Uncomfortable Truths

Twelve reasons WHY as system leaders we need to address culture to improve outcomes

As local health and care leaders we aim to work together through the ICS to achieve the very best health and care outcomes possible for the people that we collectively serve. We have set out in detail our collective ‘strategies’ and plans to do this, but we know that if we are to genuinely ‘Turn the Curve’ on the outcomes and experiences for local people, communities and our staff we need to look beyond strategy and consider the underlying culture of our health and system. As Peter Drucker once said: “Culture eats strategy for breakfast.”

A key role for the ICP is to create a space to develop and oversee population health strategies to improve health outcomes and experiences. This new ICS System Learning programme aims to bring leaders together from across Suffolk and North East Essex to work together to improve the culture in our local health and care system.

The programme will have three stages:

WHY? – a discovery phase, to analyse the current situation and form an informed view of what is needed

HOW? – a design phase, to learn from experts and define our requirements to improve culture

WHAT? – a delivery phase, to develop programmes that will build the capability needed

These 12 ‘Uncomfortable Truths’ about our health & care system will be a starting point for our journey together.

Are our services safe, integrated, equitable and compassionate?

1. People in our most deprived places in Suffolk & North East Essex have consistently poorer health outcomes than those in more affluent areas – Essex and Suffolk Joint Strategic Needs Assessments (JSNAs)

2. Not every patient experiences the care they should: recent learning from mental health and maternity –Care Quality Commission, Healthwatch, Channel 4 Dispatches

3. In 2020, approximately 23% of deaths in the UK were considered avoidable. Of these, 69% were preventable and the remaining 31% were considered treatable

4. Black and Asian women are more than four times more likely than white women to die in pregnancy or childbirth, women of mixed ethnicity two times higher and Asian women almost twice as likely – MBRRACE

Is our health and care system a fair and inclusive place to work?

5. Ethnic minority professionals are disproportionately impacted by fitness to practise referrals and proceedings – Social Work England, Nursing and Midwifery Council (NMC), General Medical Council (GMC)

6. Nearly a third of female NHS surgeons have been sexually assaulted by a colleague over the past five years – University of Exeter, the University of Surrey and the Working Party on Sexual Misconduct in Surgery

7. 98% of NHS staff report they have experienced incivility in the workplace: the NHS is described as having “poor leadership behaviours, discrimination, bullying, blame culture and responsibility avoidance”- NHS England, review into health & social care leadership by General Sir Gordon Messenger & Dame Linda Pollard

8. The 9,000 VCFSE sector organisations in SNEE employ around 16,000 staff. The effects of the pandemic and the cost of living crisis have left smaller charities particularly vulnerable – NCVO, The Charity Commission

Are we continuously learning and improving based on evidence and experience?

9. The many inequalities in clinical research include who does research, subjects recruited and type of research – the British Medical Journal (BMJ)

10. Patient safety incidents are experienced disproportionately by marginalised patient groups – these exacerbate health inequalities and biases embedded in the healthcare system, its workforce, and practice – the British Medical Journal (BMJ)

11. We don’t know anywhere near enough about how many people die in our care and why – Grant Thornton, The Learning Social Worker

12. We have been trying to integrate health and care for decades – The Nuffield Trust