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Culture, Excellence and Performance


Aneurin Bevan’s famous words that “if a hospital bedpan is dropped in a hospital corridor in Tredegar, the reverberations should echo around Whitehall” has been interpreted a number of ways by those working in and leading the NHS. Does it mean that we should have a target for reducing dropped bedpans? Or that the Westminster Government should take direct responsibility for and control over every tiny detail of care provided in the NHS? Or was he saying something more general about accountability for services in the NHS?

Well, times move on!

In 1948 the UK NHS had a budget of £437 million which is roughly £9 billion in today’s money, now this has risen to over £119bn. In 1948 the NHS employed 144,000 people today this has risen to around 1.7 million staff making it the fifth largest employer in the world! In 2015 bedpans are disposable, made of pulped paper (like egg boxes) and you would be pressed to hear the sound of one falling in Ellesmere Port Hospital in the next-door room let alone in Whitehall.

So the NHS has become much larger, more complicated, more accountable and therefore sadly sometimes more bureaucratic. We are technologically capable of doing more for patients but seemingly expected to do more than we have the capacity and resources to do as we age and our needs become more complex. One of the hardest things to do in the modern NHS is to create simplicity out of this increasing complexity but this is what lies at the heart of our ambition to become The Model Hospital.

To help get started on this journey we have surveyed and met with groups of our staff to understand better our organisational culture. Thank you to everyone who took part. Needless to say there was much to be proud of and also some very important areas for reflection, most notably: a real focus on delivering excellent patient care but a general sense that processes are getting in the way; a view that people did not always do what they said they would do – interestingly this was always other people or teams and not them; a strong impression that we tolerate things that we shouldn’t, which I interpreted as not dealing with wrong or bad behaviour; and a strong view that we do not differentiate performance with appropriate consequences, either positive or negative.

Our mission is to deliver NHS care locally that both our staff and community are proud of; and we do that by a relentless focus on our patients by being Safe, Kind and Effective. Last week the executive team spent a couple of days with Lord Carter (who is leading on work for the government) and his team to explore and plan our approach to moving the Countess towards the Model Hospital blueprint for the NHS. This work will become the foundation for delivering a Safe, Kind and Effective culture that at its very core cares for our patients, cares for ourselves and cares for our finances.

My next few blogs will describe in greater detail how we intend to make these a reality over the next months and years and how this is very different to what we have done in the past. So whilst in the meantime if a bedpan is dropped in our hospital corridors it may not reverberate in Whitehall, or even my office, I do know that the Model Hospital work we are leading will ensure that action happens here at the Countess.


About the Author

Tony image

Chief Executive of Countess of Chester NHS Foundation Trust.

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