This week we reach the 10th in our ’20 blogs for 20 years’ series, celebrating the Institute’s foundation back in 1995. This week, the Chief Executive of Healthcare Inspectorate Wales, Dr Kate Chamberlain, reflects on the dual responsibilities of Listening and Speaking Out, and how these might apply, not only to NHS staff, but to the population of Wales as a whole.
LISTEN (ˈlɪsən )
1. to concentrate on hearing something
2. to take heed; pay attention ⇒ I told you many times but you wouldn’t listen
All of us connected in any way with health services have a responsibility to ensure that we are creating an environment where ongoing and real-time feedback is encouraged and that we capture and respond appropriately: either to address concerns, or to spread the word when things are working well.
The health service collectively continues to work hard at developing care providers as “listening” organisations:
• 1000+ lives published their improvement white paper ‘The Listening Organisation’  in 2013;
• also in 2013 the Welsh Government published their ‘Framework for Assuring Service User Experience’ ;
• the revised Health and Care Standards published in 2015 reflect this ongoing importance by including a new standard on ‘Listening and Learning from Feedback’ to support the delivery of individual care ;
• Also in 2015 a follow-up paper was published by 1000+ lives titled Listening and learning to improve the experience of care 
This is essential work. When things go wrong the subsequent inquiries and investigations such as those in Mid-Staffordshire , Abertawe Bro Morgannwg University Health Board , and Tawel Fan  frequently report that patients, relatives, carers, and staff were trying to raise concerns long before matters came to a head, but encountered difficulties in doing so.
But developing listening organisations is only part of the equation…
For listening to be really effective there needs to be a body of people: staff, patients, relatives, carers, friends, who feel willing, able, empowered and enthusiastic to provide honest and timely feedback on their experience of care and constructive, positive suggestions on how services could be improved.
As highlighted above, too often people are reluctant to do so for a whole variety of reasons:
- It won’t make any difference – Its difficult, complicated and time-consuming – Afraid that negative feedback may have consequences for themselves or relatives – Not sure whether they are expecting too much
Prudent healthcare includes a principle around “achieving health and wellbeing with the public, patients and professionals as equal partners through co-production”. In practice the public, patients and professionals are not discrete groups. The Welsh Health Survey  showed the extent to which the public are also patients or users of health services:
• almost 1 respondent in 5 had attended a GP in the previous 2 weeks,
and in the previous year almost
• 1 in 5 had been to A&E;
• 1 in 10 had been an inpatient;
• 1 in 3 had been to outpatients;
• 2 in 3 had used a pharmacist or dentist.
Taking into account relatives and friends the overlap is even more pronounced.
And of course all professionals are also members of the public, users of services, related to a user, or a friend of a user; or so on. And interestingly roughly 1 in 25 (75,500)  of working age people work in the health service.
Of course we need to ensure that organisations are listening, but we also need to pay as much attention to enabling and encouraging people to speak. And those ‘people’ are all of us, in whatever capacity we find ourselves: public, patient or professional.
Wales is a relatively small country and that gives us the opportunity to harness the commitment and support for local services which is evident in the unease frequently expressed by local communities when service change is proposed, and to use this energy to drive and influence positive change.
Maybe the real power lies, not in developing the listening skills of the 75,000, but in developing, encouraging and harnessing the combined power of the 3 million to speak out and actively contribute to the development of consistent high quality care?
SPEAK OUT (spēk aʊt′)
verb (intransitive, adverb)
1. to state one’s beliefs, objections, etc, bravely and firmly
2. to speak more loudly and clearly
 ‘The Listening Organisation – ensuring care is patient centred in NHS Wales’, 1000+ lives, 2013’ http://www.1000livesplus.wales.nhs.uk/publications
 ‘Framework for Assuring Service User Experience’, Welsh Government, 2013, http://www.wales.nhs.uk/governance-emanual/document/214368
 ‘Health and Care Standards’, Welsh Government, 2015 http://gov.wales/topics/health/publications/health/guidance/care-standards/?lang=en
 ‘Listening and learning to improve the experience of care’, 1000+ lives 2013, http://www.1000livesplus.wales.nhs.uk/publications
 ‘Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry’, 2013 https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry
 ‘Trusted to Care’, Andrews and Butler, 2014 http://gov.wales/topics/health/publications/health/reports/care/?lang=en
 ‘External Investigation into Concerns Raised regarding the Care and Treatment of Patients; Tawel Fan Ward, Ablett Acute Medical Mental Health Unit, Glan Clwyd Hospital’, Ockenden, 2014 http://www.wales.nhs.uk/sitesplus/861/page/75258
 Welsh Health Survey: http://gov.wales/statistics-and-research/welsh-health-survey/?lang=en
 StatsWales: https://statswales.wales.gov.uk/Catalogue