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Most commentators state that there is not enough cash to run the health service in Wales to meet current, let alone future, demands. There is a recognition from everyone that something MUST be done, but much debate about WHAT. With disagreement about who might be to blame for this or that and a tendency to adopt a 'nothing to do with me' learned helplessness position, it is tempting to spiral down into well-worn phrases: it's all to do with austerity, sicker patients, too few beds, universal shortages of doctors, nurses or other specialised healthcare professionals. Surprisingly perhaps, there is an emerging agreement in Wales - and in our NHS in particular – that we have a unique opportunity to 'put our own house in order’ by empowering our staff, to alter the fundamental culture of all our NHS organisations.
Today, a new set of principles, developed for the Welsh NHS in partnership by the Welsh Government, NHS Employers and trade unions - including BMA Cymru Wales - has been unveiled. It forms the foundation of how all staff should, in the future, operate across and within NHS Wales. By capturing and describing our core values, the Welsh Government, NHS employers and staff have committed to a Welsh way of doing things. It poses every NHS worker with a real challenge to make our NHS feel different from bottom to top. It is a declaration that this is how we expect to do business with patients, staff and each other, internally and to the outside world.
While this is the beginning of something essential and exciting, the next steps are even more ambitious, as those who lead, practice in and deliver our NHS now have to introduce, enact and live by these values. They equally empower patients, staff and managers to build upon the excellent work already started by several health boards. It also signals that every organisation is learning to listen, to value comment, feedback and criticism in an open and transparent fashion.
If NHS Wales is serious about abandoning the blame culture, and the reported bullying and victimisation that undermine the safety and quality of the work we do, each of us must recognise that we are all in this together and that the major part of the solution is in our own hands.
BMA Cymru Wales will be actively engaging with partners to ensure that real, positive change happens and that staff and patients can see and feel the difference. If we can do this, we will have an NHS to be even more proud of. But more importantly, it will be an NHS where professionals will want to work and we will continue to attract the brightest, caring colleagues for the next generation.
Clearly, this is not something that will change overnight, but success will be measured by each of us being able to say each year, “yes, Wales is different because it listens to and values its staff, it changes and evolves like no other health service.” This culture conversation starts in earnest today. It can be as simple as two colleagues talking about what the values mean to them and sharing their views and feelings with two more. Or inviting a patient into your conversation. Our NHS belongs to our patients and the people of Wales. Those of us who work in it, manage it and fund it are merely its custodians. There is much we can do by living these values that doesn't cost a penny, yet guarantees a sound NHS for our future.
NHS Wales core principles
• We put patients and users of our services first: We work with the public and patients/service users through co-production, doing only what is needed, no more, no less and trying to avoid harm. We are honest, open, empathetic and compassionate. We ensure quality and safety above all else by providing the best care at all times.
• We seek to improve our care: We care for those with the greatest health need first, making the most effective use of all skills and resources and constantly seeking to fit the care
and services we provide to users' needs. We integrate improvement into everyday working, by being open to change in all that we do, which also reduces harm and waste.
• We focus on wellbeing and prevention: We strive to improve health and remove inequities by working together with the people of Wales so as to ensure their wellbeing now and in future years and generations.
• We reflect on our experiences and learn: We invest in our learning and development. We make decisions that benefit patients and users of our services by appropriate use of the tools, systems and environments which enable us to work competently, safely and effectively. We actively innovate, adapt and reduce inappropriate variation whilst being mindful of the appropriate evidence base to guide us.
• We work in partnership and as a team: We work with individuals including patients, colleagues, and other organisations; taking pride in all that we do, valuing and respecting each other, being honest and open and listening to the contribution of others. We aim to resolve disagreements effectively and promptly and we have a zero tolerance of bullying or victimization of any patient, service user or member of staff.
• We value all who work for the NHS: We support all our colleagues in doing the jobs they have agreed to do. We will regularly ask about what they need to do their work better and seek to provide the facilities they need to excel in the care they give. We will listen to our colleagues and act on their feedback and concerns.