As a snapshot of the state of the NHS, the three reports into failing hospitals published today make disturbing reading.In particular, the revelations of inhumane, sadistic cruelty at North Lakeland NHS trust, where mentally ill patients were tied to their commodes, almost beggar belief.
But the Lakeland case - assuming, hopefully, that it is a rare, extreme occurrence - is probably the least useful in gauging the problems facing the health service as it begins to implement the NHS plan reforms.
It is the relatively less shocking findings of the Oxford Heart Centre report which go to the heart of why the NHS is commonly perceived to be uncaring, unresponsive and incapable of raising standards of care. That report detailed a culture where poor care went largely unchallenged, and if it was, it was ignored or pushed under the carpet. It depicts an environment where staff felt intimidated into not raising the alarm over bad practice.
These failures reflect a deep structural fault in the collective NHS psyche, an endemic fear of "rocking the boat", of questioning powerful individuals, particularly doctors, out of fear of retribution. This encourages in turn a pervasive, and perverse, culture of secrecy.
When health minister John Denham called the management at Oxford "dysfunctional" he meant there was an institutionalised culture of non-accountability in which professional interests were protected at the expense of patients.
At Lakeland trust, student nurses first raised concerns about abuse on the wards in 1996, but no action was taken. A clear lesson of these reports is that if standards are to improve, the culture of "omerta" in NHS institutions must be swept away.
The NHS and ministers must lead by example. It is easy to implore NHS staff to blow the whistle on abuses and failures. But staff take their lead from the top, and there are few organisations more sensitive about "keeping up appearances" than the government and the Department of Health.
Which brings us to the commission for health improvement (CHI), whose investigations accounted for two of the reports. Billed - not by its own members - as the "Ofsted of the NHS" its appearance on the NHS scene has sent shivers of apprehension across the NHS.
Managers and doctors worry that they will be "named and shamed" in the same way that the office for standards in education has pointed the finger at schools. Such worries can quickly create a climate of paranoia and, yes, secrecy.
Reputations and careers are at stake. As CHI prepares to assess every NHS body over the next four years it must tread carefully. It will have failed if it merely creates a new culture of secrecy among senior health staff prepared to conceal and dissemble in order to prevent the inspector calling.
Related
Managers blamed for hospital failings
Explained: the Commission for Health Improvement17 October, 2000: Help squads ready for NHS trouble spots
Useful links
Commission for health improvement
Oxfordshire health authority
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