Why the culture of the NHS has to change to enable sustainability.

1. Why the culture of the NHS has to change to enable sustainability. Professor Lesley Moore Florence Nightingale Scholar National Teaching Fellow Churchill Fellow FRSA

2. Aims of the paper: • To share salient points based on personal experiences as an informal carer and more recently as an inpatient of Welsh healthcare, and current national issues, and • To raise important action points for changing the culture of the NHS.

3. Who are classified as patients in this century? “Patients are all the people who experience NHS Wales care and services. Alongside listening to patients, organisations also need to listen to families and carers.” (Williams, A. 2013. “The Listening Organisation: Ensuring care is person-centred in NHS Wales.” Cardiff 1000 Lives Plus. P7)

4. Personal experiences and observations. • Poor discharge planning for those wishing to die at home. • Poor understanding of the needs of rural communities. • Negative attitudes of some staff regards dying at home • Long shift patterns • Unanswered call bells • Priority to meet government targets • Conveyor belt surgical care that negates respect and dignity of patients and appropriate discharge planning. • Poor staffing levels • Apathy of staff, especially to question lack of resources to safely nurse patients. • Poor communication between the acute and community sectors. • Quality of care seen as less of a priority.

5. Characteristics of the traditional NHS culture. Paternalism Medical dominance Professional power Therapeutic privilege Expert witness Task orientated care Illness model – passive patient

6. Paradigm shifts in Healthcare Culture X Y Paternalism Medical dominance Professional power Therapeutic privilege Expert witness Task orientated care Illness model – passivepatient Autonomy Interprofessionalism User balance of power Shared knowledge Holistic care Expert and active patient Health promotion model

7. Characteristics of the NHS Trust culture reported by Francis(2013).

8. Francis’ call for leadership actions to effect change.

9. A learning organisation (Senge 1999:14) “…continuously expanding its capacity to create its future. For such an organisation, it is not enough merely to survive. “Survival learning” or what is more often termed “adaptive learning” is important –indeed it is necessary. But for a learningorganization, “adaptive learning” must be joined by “generative learning,” learning that enhances our capacity to create.”

10. Characteristics of a learning organisation (Clarke 2001).

11. Conclusion: Key Words to act upon in the future • Person-centred care • Reflect, document and learn • Active listening • Action learning – work-based learning • Co-production of knowledge • Sharing knowledge • Ethical, transformational leadership at all levels.

12. Remember: • The NHS in Wales is just surviving. It does need to be transformed, but this will not happen without a change in the NHS culture.