Conversations in the snow returning from the Nuffield Trust’s annual policy summit made me realise how much the #MeToo movement has to teach us.
The summit was its usual theme park of fantastic things to see and (more importantly) people to meet. As a barometer of health policy land, it’s unbeatable.
What stood out in its 2018 edition was the ability of many of our policy beliefs to be utterly taken apart, and for us to continue regardless.
Louella Vaughan surgically dissected the fiction of how we think about small hospitals – no real evidence they produce worse outcomes, and, by the way, on any international scale, they’re not even small. Julien Mousquès reiterated yet again for the record that efforts to promote integration don’t save money, however much we hope they will.
The jewels in the crown were Liz O’Riordan and Mandy Stevens, both experienced NHS staff, describing their time as patients. All those beliefs about our patient-centred NHS knowing what it’s like to be a patient? Tosh. The inner turmoil of thinking "I know what this is like" while experiencing something utterly different was writ bravely, beautifully, painfully, large.
Carry on regardless In another world, Liz and Mandy’s session alone would be enough for us all in the health sector to pause. Thought stops play. Let’s look at other beliefs we hold self-evident and see if they’re wrong too. An immediate, impromptu truth and reconciliation commission where we all hold our hands up to things we’ve spouted but fear may be drivel.
Except we don't. We continue on.
How does this off-the-chart level of cognitive disconnect persist in health circles? Perhaps part of the answer is that we wonder how much good it would do us. How much power would we have to change anything anyway, even if we realised we should? A feeling of being trapped (although by whom remains a fascinating question all of its own).
What does this mean? Two implications.
The first is the general: the need for us to own up to our chronic penchant for fads, groupthink, and going with the herd. How do we more readily question such 'wisdom', and encourage others to do likewise? In the last six months alone we’ve had two ‘significant policy shifts’ which have, er, actually been minor linguistic changes (the renaming of DH and ACOs respectively). Questioning voices weren’t absent, but neither were they universal.
"That such bullying goes on is not disputed. This might be the biggest obstacle to our biggest challenge...and yet we barely talk about it."
The second is to take the dissonance and apply it to the most talked about summit topic –morale, compassion, and the need, to quote Liz’s main reflection, "for us just to be kinder to each other".
We can intellectually engage in this conversation – how to promote better working environments, values based recruiting, how to bottle the pure joy exhibited in such technicolour detail by Bob Klaber.
But the elephant that we didn’t talk about was the whole host of data sources that tell us bullying, from the top downwards, is still a massive problem in the NHS. The inquiries (and follow-up reports) of Robert Francis and Bill Kirkup were explicit that behaviour seen in Mid-Staffordshire and Morecambe Bay were closer to the norm than many of us feel comfortable to admit. How much has changed?
As told by the NHS Staff Survey (2017 results out today, 6 March), the percentage of staff experiencing harassment, bullying or abuse from staff in the last 12 months has reduced since 2015 – but only marginally (24.9% to 24.3%). Only 48% of those affected had reported it.
We need to talk That such bullying goes on is not disputed. This might be the biggest obstacle to our biggest challenge… and yet we barely talk about it. And while there are some fantastic exceptions, such as the work of the Royal College of Surgeons of Edinburgh, you start to wonder whether how much of this is merely silence, or its more malign bedfellow, acceptance.
What behaviour do we wrongly accept in the NHS as just the way it is? Undesirable, yes, but part of the overall package, and too entrenched to shift.
This is where #MeToo started. The growing realisation that some behaviour has no place now, nor ever. "If all the women who have been sexually harassed or assaulted wrote 'Me too.' as a status, we might give people a sense of the magnitude of the problem," tweeted Alyssa Milano on October 15 2017. The hashtag was used by over a million people within 48 hours, and tens of millions since.
What would a version of #MeToo look like for bullying in the NHS? To allow people, at any level, to know that they're not alone, that bullying behaviour has no place in the NHS in any circumstance, and that something needs to change. To give people a sense of the magnitude of the problem.
What if we all started calling out such behaviour? What world would we then inhabit at the next summit?
Since you’re here… ...we’ll let you in on a secret about Kaleidoscope’s funding. Spoiler alert: it’s not a secret. We’re a business. We design and support collaborations, run events, and help to develop strategy and policy. Our work is shaped by our clients’ challenges. We’d love to hear about yours: find out more about our services.