Who’s to blame for the NHS’s blame culture? | NHS

Article by Jeremy Hunt (This is the direct effect of our NHS blame culture: children are dying. Tragedy after tragedy, this cannot continue, October 9) will be welcome to many, especially those healthcare workers who have had to endure the daunting mistrust and hostile work culture it describes.

What is missing from his story is the fundamental role of government. National Health Service reforms in creating these problems. In particular, the creation and then proliferation of commercialized and competing stand-alone NHS trusts and external providers over many years. This has given rise to a growing culture of corporate defensiveness and reputational concerns. In such environments, practitioners then adapt and behave in the same way as employees of large commercial organizations – they must demonstrate compliance, “loyalty”, compliance and smooth operation, albeit at first glance.

This trend has increased with each reform over the past 40 years; each promoted a neoliberal agenda – both Labor and Conservative governments developed policies and governance to ensure this. The now-vaunted 10-year plan will only make the problems worse Jeremy Hunt otherwise he so cleverly noticed and understood.
Dr David Zsigmond
NHS Physicians' Executive Committee

Jeremy Hunt rightly points out the reluctance of health professionals to admit mistakes have been made and praises the example of a midwife who met with the father of a deceased child, where she expressed remorse and expressed regret for having acted differently. This honesty led to forgiveness and increased confidence that lessons had been learned.

It amazes me that, in general, politicians are just as reluctant to admit that they are wrong. Introduction by Jeremy Hunt in 2015 new contract Junior doctors (now called resident doctors) were made on the false premise that if they could be made to work more on weekends, this would reduce delays in treatment and discharge.

He didn't realize that this simplistic solution would also require support services – research, physical therapy, social work – to be fully funded and run seven days a week. The ensuing doctors' strike and the subsequent imposition of the contract caused enormous resentment. Perhaps this is a case of “politician, heal yourself”?
Dr. Richard Sloan
Former Palliative Medicine Consultant, Dorchester, Dorset

Jeremy Hunt's comments are well intentioned but not original and he had ample opportunity to change the system. The most significant call to end the culture of guilt came 25 years ago by Professor Donald Berwick in his seminal publication To Err is Human. The Ministry of Health then published Organization with memorywhich spelled out constructive error management, but the 2019 NHS Patient Safety Strategy (after Hunt had served as Health Secretary for six years) said we needed to do more to change the culture.

Hopefully the 10-year plan will help bring about these changes by making it easier for patients and the public to have a voice.
Dr. Eric Watts
Former Chairman, Doctors for the National Health Service

While I agree with Jeremy Hunt's sentiments about promoting a no-blame culture, implementing it is easier said than done. It's not just litigation that hinders learning. Other factors such as complaints processes, coroner's inquests (which are increasingly hostile) and even the threat of referral to professional bodies all act as a deterrent to a culture of openness and self-reflection.
Dr. Ian Freeman
Consultant pediatrician, Manchester