treated 12 years ago for cancer, NHS care was good in its disease treatment there was no knowledge or support for other interventions around building wellness or using other approaches to complement chemotherapy or radiotherapy. In fact measures I took myself and found really effective and helpful were seen as useless by staff. I know that some treatment centres have become much more accepting of the value of complementary approaches and have taken steps to integrate choices in care for patients undergoing cancer treatments but there remains much work to do. There is a growing body of research about the benefits of dietary and psychosocial interventions and most importantly ‘cancer patients’ are not a homogenous group and each person and their needs are different. A wider more integrative approach is greatly needed.
Great comments – I think to focus on health and healing is the direction, having worked for over 30 years in the NHS as Clinician then Patient Engagement lead. Have a look at Defy Gravity by Caroline Myss for some clarity and inspiration on healing.