Dementia Centred

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By Mark Butler

July 24th, 2014

Missing the Point Again

Today’s Herald includes a news item in which the head of the Health department and the NHS in Scotland, the senior civil servant Paul Gray, is quoted as rejecting comments from Professor June Andrews about the inability of a true picture of the NHS to surface and be addressed honestly.

This looks very much like a journalist-generated story in which a misrepresentation of someone’s comments is countered by someone else who has to disagree, thus generating two pieces of useful copy for the price of one.

The issue at the centre of the story (which is not really news item but is important) is about the nature of openness and transparency on risks in hospitals.  It is a question which arises directly from work June Andrews undertook in Wales, with me and others, around the safety of older people’s care in two hospitals.  The resulting Report, Trusted to Care, included 14 recommendations for action which the Welsh Assembly discussed at length and which the Minister for Health and Social Services in Wales supported in full.

This experience brought into focus a question which June and I have discussed over many years in our differing leadership roles around health services in the UK.  Is it possible to be honest with the public about what can really be expected of hospitals and health services?

This has very little to do with the policies and processes which Scotland, like the rest of the UK, has introduced following the well-publicised and desperate problems which festered in Stafford Hospital.  These have, as the Herald article mentions, been largely about encouraging whistleblowing, safety regimes and cultural change.  This may all be helpful in itself but the point being missed is more important.

The fundamental problem which prevents openness in and around hospital services is not that people need to feel it is OK to speak out.  There have been, and remain, problems with this.  But the deeper issue is more that hospitals are fragile and complex places where things can “go wrong” as a routine part of the way they work.  Some of this will be unavoidable and some won’t.

The leadership tone which senior figures  across the UK are setting is not really recognising or engaging with this problem of the inevitable fragility and unavoidable inconsistency of outcomes.  It seems that what matters is having the channels of communication in place, so corrective action can be taken if things are wrong.  People who actually know how services work recognise this as the wrong reassurance and do not trust it. 

The far more difficult role for health leaders to perform is to help shape a proper understanding of the risks in hospitals which the public and staff can work on together – a joint enterprise which depends on shared decision-making and learning.  This positive partnership remains very rare in health settings. The political imperative to believe that health services are inherently fine makes something not going perfectly being framed in terms of avoidable failure and individuals to blame.  This is deeply-rooted and would require courageous leadership which helps the public and the staff engage with a fragile NHS – a health system which requires more honesty and openness about what can be expected and why, and what can be done about the it.

In the Herald’s desire to manufacture a disagreement between two senior health figures the real story seems to have gone missing. Again.