In perspective - We need to talk ... about professionalism

It’s almost a year since I initiated the ‘Big Conversation’.

Reading transcripts of the Francis Mid-Staffordshire inquiry, I became aware of two conflicting emotions; firstly, horror and shame at what people had endured and, secondly, relief that no allied health professions (AHPs) seemed to have been implicated.

I am not proud to admit the latter.  I reflected on my feelings.

The first was a human response while the second was my response as the chief allied health professions officer.

This caused me to think about clinicians in the frontline – can you sometimes lose your humanity when performing as a clinical professional?

I started to talk about what I had read from Mid-Staffordshire at conferences and was struck by how many AHPs said AHPs ‘didn’t do those things’.

These reactions imitated my initial feelings, but hearing them from others made me realise this was a dangerous place to be, not least because of the impact this could have on patient care.

I got together clinicians, patients, the professional bodies, educators and the Health and Care Professions Council (HCPC) to discuss the issue and what action, if any, we needed to take.

The professional bodies and the HCPC do great work on professional conduct and standards of proficiency and, while there is no evidence of a significant problem among these professions, we agreed any instance of unprofessional behaviour can be detrimental to patients and carers.

Given a recurring theme in Mid-Staffordshire was the ‘normalisation’ of unprofessional behaviour, we agreed raising awareness of professionalism was timely.

And so the ‘Big Conversation’ was born. Branding it this way it has become visible at the highest levels.

I am enjoying participating in Twitter conversations and reading items in bulletins, journals and on websites.

We know if you talk about a subject, you raise consciousness and so discussing the issue through social media, at team meetings and with colleagues is crucial.

The conversation is essentially ‘What would you do if ... ?’

Note that it is ‘do’ and not ‘think’. What would you do if you saw a colleague texting while assessing a patient; if you heard a colleague call a patient ‘darling’; or if you saw a colleague rush treatment to finish work on time?

I encourage you to start a conversation, if you haven’t already. Use real-life scenarios. Challenge each other’s responses.

Since the Big Conversation started, people have said initiating it suggests a problem with AHPs.

I have two answers: firstly, we do. What happened in Mid-Staffordshire cannot be located in one profession. Any clinician who saw what was happening and did nothing was colluding in something dreadful.

Secondly, I would rather take action now than wait for a problem to surface,. Such problems represent at best vulnerable people not getting the service they deserve and, at worst, being harmed.

See: and

  • Karen Middleton is chief AHP officer, Department of Health
  • Jess Belmonte is ERUS National Officer at the CSP


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