The Darzi Review is a stark articulation of what doctors, nurses, and managers have been telling us for some time.
Lord Darzi correctly identifies the key levers for change: greater investment in capital and technology, more sensible management and accountability structures, and louder patient voice coupled with increased staff engagement.
In the coming months, it’s vital we don’t lose sight of these last factors. Patient voice and staff engagement can often be overlooked when we talk about change. They are not seen as important as strategy discussions or less hard-headed than funding increases.
In fact, there’s a wealth of evidence showing staff engagement is key to improving patient care. Studies have shown that when staff don’t feel respected or have wellbeing promoted, patients report being less satisfied, and Care Quality Commission ratings describe poorer care and poorer use of resources [see this for example].
At the risk of making everything about ‘race’, there is less focus in this review about how those who are racialised as Black and minority ethnic experience the NHS. This is a large proportion of valuable NHS staff and patients who we have promised to treat as well as we can. In our view we can’t ignore a basic entitlement they have: being able to work, care, and be treated without experiencing discrimination. When thinking about staff engagement, then, it is important to think about how we support leaders to manage diverse staff teams, how we tackle incivility and racism, how we encourage staff to talk about race and diversity, how we develop induction processes that make people feel included, and how we support leaders to consider their relationships through an anti-racist lens.
Lord Darzi talks about the impact of the covid pandemic on staff engagement. The exhaustion from overwork and the emotional strain of seeing such suffering. But it is important to understand lower levels of staff engagement, particularly for BME staff, were exacerbated by the pandemic, not the cause of it. BME staff have faced higher rates of bullying and marginalisation for years.
If we can tackle this, we will also be able to tackle some of the inequalities Darzi points to (Black women are almost three times as likely as white women to die in childbirth, for example; Black people are more than 3.5 times more likely to be detained under the Mental Health Act). Admitting our responsibility to do something about it is the next step. Taking accountability for our part in creating cultures where racism can thrive would be the icing on the cake.
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