The Forgotten - how non-clinical staff are the key to a better NHS

by David Gilbert

April 5, 2017

Andy, who was later to hang himself had put his fist through the window. The trail of blood from the window led down the corridor of the psychiatric unit. While all clinical staff were deployed chasing him out to the car park, with their readied needles, we ‘residents’ watched the drama unfold. The only person that helped calm things for me, was Mandy the receptionist, who sat me down in the ward entrance area and made me a cup of tea (sugary).

I have written more about Mandy et al here

Non-clinical staff – security staff, fire officers, receptionists, porters, admin folk, even those nasty ‘bureaucratic box tickers’ called managers - are as forgotten sometimes as people who use services. How would the NHS function without estates managers, HR professionals, finance experts, those who run the show, who have a public image that lies somewhere between politicians and estate agents.

Even the title ‘non-clinical’ defines them by what they are not. It isn’t asset based, that’s for sure!

I've just read an article suggesting that the NHS might consider saving money on the ‘soft jobs’, such as chaplains.
There is little evidence of the ‘impact’ that such roles have on quality, safety or patients’ experience. But in this frenzied system, where what is measured matters, you can bet that there is not a whole lot of money going into validating the role of such folk.

Absence of Evidence

The system’s perpetual focus on clinical delivery (and money of course) is exacerbated by a research industry that focuses almost entirely on the clinical. It’s an absence of evidence, not evidence of absence. Any work would also need to focus on ‘what matters’ to people who use services. And the chaplain at the psych unit was my only visitor most days, when I had lost my identity, my health, my job, my relationships… Almost my life. How do you want to measure that?

I’ve done some work in this area professionally. I ran the first national survey on GP receptionists when I worked for Which magazine. We asked receptionists and patients for their improvement priorities. Surprise, surprise, they were almost identical, with receptionists also wanting more knowledge of clinical issues (perhaps because they felt in the frontline, having to ‘screen’ patients inadvertently sometimes). Many told us about how hard their job is. I’m not sure I would want to be one.

At the ill-fated NHSU, we explored patient and staff perspectives of non-clinical staff to generate standards of ‘supporting care’ (I need to fish that one out – see below). And while at Croydon PCT, I kickstarted a project to find out what non-clinical staff (and clinical staff) learned from patients through their ‘thousands of everyday conversations’. Unfortunately, the new Director of Community Services scrapped the project just after we bought 10,000 post-it notes that we're going to be used in staff meetings to record their learning. I wonder if they are still there?

The non-valued clinical staff still are.

Why I took the Patient Director role

When I learned about the Patient Director job at Sussex MSK Partnership, I was invited down for the day to meet folk. It was cold, it was a dawn ride around the M25, and I had a heavy cold. I wasn’t sure about the job. I met various lovely people.

Then I shadowed Stephen Cracknell, who was then what we call a ‘patient care adviser’. When we receive GP referrals for musculoskeletal conditions, an expert clinician ‘triages’ (assesses and screens) the referral and decides whether the person should come to one of our ‘community specialist clinics’ or be advised to go to see someone in secondary care (the hospital). Then it’s people like Stephen who take over.

The PCAs get in touch with the patient by phone or letter, offer an appointment and handle any queries on the phone.

I was intrigued. I had never worked in a service that so relied on such people and who were integral to everything it did. I listened to Stephen handle calls, leave messages, answer difficult question, keeping his calm, and sorting out tricky problems.
Here was an ‘expert’ who required the skills and qualities of the top end of ‘customer care’ services. And, if they were in this close contact with patients, then surely they could also be a ‘sponge’ for learning about what matters to patients and carers. Their thousands of everyday conversations could fuel any ‘patient experience’ work we (I was beginning to think ‘we’ by this time) could do.

But there was one more thing I needed to know. I asked Stephen whether he enjoyed his job. Staff experiences and patients’ experiences go hand in hand as you all know. He said he loved it, that his team were all friends, that he enjoyed being of service and got a real kick out of supporting people.

And that’s when I decided I would apply for the job.

The above is a story I tell regularly, partly to embarrass Stephen. But also to remind us all why we are here.

Time for an exciting piece of work

Now I have the opportunity to be part of a project that could help Stephen, the PCAs, other non-clinical staff, and of course the people we serve. The local CCGs (Brighton and Hove, Mid Sussex and Horsham) have agreed to make a project called ‘Supporting Care’ one of three CQUIN projects for 207/18. This means we will get additional funding for Focusing on this aspect of improving quality – supporting non-clinical staff to get even better at providing a great service.

We will focus on:
• Patient Care Advisers and phone contact – including their ‘contact’ skills, signposting abilities, etc
• Receptionists – including their welcoming of people, but also how they can improve the environment, etc.
• Other corporate staff – for example, how do people in ‘backroom’ roles keep connected to ‘what matters’

The project will be co-produced with our Patient and Carer Forum, Patient Partners and of course staff (clinical too!). We will explore the issues (partly through surveys and qualitative research) and come together in June to think through some ways of improving quality. It’s going to be fun.

Can you help?

This is where you come in: Do you know of any work that explores these issues?? In the health or non-health sector? Do you know of any ‘standards’ or ‘values and principles’ that have been generated with, and for, non-clinical staff? Do you have ideas on how we can explore what helps and what gets in the way of these good folk delivering a great service?

I am not interested in work that is about ‘beating up’ staff for doing a bad job – of course, we need to know what’s going wrong, but if we don’t, in the work itself, model the relationships we want to see at the ‘frontline’, what’s the point? We are all under enough pressure as it is. Nobody is trying to do a bad job, and few in the health service feel valued as it is. This is a chance to celebrate great practice too!

I’d love to hear from you. Please get in touch with me at [email protected]

Let’s remember the forgotten, this time before they fall.


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© David Gilbert 2017

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One comment on “The Forgotten - how non-clinical staff are the key to a better NHS”

  1. I felt you'd been reading my mind when I read this as I was just talking about such staff yesterday & expressing my view that to have any job title that started with 'non' showed a lack of imagination or thought for a human being.

    Very often it is the receptionists, PAs, porters, cafe assistants .. who see such a lot but are rarely valued as much they should be or asked for their observations or opinions.

    When the NHS talks about 'workforce' and means everyone, including volunteers, then real progress will have been made.

    In the meantime if one or two organisations can lead the way that would be a great start.

    Glad you've drawn attention to this David.

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