For Those in Peril on the Sea
Thursday, 05 March 2020
Prof Sir Lewis Ritchie, Prof of General Practice, Aberdeen
Professor Sir Lewis Ritchie worked as a GP and medical researcher. He is the James Mackenzie Professor of General Practice at the University of Aberdeen and holds honorary professorships at the University of Edinburgh and the University of the Highlands and Islands. He has a long record of contributing to the NHS in Scotland including Director of Public Health NHS Grampian (2012 – 2014), Principal General Practitioner Health Centre and Community Hospital (1984 – 2012) and chair of a number of national advisory committees to the Scottish Government, including the Independent Review of Primary Care Out-of-Hours Services in Scotland in 2015. Sir Lewis has received a number of national and international professor awards and was knighted in 2011 for services to the NHS in Scotland.
Sir Lewis will talk about the care needs of communities throughout Scotland and supporting colleagues in often difficult circumstances to give of their best.
Meeting notes from 5 March 20
The President, Dr Reith, welcomed everyone to the meeting. He informed members that there had been some recent issues with the Med Chi e-mail account and apologised for this. The problem related to a change in the University e-mail system and has now been resolved. He reminded members about the forthcoming James Petrie lecture on 25th March and for which registration is via the RCPE and noted the next Med Chi lecture on 2nd April by Professor Blair Smith.
Dr Reith then introduced the speaker for the evening, Professor Sir Lewis Ritchie, and highlighted his extensive biography (as above).
Professor Sir Lewis thanked Dr Reith for his introduction and began by explaining his choice of title for his talk; For Those in Peril on the Sea. He has an interest in Lifeboats and purchased and donated the former (1939-69) RNLI Gold Medal Winning (1942) Peterhead Lifeboat RNLB Julia Park Barry of Glasgow, restored to original condition and housed in a specially constructed building within the former HM Prison Peterhead, now a Heritage Centre. One of Professor Sir Lewis’s many roles has been to lead reviews in to challenging situations and occurrences within different Health Board areas throughout Scotland. The analogy is as follows:
Peril = systems/people in distress when working in the NHS
He noted that 2020 marks the 50th Anniversary of the capsize of the Fraserburgh Lifeboat during a rescue, with the loss of five RNLI volunteers. A further analogy is that rescue attempts for challenged areas within the NHS are not always successful. Peril often occurs because of generic and repeating issues and his talk reflects on lessons learned through various case studies. Professor Sir Lewis indicated that he would illustrate his talk with various paintings and photographs of Lifeboats in service throughout the history of the RNLI.
Having a role as Professor of General Practice, he initially summarised his thoughts on the role of clinical academics:
- To teach medical students well
- To aim for research excellence
- To influence and benefit national and local health policy
Whilst subsequently working in Public Health, Professor Sir Lewis found his career swerve from prevention e.g. cardiovascular disease and vaccination (especially meningitis) to “rescue and salvage”. Instances where this has been required are varied e.g. struggling out-of-hours services, areas with financial difficulties and areas with poor communication, broken trust and denial/defensiveness. However, the underlying issues and lessons to be learned are often generic.
Some of the generic lessons are:
- Denial and defensiveness - can occur when problems are noted and help offered
- Expecting the best and preparing for it (optimism bias) - it is better to prepare for worst case scenarios
- Leadership is imperative - a leadership vacuum can have undesirable consequences
- Hope and help - it is necessary to provide a sense of this when input is given to areas experiencing challenges
How do you conduct a review?
1. Thoroughly-agreed terms of reference at the outset, process followed correctly and in accordance with the seven Nolan principles of public life, ie.
- 2. Do the review with people and not to people (application of the hope and help principle).
- 3. Communication and establishment of trust underpin the process (“listen”).
- 4. Publish clear recommendations with implementation, follow-up and scrutiny i.e. diagnose/treat/carefully monitor.
Guiding principles of a review
- 1. Person-centred (public and staff).
- 2. Intelligence led-make the most of what we already know about people seeking help.
- 3. Assets-should be optimised
- 4. Outcomes-should be focussed.
- 5. Services should be desirable (e.g. clinically effective, safe), sustainable, equitable and affordable.
Examples of issues encountered during reviews over a number of years reflect many of the generic lessons listed above:
- Optimism bias
- Conflicting goals between senior leaders within a team
- Service failure with lengthy period to re-stabilise service once help sought
- Financial distress being a signal of other systemic issues e.g. clinical leadership vacuum
- Defensiveness, denial and deception
- Flawed service redesign
- Failed expectations
- Poor communication and lack of inclusion of local staff and communities in future planning
- Poor leadership and workforce planning
- Failure to implement recommendations of national review
Application of the guiding principles, and in particular the Nolan principles, was very helpful in bringing together recommendations to address the challenges identified by the reviews.
- Defensiveness has been a recurring finding during reviews of system failures or problems
- Optimism bias is a recurring issue
- Trust, relationships and communication are very important
- Clinical leadership is imperative at all levels with strong management support i.e. clinically led services
- Buy-in is essential - co-production with service users and public representatives
- Hope and help are also key
The evening concluded with Professor Sir Lewis answering questions and receiving thanks from the President.