NHS Change Day: let’s get back to the grassroots

First published on the Guardian Healthcare Network on 20 March 2015

Pledging ‘to be the Beyoncé of occupational therapy’ is an extreme example of a meaningless pledge. Photograph: Armando Arorizo/Zuma Press/Press Association Images

Anyone who has followed it since it began two years ago will have noticed that NHS Change Day pledges are becoming the new year’s resolutions of healthcare: lofty, vague and unlikely to happen.

Let’s go back to the beginning. NHS Change Day is a response to the “computer says no” elements of NHS culture. It’s less about red tape — changing regulation is thoroughly out of scope — and more about giving excellent staff the permission to trust their professional judgment and get on with sensible, obvious stuff they can’t believe no one’s already fixed.

Working in an NHS organisation of thousands and a collective health service of 1.4 million, there can be a never-ending chain of people to involve in decision-making and sign-off. Change Day says: trust your instincts; and if you’re a manager, trust your staff.

The best pledges, some of them profiled on the Healthcare Network, are the practical ones. Take the sepsis toolkit of straightforward guides to help clinicians spot sepsis early. Or the #stopthepressure campaign to take small, daily steps to reduce avoidable pressure sores in hospital beds. These are real, practical things that actual people are promising to start doing very soon, if they haven’t started already.

It’s vital that Change Day doesn’t become yet another policy wonk wishlist. Search the #nhschangeday hashtag on Twitter and you’ll find the wonks out in full force. Crap pledges are easy to recognise because they go along the lines of “something something, better care”. Here are some real examples:

  • “It’s #NHSChangeDay and I pledge to continue work to break social stigma on mental health and work towards improving services.” Sounds important. Now what?
  • “This #NHSChangeDay we celebrate the role of nurses, HCAs and midwives who adapt every day to provide high quality care for their patients.” Nurses, healthcare assistants and midwives are indeed excellent. What one small thing could all of them do to make the NHS that little bit better?
  • “I pledge to work to improve quality of life and experience for young people with arthritis and long-term conditions.” I see what you’re trying to do there, rheumatology researcher, but doing your job is not a pledge.
  • “I pledge to be the Beyoncé of occupational therapy.” Actually, I like this one too much to make fun of it. Occupational therapy needs more Beyoncés.

Good pledges follow the lead of the NHS Change Day organisers. As Danielle Baker has written elsewhere, last year’s 800,000 pledges demonstrated a groundswell of support for distributed leadership (or, in human speak, trusting brilliant NHS staff to do what they do best). But in 2015 the organisers were calling on those in the NHS not to make a pledge, but to record and share their actions — the stuff they were actually doing. That message didn’t quite seem to get through this year, but enormous kudos are due to people like Jeremy Tong, who’ve turned last year’s pledge into this year’s how-to guide.

So I’m proposing that for next year’s Change Day, we all adopt one of two pledges (or actions, if we’re being picky). Option one is that we change the name to “NHS STFU and JFDI Day” (and I’m not talking about involving the Southern Tenant Farmers’ Union). Option two is let’s all agree what makes a good pledge — staff and teams giving themselves permission to make common-sense, human-sized changes — and leave the wonk talk in the conference centre.


Originally published at www.theguardian.com on March 20, 2015.

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