Sometimes a culture cannot be changed from within, because it is so “ill” that none of the people with the power to change it have the tools to do so. This is the case for the 4 UK Health services. The “Blame Culture”, is not the only issue, because free speech is denied staff, and punishments are withheld only for non interference or not rocking the boat. There are big incentives to keep quit, and minimal commitment and involvement are rewarded. If the culture is to change an outside Human Resources agency needs to come in, and start with exit interviews. These should be on all staff, and board members, the chair and the CEOs. When doctors are afraid to be honest in their portfolios, and reluctant to speak out the public needs to know why, and what is being done about it. So far – nothing constructive. We need “zero budgeting” equivalent in HR, and trust can only be restored by a completely new system.
Jacqui Wise and/or Peter Blackburn in the BMJ (2018;362:k4001( Blame culture and safety fears on the rise, finds survey published 20th September 2018 reports. On line:Survey of UK doctors highlights blame culture within th e NHS.
A major survey of UK doctors reveals a bleak picture. Many feel they work in a dangerous and toxic environment with a blame culture which jeopardises patient safety and discourages learning and reflection.1
The survey of 7887 doctors—including GPs, junior doctors, and consultants—was carried out as part of a BMA project, Caring, Supportive, Collaborative, aimed at finding solutions to the challenges faced by the NHS.
Most doctors (78%) said that NHS resources are inadequate and that this significantly affects the quality and safety of patient services. Patient services have worsened, including waiting times for patients and staffing levels, they said. Around three quarters said that national targets and directives are prioritised over the quality of care…
On line: Doctors are increasingly expected to provide patient care in unsafe environments where a persistent culture of blame stifles learning and discourages innovation.
Those are the findings of a BMA survey which is part of an ambitious project aiming to find solutions to the challenges faced by the NHS.
The project, ‘Caring, Supportive, Collaborative’, has seen almost 8,000 doctors provide accounts of their working lives across the NHS – and will go on to look at how working life can be improved.
BMA council chair Chaand Nagpaul said: ‘It is vital that the Government and policy makers heed the views of all doctors who provide care at the coalface; they are in the best place to know the problems the NHS faces on a daily, hourly basis.
‘They know the scale of impoverishment in the NHS is staggering and they are working in a culture which has improved little since the publication of the Francis and Berwick reports following the tragedies in Mid-Staffordshire five years ago.’
The stark survey reveals the damaging effect of asking doctors to provide care without enough funding, staff, beds or equipment to meet the needs of patients. The results also suggest that poor lines of communication and organisational divisions between general practice and hospitals is undermining patient care. The accounts from doctors also reveal a lack of IT support is holding back efforts to encourage collaboration and greater innovation in our health services.
Dr Nagpaul said: ‘Doctors experience challenges of trying to provide safe patient care when there is poor staffing, gaps in rotas, lack of adequate facilities and where a persistent culture of blame stifles learning and improvement.
‘The BMA’s Caring, Supportive, Collaborative project aims to understand and find solutions to these challenges.’
The survey also reveals a significant number of doctors are fearful of making a medical error and that the level of fear has increased over the past five years. Nine out of 10 doctors say one of the main reasons for making errors is pressure and lack of capacity in the workplace.
As well as a culture of fear and blame, the survey also showed that BAME (black and Asian minority ethnic doctors) remain disadvantaged by the NHS. Only half of BAME doctors feel respected or culturally included in their place of work.
They talked of experiencing unconscious racism in everything from job progression to training and patient interaction.
Dr Nagpaul said: ‘BAME doctors make up more than a third of the medical workforce and play a vital role, day in day out, delivering care to patients across the country. Yet despite their commitment they’re more likely to face referral to the GMC, are more likely to have their cases investigated and are more likely to face harsh sanctions following an investigation. Only 7 per cent of very senior managers are from BAME backgrounds.
‘BAME staff in the NHS workforce as a whole are more likely to experience bullying, harassment or abuse from other staff. Differential achievement in exams and poorer career progression are another worrying factor, and with independent research showing that this is not related to any lack of ability. In the 21st century, that is not acceptable.’
Read the report
In Scotland Peter Gregson has the bit between his teeth, but has been meeting resistance:
Dear Lewis Macdonald MSP,
I’d like to draw your attention to this article in Health Service Journal by Shaun Lintern of 27/9/18 “Thousands of NHS staff use speak up guardians“. As you may know, NHS staff in England can take reports to their Board’s “speak up guardian” – a beefed up version of the “whistle-blower champions” we have in Scotland. All their reports are then collated by the Freedom to Speak Up National Guardian, Dr Henrietta Hughes (whose office might correspond to our INWO if there were a hotline in Scotland in place for staff to use). She counts 7,000 reports in the year ending March 2018.
There are 1,200,000 NHS staff in England, so therefore 0.58% have filed reports.
There are 162,000 in Scotland. If we had the same response rate in Scotland as England, we could expect 945 reports pa.
Last year the NHS Scotland helpline received in the period to 31st Jan 2018 just 48 reports.*
Could it be that Scotland’s health service is 20 times better than England’s? I doubt it, if recent reports from Tayside and the Highlands are anything to go by.
Yet our Health Minister believes current arrangements and plans for an INWO to be perfectly adequate.
I beg you to reconsider her claims in light of this data from south of the border.
* This is bad, but worse is that the numbers using our helpline have decreased significantly since its introduction five years ago. Even more worryingly, looking more closely at the data reveals that the correct number and/or email address was provided for re-contact in just 11 (65%) cases. That means 35% either did not leave their details or left the wrong ones. This figure begs the question as to why whistle-blowers have so little confidence in the helpline that they would do such a thing..
From: Peter Gregson <email@example.com>
Sent: 26 September 2018 23:49
To: ‘HealthandSport’ <HealthandSport@parliament.scot>
Cc: ‘Miles.Briggs.firstname.lastname@example.org’ <Miles.Briggs.email@example.com>; ‘Alex.Cole-Hamilton.firstname.lastname@example.org’ <Alex.Cole-Hamilton.email@example.com>
Subject: RE: Whistleblowing in NHS Scotland
Dear Lewis Macdonald MSP,
Today I read in the Herald : NHS Highland medics blast ‘culture of fear and intimidation’ silencing concerns over patient care
Amazingly, there is footage in the Parliamentary video archive from 19th September 2017 of the NHS Highland Chief Exec boasting to your Committee of how excellent their measures are. A claim which now rings hollow. The written version is at http://www.parliament.scot/parliamentarybusiness/report.aspx?r=11090&mode=pdf where Elaine Mead from NHS Highland must fair be regretting her words. See page 14:
Elaine Mead: I am sure that they could feel frustrated by that, but we need to encourage staff to take responsibility for their own work and make the changes in their own workplace, and we in NHS Highland are doing that. That takes time, but we are certainly encouraging local staff to take every opportunity they can to do their job and to change their job for the better. In fact, they feel more empowered and more engaged to do that. I come back to my point about that being an issue of the culture in the organisation. We have to live it as well as saying it. It is really important for the staff to know that they will be listened to and that they can influence the way in which their jobs are working and how their services are run and organised.”
There is some interesting stuff in there from NHS Tayside as well, showing Governance was failing even as fine words were being fed to MSPs.
Please consider what measures can be taken to get the Health Minister to “wake up and smell the coffee”