A Word on Bravery Certificates ...

I had another lightbulb moment today - a truly privilidged experience of "walking in my patient and their families shoes" and understanding the very importance of the impact healthcare professionals can have upon those under their care.  For a while now one of my guiding principles has been an inspiring quote by the great writer Maya Angelou.  She said:

With that context in mind, for those who do not mix in paediatric healthcare circles - let me explain the principle of a "bravery certificate".  A Travel Health Nurse specialist describes bravery certificates as "one of the most popular items nurses like to use when seeing children".  It's very true.  In my 13 years qualified as a nurse, I have seen again and again how important they are to the young people and their families.  But largely within the NHS - they are often seen as a "luxury" that a nurse can only personalise for their patients if they have time.  Sadly the comment I often receive if I am taking time to colour in a bravery certificate for my patient is - "well you obviously aren't busy if you have time to do that".  I understand that comment - in an NHS often consummed with bed numbers, targets, waiting times and so on - a "little" thing like a bravery certificate is seen as unnecessary.

But here's what made me re-energised in the important part they play in the overall experience for especially children and young people and their families - twice this week, and from two different families, I have been able to find the time (usually during my break) to colour in bravery certificates for my patients and have given them on discharge.  And both times I got the same comment from the families;

"Oh wow - look at that "Billy" - we will frame that and put it on your wall!".

Let me make it clear - I am no artist.  My colouring is poor and I sometimes step outside the line.  It is no masterpiece worthy of the National Gallery!  So why this response I wondered?

My reflection leads me to believe that it is quite simply that this certificate reinforces to your patient and their family the fact that you - their nurse - have thought of them as a PERSON - not as a bed number.  The very little bit of colouring demonstrates that you have taken a little bit of extra time in your busy day (and your patients know you are busy - they are mostly watching you!) to express your admiration for the bravery they have demonstrated.  And I think that by giving them this little gift along with their discharge paperwork - you are showing that you recognise they and their families have been through a great deal in coming into hospital and going through the procedure they have or the treatment they have.

My call to nurses is - it doesn't have to be bravery certificates.  It's not about "what".  It's about "how you make them feel".  It is the little action of showing your patient and their family that you are recognising they are people, they have their own individual stories and hopes and fears and aspirations.  It shows that you recognise them coming into hospital is a big deal for them (and possibly scares them rigid) and you care about that and their feelings.

So don't think "it's nothing - it's not important" as yes - bravery certificates can't be quantified, and don't meet CQUIN standards for NHS Trusts.  They are important I feel, because they make a difference to the patients and their families at that moment in time, and improves their patient experience ten-fold.  And that is the one opportunity we have.  Chief Nurse of NHS England - the wonderful Jane Cummings - always says "we only have one opportunity".  And back to my opening quote from Maya Angelou;

"They may forget what we said, they may forget what we did - but they will never, ever forget how we made them feel".

And as nurses - our NMC Code of Conduct binds us - we MUST put patients first!

A View of Things That Matter

This blog post is dedicated in particular to Julie Bailey, Deb Hazeldine, James Titcombe, Liza Brady and Dr David Drew - among so many other whistleblowers.  It takes tremendous courage to speak out and "rock the boat" - courage perhaps more than I possess.  These people have suffered unbearably but want - only the best.  We need to hear from them.

It's been on my mind to write about the last year's public opinion of the NHS for some time.  The important whistleblower revelations of Mid-Staffs, Morcombe Bay and others have broken the rose-coloured fallacy that the "NHS is perfect because it gives free care to people who need it".  That is true and it is wonderful.  But the NHS is made up of imperfect human beings from the porters and domestics who enable hospitals to run, to Chief Executive Officers who lay down vision.

As is common in human behaviour, we tend to hold opinions of extremes (I hold up my hands and admit I personify this!).  If we do not love something passionately, we hate it with a vengance - particularly if wronged by it.

It particularly troubled me to see the horrendous backlash against key whistleblowers such as Julie Bailey and Deb Hazeldine, James Titcombe and Liza Brady.  For those unfamiliar, these two ladies lost their beloved parents in the most appalling failures of care and were not giveNOT just treat "the patient".  That "PERSON" comes as part of a family - and care given to them (whether good, bad, excellent or dreadful) will impact upon the closest people to them.  A caveat: I can somewhat understand why a lot of the backlash comes from the people of Stafford who face losing their hospital.  They are looking for a scapegoat, and inevitably (I suppose - however unacceptable) will look to the whistleblowers.
n the answers and reassurances they deserved - and so began to campaign.  The NHS and health professionals owe them a debt!  They are a reminder that we do

But I want to ask - does anyone mildly rationale think these two ladies - Ms Bailey and Ms Hazeldine EVER considered "becoming campaigners" or "whistleblowers" five to ten years ago?!  We must consider why fate led them to this.

1.  A Step Back and Pause for Thought:

Over this past year I have had a lot of time to think, read and consider the NHS as something incredibly important to me.  The availability of the Mid-Staffordshire Inquiry has enabled in depth reading and consideration of the mistakes and errors and lapses in communication.  In particular I wanted to read the accounts of families like Julie Bailey and Deb Hazeldine to learn and ensure that in my experience - this would NEVER happen again in my human power or sphere of capability wherever I work.  I was seized by a comment Deb Hazeldine made in her testimony to the Inquiry that I think it incredibly telling - she made it early in the complaint (point 25);

"If Martin Yeates had been up front and honest in the first place, I would have walked away.  I just wanted justice.  If he had said; "Hands up, it's bad" but could demonstrate in a robust way that it wouldn't happen again - I would have walked away secure in the knowledge that vulnerable people were not at risk".

I would hesitate a guess that virtually all families who have suffered unjustly or through human error would be actually satisfied with a swift, sincere apology and evidence of real lessons learned and proof that identical mistakes would not be made - would be enough.  I wonder if we can allow for the fact that whistleblowers have happened - because one of the human errors of the human NHS is that we collectively haven't been good at admitting error and learning from mistakes?

When I was at school (a private Christian religious school run by my parent's church) we used to have reports on our progress - both academic, but being religious, also character.  One consistent character point I scored very badly on was called; "Responds Well to Correction".  I can only assume at heart at that point I was an intensely proud and/or stubborn character as I consistently would score; "Needs Improvement".

This is an error I have somehow (I am not sure how) been keen throughout my life to remove and hope will continue to do so.

2.  Applaud the Good but Admit the Bad - and Learn and Improve from It!

There was a report in the Independent today that somewhat ignited the difference of opinion about the NHS.  Sir Mike Richards - the Chief Inspector of the NHS - wrote and commented favourably about the NHS.  He said;

“Compassion in the NHS is alive and well.” And then with extra emphasis: “We’ve also seen some really excellent care.”

This surely is good news?  But on Twitter again opinion was divided.  Those desperate to see the tide of public opinion turn on the NHS highlighted the story and applauded it.  The whistleblowers still seeking "something more" were justifiably concerned - all is still NOT well in the NHS and there is a great distance still to go.  The Sir Mike article states it itself;

"It is what I hoped I would see,” he adds. “But seeing is believing.”

There is a reason that I love reading the Birmingham Children's Hospital Foundation Trust Parent and Carer Feedback page on their website that collates feedback from the instant "Feedback Application" (Award winning!).  It demonstrates so clearly that feedback and performance change.  Some days the NHS gets it very right.  Some days the NHS gets it very wrong.  We are human.  We change!  But as long as we are transparent, live, love and learn - surely there is hope?

I for one - as a proud current NHS healthcare professional - promise and pledge here and now to devote the rest of my working life (up to 70 now I believe!?) to ensuring the patients and families under my care NEVER have any cause to have to raise concerns about the standards of my care.

PEOPLE matter.  End of.  FAMILIES matter.  End of.  And it is our (my) everlasting privilidge to be able to care for some of these vulnerable people when they need it most.  That expression of trust must not be ever let down.

The Human Beings Behind the Trust Boards

I am writing this short blog post inspired by a tremendous friend I have yet to have the privilidge to meet (awesome Twitter effect again!).  Rev Dave is a chaplain in Worcester and he runs an outstanding blog celebrating the good news stories within the NHS.  This is something we both feel PASSIONATELY about and have spoken of much.  Much of the media focus on the NHS at the moment is negative - and perhaps rightly so.  There have been awful cases of unforgivable poor care and we must learn, take responsibility and make every effort to ensure it never happens again - and as NHS privilidged staff we REALLY make every contact count.

Rev Dave was published recently in local media writing an article about his local Trust Board that profoundly impacted me because of it's unique slant and his passionately, positive attitude shining through.  So I want to reflect somewhat similarly on my local Trust Board at Birmingham Children's Hospital FT.  I could write about many NHS Trust Boards that I have watched through the wonderful medium of Twitter and the new transparent accountability it brings (national heroes of mine include Chief Nurse of NHS England, Jane Cummings, NHS Employers CEO Dean Royles, Patient Experience Lead for NHS England, Kath Evans and of course - never forgetting Sir David Nicholson, CEO of NHS England himself - among many others such as the wonderful CEO of South Tees FT Professor Tricia Hart).

But many of us in the NHS work locally, and it is therefore obvious that most of our contact and observation is to our local Trust Board.  I have been MASSIVELY privilidged as a mere Band 5 staff nurse to perhaps have a little more contact and observation from afar of the BCH Trust Board than others (mainly through the wonderful participation I used to have on the BCH Flufighter Team).  So like Rev Dave - I want to write personally as a frontline nurse on what I have seen of the BCH Trust Board and the people who carry responsibility for the hospital.

One word about salaries - it is, I supppose obvious, that in the popular critical culture of media coverage of the NHS, that some spotlight is put on the salaries of Trust Boards.  This is guaranteed to raise my blood pressure and incense me beyond words.  Here's why.  A quick Google search through the Financial Times reveals that CEOs or Directors in the private sector earn ridiculously more than NHS Trust Boards.  How can you compare a salary of $4.1million (salary of the CEO of Barclays) even with the current salary of the CEO of NHS England?!  One CEO of course takes responsibility for the money passes through an organisation.  But NHS CEOs and Trust Directors take responsibility for HUMAN LIVES.  And they are paid far less for that responsibility.  I have said before - and again - I never resent them a penny, who can imagine the pressure they are under for running our hospitals?

So - the Trust Board of Birmingham Children's Hospital Foundation Trust (in similar vein to Rev Dave - let me tell you some stories):

Chairman Jo Davies: (I must add BCH have been ably cared for by acting-Chairman Keith while Chairman Jo was away and I understand they are looking for/interviewing a new Chairman).  But my first real contact with the pinnacle of our Trust was breathtaking in real humanity!  Chairman Jo was eager for her #flufighter jab, and I was invited to her office a few years back to give it.  I was on full, "political correctedness" mode but she breezily popped her shoulder out for me and presented, without fear!  Further contacts amazed me with her absolute fierce passion for the BEST care for the children and families coming through the hospital.  I can only imagine the tight rule she had over Trust Board meetings and the questions she would have (somewhat like HM the Queen to encumbent Prime Ministers?) if she wasn't content the best was being done!

But this amazing, force of nature could sweep through the hospital wearing the most amazing coats of a variety of velvet, gold and all manner of materials!  Presence was the word!  But this Chairman could sit happily with the children (most important in her eyes) and talk and laugh with them.  I have no doubt her successor will have to live upto her high standard!

Chief Executive Sarah-Jane Marsh:  Ah where to start with this absolutely amazing lady.  Like the Chairman, my first contact was through promoting the Trust "Flufighter" campaign.  I was amazed at the strong support from the CEO that came through persistently and positively.  Sarah-Jane always was interested in uptake results, and still is to this current day - the amaze current campaign is here!  Through that initial contact I became progressively vastly impressed with her committment to the absolute and best patient experience (this was pre-Francis) for the patients and families who came through BCH.  I seized many, many quotes from various CEO briefings I was fortunate enough to hear that I have never forgot such as;

"It's not just what we do - it is the WAY we do it that really matters".

A couple of times I heard from parents under my care who hadn't had the best experience and were upset about it.  It was without fear, and complete trust that I recommended they contact the CEO Sarah-Jane.  I would tell them of my brief contacts with her and suggested I felt she would care, and would seek to make changes.  One father in particular excitedly told me he had written a 6-page letter to Sarah-Jane!  I did have a brief moment of complete fear and anxiety wondering if my P45 would be in the post!  I was floored to be updated now and then that Sarah-Jane and our Chief Nurse Michelle (more later) had met the father and implemented REAL change from what they had learned.

One final unforgettable encounter with this amazing woman - I had the amazing opportunity to meet Sarah-Jane just before Christmas (related again to flu I think) and she asked me genuinely how my substantive work (then as a PICU staff nurse was going).  I related to her a very tragic account of being so privilidged to care for a family who were going through the tragedy of facing the withdrawal of care on their poorly child and palliative care for them.  I was stunned to see visible tears in her eyes as she connected instantly with the pain and anguish a family was going through who she had not met.  I have never forgot that.

Chief Nurse Michelle Mcloughlin:  The CEO Sarah-Jane quite rightly refers to Chief Michelle as; "a force of nature".  Patient Experience Lead Kath Evans refers to her; "Can do - will do" attitude!  This so accurately represents a role model in the most excellent, highest standard of patient care and experience delivery - I have been privilidged to meet.

Once again, my first real contact with Chief Michelle was through the contact of the "Flufighter" campaign in 2009.  I was amazed to find that Chief Michelle had expressed her wish to become an "Immunisation Champion" and join in immunising staff.  This was highly unusual around the time - typical NHS practice was to run campaigns via Occupational Health services.  Chief Michelle was key in spreading the positive message of flu vaccination to top consultants who previously may have avoided frontline immunisation nurses.

My later contact with Chief Michelle before leaving the Trust was focused around patient experience and in particular the importance of play therapy and input for our patients.  I again was Patient Experience Application" which has won several awards - and also the "Dignity Giving Suit" - which I think is the most FANTASTIC innovation for giving dignity to young people ever!
amazed at her passionate focus on improving and exceeding everything in the Trust that could be affected and improved.  I caught that vision, loved it, and it remains with me to this day.  Like Sarah-Jane - the CEO - Chief Michelle has been one of the main hero impacts on my nursing career.  Since being away from the Trust, Chief Michelle has been influential and behind the "

Chief Medical Officer - Dr Vin Diwakar:  I have always have had something of a tremendous soft spot for expert clinicians.  This comes from, I think, my esteemed and expert uncle - Dr Andrew Long (Consultant Paediatrician at Great Ormond Street Hospital FT and head of the London School of Paediatrics as well as being on the Board of the Clinical Ethics Team).  Dr Vin has more than earned my tremendous respect and admiration again - all through the accounts of his patient experiences.

As a Paediatrician, Dr Vin Diwakar has cared for and built up a tremendous rapport with many of his patients, and I have heard that many of them have his personal phone number so they can seek support and help if they need it.  He manages to balance his Executive and clinical duties somehow (who knows how!?) and is seen frequently on ward rounds, but also of course at Board meetings promoting patient interest - and the vital role of safety in the Trust.  Just as per Chief Nurse Michelle, Vin strongly supports the Trust "Flufighter" campaign and was pictured this season with Chief Michelle being jabbed!

Chief Finance Officer - David Melbourne: - Non-clinical Directors often receive a less-than-high-profile.  They have no obvious cause to circulate among patients and are often seen to be hiding in offices.  David is not guilty on all counts!  He acted up as Chief Executive while Chief Sarah-Jane was off on maternity leave, but now is frequently seen around the Trust.  I have heard many accounts of his sheer generosity and giving attitude (in an atmosphere of austerity when the NHS should be counting every penny) if it benefits true patient experience.  Quite rightly and deservedly he won the austure "Finance Director of the Year" from HFMA in 2011.

I have no doubt he manages the finances of the Trust sensibly, carefully and accurately - but love accounts where he eagerly invests money if and when it directly benefits the patient experience at BCH.

There are of course, many other BCH Trust Board Directors who I do not have the privilidge to have encountered, but have no doubt (from reading the Trust Board minutes as I do monthly) that they daily defend the importance of nothing less but excellent patient care.  But like Rev Dave - I wanted to highlight the PEOPLE I have had the honour and privilidge of meeting who step up and take responsibility for the care of the precious and vulnerable children a
nd families who are daily cared for by BCH.  I haven't even had the time to talk about the Non-Executive Directors of BCH like Professor Jon Glaseby - who again I am positive carry out a vital role in the care of the children and families in BCH.

They are nothing less than true NHS heroes and want nothing but the best and most excellent care for the patients.  For that they should be saluted!  Of course there will be some "human" Trust Boards who do sadly fail the patients they are entrusted with (such as Mid Staffs) and they should rightly face the accountability of the Secretary of State and the Department of Health and indeed the nation if appropriate.  But until such errors are revealed and proved, Trust Boards across NHS England need our support and thanks as they seek to lead the NHS to do better - and better.  A never-ending journey for the good of our patients.

To end with Rev Dave's words;

"And OK, since you’re asking, (I can’t resist it) here would be my words: expert, professional, passionate, caring, engaging and visionary. But then my Mom always used the quote from Disney’s Bambi and tell me: “If you can’t say anything nice, don’t say anything at all!”