David Oliver: Values statements aren't worth the paper.

In A Sceptic’s Medical Dictionary, the great Michael O’Donnell mademischievous fun of mission statements in the NHS, calling them “pious utterances trusts print below their expensively commissioned logo.”Values statements are close siblings; both are ubiquitous in health and social care. There’s nothing wrong with publicising your guiding values. But I suspect that most patients and families would prefer to experience these in the way they’re treated rather than see them written on leaflets, posters, and letterheads. Too often, statements are platitudinous—who could disagree with them? You can test this by saying the opposite, to see how daft it sounds. For example, try NHS England’s six Cs of nursing: care, compassion, courage, communication, commitment, and competence.Very good, but whowould value carelessness, callousness, cowardice, or incompetence? Skilled, compassionate, caring practitioners and teams are legion in the NHS, but certainly not because of meaningless mantras. There’s a surfeit of worthy spiel about good care being dignified, person centred, personalised, putting people first, respecting choice, and so on. But does this describe the care our pressurised, underfunded, and fragmented systems allow us to provide? The brilliant Dignity in Practice study was based on detailed observation of ward care for older people. These observations centred on failing to see patients as individuals and prioritising system priorities, procedures, and pressures from managers. Here are some things, that in my experience we still do far too often: • Move people around hospitals, sometimes repeatedly, at cost to them personally, to continuity, to communication, and to bed occupancy and flow 6