Who’s to blame for the NHS’s blame culture? | NHS
Jeremy Hunt’s article (This is the direct effect of our NHS blame culture: Babies are dying. Tragedy after tragedy cannot continue, October 9) will be welcomed by many, particularly health professionals who have had to endure the intimidating mistrust and confrontational work culture he describes.
What is missing from his account is the instrumental role of government reforms to the NHS in creating these problems. In particular, the creation, and then proliferation, over many years, of autarkic NHS trusts and commercialized, competing external providers. This has generated a growing culture of corporate defense and reputational anxiety. Under such conditions, practitioners then adapt to behave like employees of large commercial organizations: they must demonstrate unfailing, if specious, compliance, “loyalty,” compliance, and performance.
This trend has become more pronounced with each reform over the past 40 years; each has put forward a neoliberal agenda – both Labor and Conservative governments have designed policies and management to ensure this. The much-vaunted 10-year plan will only reinforce the problems that Jeremy Hunt so astutely observed and understood.
Dr. David Zigmond
Executive Committee, Doctors for the NHS
Jeremy Hunt rightly highlights the reluctance of health professionals to admit that mistakes have been made and praises the example of a midwife meeting the father of a deceased baby, where she expressed remorse and wished she had acted differently. This honesty led to forgiveness and greater confidence that the lessons had been learned.
I’m struck by the fact that politicians in general are just as reluctant to admit when they’re wrong. Jeremy Hunt’s 2015 imposition of a new contract on junior doctors (now called resident doctors) was based on the false premise that if they could be forced to work more at weekends it would reduce treatment delays and discharges.
He failed to appreciate that this simplistic solution would also require ancillary services – investigations, physiotherapy, social work – to be fully funded and operational seven days a week. The resulting doctors’ strike and subsequent imposition of the contract created enormous resentment. Maybe it’s “politician, heal thyself”?
Dr. Richard Sloan
Retired Consultant in Palliative Medicine, Dorchester, Dorset
Jeremy Hunt’s comments are well-intentioned but not original, and he has had enough opportunity to change the system. The most significant call to end blame culture was made 25 years ago by Professor Donald Berwick in his seminal publication To Err Is Human. The Department of Health later published An Organization With a Memory, which outlined constructive error management, but in the 2019 NHS Patient Safety Strategy (after Hunt had been Health Secretary for six years) it was stated that we needed to do more to change the culture.
Hopefully, the 10-year plan will help bring about this change by making it easier for patients and the public to speak out.
Dr. Eric Watts
Former Chairman, NHS Doctors
While I agree with Jeremy Hunt’s view on promoting a blameless culture, implementing it is easier said than done. It’s not just litigation that poses a barrier to learning. Other factors such as complaints processes, coroners’ inquests (which have become increasingly contradictory) and even the threat of referral to professional bodies all have a chilling effect on a culture of openness and introspection.
Dr Ian Freeman
Consultant Pediatrician, Manchester
