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Editor Nora Elias: it’s time to tackle the NHS blame culture

By Gemma Collins
17 October 2018

The culture of blame in the NHS targets medical staff while failing to address the flaws in the system, says Nora Elias

Since taking over as editor of Healthcare Leader a few months ago, I’ve become used to hearing the phrase ‘a culture of blame’.

This summer, the term cropped up frequently in cases such as the Gosport War Memorial Hospital scandal – which found that at least 450 people had their lives cut short as a result of the incorrect prescribing of opioid drugs at the hospital between 1989 and 2000. Another instance was the Dr Hadiza Bawa-Garba appeal.

When the term is used, it’s to highlight the health service’s tendency to respond to fatal mistakes by apportioning blame. And to lay the blame at the feet of individual clinicians, without examining wider system failings.

The acknowledgement of this blame culture is not new. Two years ago, the then health secretary Jeremy Hunt emphasised the issue in a speech to the inaugural Global Patient Safety Summit.

Speaking of the need to move from ‘a blame culture to a learning culture’, he outlined the importance of not just looking at the clinician who might have made a mistake, but also the environment in which it happened.

Mr Hunt referred to past cases where ‘our system was more interested in blaming than learning’ and stated that ‘a profound culture change [is] necessary’.

In June this year, Professor Sir Brian Jarman, head of the Dr Foster Unit at Imperial College London, said we are likely to see situations such as Gosport again. NHS staff are, as he puts it, afraid to call out poor and unsafe practices, even when they fear the consequences to patients.

The reason, Professor Jarman told the BBC’s Today programme, is that: ‘At the moment whistleblowers are fired, gagged and blacklisted’.

It’s natural for those who have lost loved ones to want to know how the mistakes happened, and it’s their right to expect answers. No one is questioning that such incidents should be investigated.

The problems start when you’re looking for a specific culprit. Doctors and nurses go into the profession to help people, not to harm them, and while there will always be occasional neglect or incompetence, these are the exception, not the rule.

In the vast majority of cases there are other factors involved. NHS staff work long shifts in highly stressful environments. Given the current shortage of doctors and nurses (NHS Improvement figures for the first quarter of 2018 revealed 108,000 vacant posts across the NHS provider sector, with a 11.8% vacancy rate for nursing roles, and 7.9% for other medical staff), that doesn’t seem likely to change soon.

You can, of course, never dismiss an error that has fatal consequences as ‘just a mistake’. But it is undeniable that exhausted and overstretched medical staff are more likely to make decisions that turn out to be devastatingly flawed.  That doesn’t mean they’re not doing their best, it just means they’re human.

To deny that is to unfairly hold individuals to account for situations largely created by the system. A system that looks for individuals to blame is likely to fail to examine the structures, processes and environments that increase the risk of errors.

Which means such mistakes will continue to be made – and that would be the greatest tragedy of all.

Nora Elias is editor of Healthcare Leader

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