Let’s be frank about the NHS

In a guest blog for The King’s Fund, Laura Fulcher explains how her poor experience as an NHS patient has prompted her to question whether our affection for the NHS as a national institution is blinding us to how it needs to change and improve.

What best represents the UK today?

Is it Britannia, with flowing mane, trident in hand, on a 50p coin? Or perhaps Lord Kitchener, his stubby finger pointing at you from World War 1 propaganda: ‘Your country needs you.’ No, such militaristic images don’t define us nowadays.

For a country devoid of a unifying religion, with nationalist pride used by some to justify racist thuggery, we must find our identity somewhere. And we find it in the NHS – that all-compassionate healer of the sick.

National Helth Service

Yet NHS propaganda comes with the implicit threat of Kitchener’s finger. Without our zealous support, the health service could well be snatched away. ‘Save the NHS!’, the placards scream. For if we are deprived of our health service, who will cure the sick, who will deliver babies, who will save us in our hour of need?

And so we clutch the NHS to our bosom. We must protect it; ensure it doesn’t change; never a bad word must pass our lips.

I was born within the NHS for free – it’s the greatest treasure in the world!

No one could ever say anything bad about the NHS, because it’s made up of such caring, hardworking people.

With the NHS so entrenched in the nation’s psyche, it has become almost a treasonous act to call for improvements. We place the NHS on a pedestal as the envy of the western world. And as the system is now synonymous with hardworking clinicians, negative patient feedback is stifled further. We can’t possibly criticise overworked nurses, can we?

And so we don’t seek policy change or campaign for specific meaningful investment.

I too trusted the NHS once.

As a secondary school teacher, I was confident that the health service would be there for me in much the same way as I supported my students. But after the 15 months it took to fight for a cancer diagnosis at 29, that blind trust is long gone. Thousands of others are placed in a similar or worse situation every year, many of us waiting months or years to be diagnosed.

But there’s no use complaining about the delay. You’re told no mistake has been made; your treatment was timely; the only thing failing the NHS is ‘limited resources’ – something seemingly out of any one person’s hands.

As a secondary school teacher, I was confident that the health service would be there for me in much the same way as I supported my students. But after the 15 months it took to fight for a cancer diagnosis at 29, that blind trust is long gone.

‘Limited resources’ has become a catch-all of excuses; the ultimate shut-down of debate and improvement. This inertia now pervades the public, NHS workers and politicians too.

And to those whose eyes are open to the NHS’s issues, what options are there but disillusionment and disempowerment?

Certainly you can’t speak up. The formal complaints procedure is out of reach for anyone who values their mental health. Policy decisions are kept far away from patients. Not one person sits on the NHS England board in the sole capacity of a patient. Where is our People’s Champion? Who represents our views? Even NHS jargon, either purposefully esoteric or pointlessly truistic (‘person-centred care’ – I ask you!), seems set to complicate matters further.

With no opportunity to campaign for better, disillusionment breeds frustration. Harsh words are spoken. Commissioners begin to believe all patients just want to cause trouble; they batten down the hatches; they don’t want to engage. The public is perceived as too passionate, too uncontrollable.

Behind closed doors, financial decisions take priority over human life. Commissioners are told they can’t slide into further debt, so NICE guidance is overruled, services cut, waiting times lengthened… capacity never found. Propaganda states that private hospitals are the devil for putting profits first – but is this worse than an NHS at the mercy of an austerity-leaning government?

I paint a picture steeped in impossibility – everything seems just too difficult. With the menacing rhetoric, the ‘limited resources’, the jargon, the adversarial public relationships, the demonised government, the politicised system, the fact that policy decisions are all made so very far away… how can change ever be made?

The solution is brutal honesty.

The NHS in its current form is a system born of policy, targets and financial investment. Viewing it as such allows us to talk frankly about what we actually want from a health service without worrying about denigrating overworked staff or bruising our national pride.

The NHS in its current form is a system born of policy, targets and financial investment. Viewing it as such allows us to talk frankly about what we actually want from a health service without worrying about denigrating overworked staff or bruising our national pride.

Hard questions do not just need posing, they also need answering. And it is the public’s responsibility to do just that.

How long does Grandma really need wait for her hip replacement? A month, or two. Shouldn’t all cancer patients be diagnosed within two weeks? Yes! Do we really want our hardworking doctors and nurses run in to the ground? Definitely not. And fundamentally, don’t we all want a service that genuinely meets the needs of all?

The nation’s answers to these blunt questions must replace the current moveable targets that are so easily manipulated. Instead, they will form a transparent contract outlining what the public can expect from the NHS, with no place for blind trust in vague promises. Solid expectations would empower us all to champion ourselves.

But to reach this open and honest world, culture needs to change. The NHS should never feel faceless or corporate but should be ‘people powered’ and wholly entwined with the local community. Red pens should be wielded to cut the jargon that makes strategy so inaccessible. Communication channels should open – through social media, email, by providing open-office hours, and launching Westminster ‘fly-ins’ to engage the public in debate.

Complaints should be treated as opportunities to improve rather than pesky letters to be dismissed and ignored by departments that are so distanced from the front line. Leaders must stop seeing policy as a set of divine commandments inscribed in stone, but guidance to be challenged and upgraded.

And in all this, the public should be reimagined, not as the ‘great unwashed’ fixated on problems, but as energetic folk with the capacity to lead on improvements with innovation, passion, and resolve.

Source: The King’s Fund

Disability and Employment

Disability can be a difficult topic to speak about especially when it comes to employment. Employers are often thinking what are the best practices when employing someone with a disability so in this blog we are going to be speaking about the recruitment and employment of people with disabilities.

Disability and Employment

What is a disability?

There are many types of disability. Too many to name, but there are several umbrella terms to disability, which are sensory, physical, mental and learning.

Here are some examples:

Sensory – Vision and Hearing Impairment
Physical – Cerebral Palsy, Diabetes
Mental – Depression, Anxiety
Learning – Dyslexia, Dyscalculia

Just to make it even more complicated there are variants within this as some people like myself have more than one disability from multiple categories. To make it even more complicated than that, long-term health conditions are also considered as a disability.

Not all disabilities are visible; there are also many invisible disabilities for example depression or HIV.

Legislation – The Equality Act 2010

The government created legislation in 2010 that protects people with disabilities from discrimination both in and outside of the workplace.

Not every disability or health condition is protected by The Equality Act 2010 and the following definition should be applied:

‘’You are disabled under the ‘Equality Act 2010’ if you have a physical or mental impairment that has a ‘substantial’ and ‘long term’ adverse effect on your ability to do normal daily activities.’’

When working alongside people with disabilities in employment you will hear the term ‘reasonable adjustment’. The Equality Act 2010 states that employers and service providers must make reasonable adjustments to prevent people with disabilities being put at severe disadvantage.

So your now thinking what does a reasonable adjustment look like?

For a national organisation, which employs a person with a physical disability, a reasonable adjustment might be step free access to enter and exit a building. However if an independent shop employed this person, it might be more reasonable for the shop to provide the employee with a wheelchair ramp for them to enter and exit a building.

Now the word reasonable is a very grey term because what is reasonable to one person is not necessarily reasonable to another and there are also considerations to how large the employer is. However there are ways in which to seek this information to inform your decisions if as an employer you wish to ensure you are abiding by the rules, regulations and best practice.

 Fair and accessible

In order for us to recruit people with disabilities we must make the recruitment process fair and accessible. Some employers don’t realise that before a candidate with a disability gets to the job interview stage, there are multiple barriers that they face for example job adverts being inaccessible. In some cases job adverts have excluded people with disabilities by stating such things as you must hold a valid driving license. This isn’t completely true as somebody with a disability may have access to a vehicle and may be entitled to a driver funded by access to work.

There are some people with disabilities who would require the advert in a different format for example by having someone read out the information via the telephone and some people use email as an alternative method. In most adverts there are contact details listed at the bottom of the advert. Is this person well informed about the job and are they able to provide the advert in an alternative format?

The job interview comes with multiple barriers for people with disabilities. Some people with disabilities may find it difficult to get to a job interview for a number of reasons for example they haven’t secured the job with you in order to have access to funding that may enable them to get to work on time, they may have recognised the job advert at short notice and arranging support to enable them to attend the interview could prove difficult. Advances in technology such as Skype or the good old telephone may prove invaluable in opening up this job opportunity to a wider field of candidates.

Advertising equals diversity

Ensuring the way your job is advertised in more than one place is key. Most providers promote their job adverts on one particular platform. How about having a multi-layered approach by advertising your advert on multiple platforms. Some may pose the question that this could be costly for organisations but forums for people with disabilities, social media, and many other advertising channels are sometimes free and provide the opportunity to create a diverse workforce, as inevitably you will get different types of candidates.

Is it all about physical adjustments?

Often those involved in making the recruitment process accessible fixate on physical adjustments such as step free access, lifts, hearing loops, which are the very obvious ones. Although they are still very valuable there is much more to recruiting someone with a disability than this. Being aware of the way in which you speak to someone with a disability, maintaining eye contact and also looking in the candidates general direction when they are vision impaired. It is often the case that because the candidate has limited eyesight the interviewer doesn’t maintain eye contact. By treating someone fairly and with the same level of enthusiasm as a non-disabled candidate, will ensure better rapport. Furthermore if that candidate is then successful in achieving the job there is a better impression of the organisation on the run up to the candidate accepting the position.

Interviewing candidates for a job requires a vast amount of skills in which some people often miss out. Interviewers must recognise their own unconscious biases and have a certain amount of self-awareness to ensure fair treatment for all.

Top tips:

  • Ensuring that job adverts are accessible
  • To hold the job interviews in an accessible location
  • To hold yourself in the same way you would when interviewing someone who doesn’t have a disability

To find out more about making your recruitment process accessible you may wish to attend Disability Awareness Training.

Written by Centre for Resolution