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NHS ‘culture of fear’ highlighted by BMA in new vision for reform

NHS ‘culture of fear’ highlighted by BMA in new vision for reform
By Eleanor Philpotts
13 September 2019

The British Medical Association (BMA) has set out its new vision for reforming the NHS, which it blasts as ‘unsafe’ and ‘underfunded’, as well as having a ‘persistent culture of fear’.

The trade union used its Caring supportive collaborative: a manifesto for change report to reiterate that GP and hospital doctors alike are working in settings that are ‘hugely understaffed’ and promote a culture of bullying and blame.

This forms part of wider research into the state of the NHS, via a year-long study titled Caring Supportive Collaborative: Doctors’ Vision for Change.

‘Radical change’

Calling for ‘radical change’, BMA council chair Dr Chaand Nagpaul said healthcare services are struggle to cope after ‘years of funding investment failing to match patient demand’.

He continued: ‘Nine in 10 doctors tell us that staffing levels are inadequate and that they work in environments where they fear the toxic combination of ever-increasing demand for services and lack of staff capacity will lead to mistakes.

‘They tell us there is a persistent culture of fear across the NHS, where blame stifles learning, contributing to the vicious cycle of low morale so staff leave and then there’s a problem of recruitment.

‘This unsafe, underfunded environment is as damaging for patients as it is for doctors.’


The report has been followed with a manifesto, sent today to health secretary Matt Hancock and other MPs. With a focus on changing the accepted culture and ultimately improving patient safety across the health service, its key recommendations are:

  • Addressing the funding gap by increasing spending across the UK by at least 4.1% per year to put the NHS on a sustainable long-term footing, equating to an extra £9.5bn by 2023/24,
  • Legislation in England ensuring accountability for safe staffing levels and that individual clinicians aren’t blamed when the system places them under unmanageable pressure,
  • Reviewing the CQC with the intention of introducing reforms which will deliver a truly proportionate regulatory system,
  • Investing in a comprehensive IT programme so the NHS has access to the right IT equipment and facilities to provide the best care for patients, including basic IT infrastructure, access to high-speed broadband and full digitalisation of all patient records.

As well as the Government and parliamentarians, the project authors intend for it to reach commissioners and those occupying leadership positions throughout the NHS, in order to develop a ‘truly sustainable’ system characterised by ‘adequate funding’ and ‘decent terms and conditions for doctors’.

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