The NHS is a national treasure. We must continue to guard it

The biggest study into quality and safety in the NHS found spots of inspirational and compassionate care in every organisation. Photograph: Christopher Thomond

While there has been progress in the NHS on standards of care, it takes only one high-profile case of inadequate services to unsettle levels of public confidence and add to vague public perceptions that NHS care is disintegrating. The reality is far from this.

In the biggest ever such research programme, funded by the Department of Health policy research programme and published in the British Medical Journal Quality and Safety, we used observations, interviews, archival data, surveys and national data sets to study acute, mental health, ambulance and primary care across the whole of England. The findings have clear implications for the NHS and have already informed the Berwick and Keogh reviews.

We saw bright spots of inspirational and compassionate care in every organisation. And there were dark spots, too. We concluded that the challenge is to raise the overall level of care while reducing avoidable variability. Our research indicated how this can be achieved.

For example, echoing Francis, we concluded that clear leadership at a national level is needed to ensure an integrated approach to developing high quality cultures. With regulatory agencies pursuing different but overlapping functions, multiple and sometimes contradictory expectations, standards and targets, there is understandable confusion and loss of focus in NHS trusts. Regulators often adopt a deficit model, seeking poor performance while failing to highlight and celebrate outstanding performance and encouraging diffusion of good practice. This creates avoidance and anxiety that reduces innovation and encourages box ticking.

NHS England, the Care Quality Commission, patient organisations, politicians, Monitor, clinical commissioning groups and others with a powerful say in the NHS and social care must integrate, align and work effectively as partners to provide clear direction focused primarily on the delivery of high quality and compassionate care. And such organisations should reflect on their own cultures and the extent to which they encourage compassion and patient focus.

Partly because of this, the priorities at trust board level have often emphasised productivity, targets and efficiencies to the detriment of a focus on quality and safety. While productivity is vital, boards and senior teams need to retain a relentless focus on quality of care, safety, compassion and the patient experience in order to maintain the right balance in their priorities.

Boards must clarify their own six or seven objectives that are clear, challenging and measurable, and include care quality as the top priority. This goal clarity must be replicated at every level of the organisation – in directorates, teams and for individual frontline staff.

The NHS needs to get better at listening to the experiences of patients. Not box-ticking approaches that prioritise bureaucratic compliance with external requirements, and that only pick up comforting messages. Effective boards and trusts actively seek out and respond to problems by gathering rich, in-depth views from both patients and staff. They use the data intelligently and feed the knowledge back into the system and to frontline staff.

Every day the vast majority of NHS staff strive to deliver the highest quality of care. If we want them to treat patients with compassion, respect, dignity and professionalism, we must treat staff with compassion, respect, dignity and professionalism. In the best NHS organisations, we saw that staff were valued, supported and, above all, listened to. And they worked in effective teams with a high level of positivity and engagement to deliver truly compassionate care.

The best organisations have cultures of positivity, self-belief and compassion rather than fear, anxiety, hierarchy and defensiveness. Everyone is responsible for creating such cultures beginning with politicians, regulators and boards but also including staff, patients, media and the public. The NHS is a national treasure. We must continue to guard it rather than undermine it.

Prof Michael West is professor of organisational psychology at Lancaster University Management School.

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