Nobody who works in the NHS would claim it is perfect. The more politically active may lay the blame at the current government’s door, or the one before that, or before that… but leaving politics aside, everyone who works in the NHS knows it could be better. We get it wrong. A lot. And patients are harmed, trust is lost, and precious resources are wasted.
We get it wrong for many reasons. Malicious acts do occur but they are thankfully rare. Much more common are the co-incidence of mistakes and misjudgements by front-line staff with a system that fails to prevent or reduce the impact of these errors on that particular day, at that particular time. The whole system can feel like it was designed to be wasteful, bureaucratic and with the needs of the patient at the back of the queue.
We get it right a lot too. Patients receive fantastic care and sometimes cures. Resources are used wisely. Staff, in every layer of the NHS do their best, give their all, catch the errors and make the systems work for our patients. Staff give their energy and time to making little or big changes here and there to make it better next time.
Getting it mostly right is actually the default state of affairs. But you might not believe that if the only story that is told is of the NHS’ failures. Politicians and regulators seem to almost revel in the number of ‘Never Events’ that occur. Sadly, no-one seems in the slightest bit interested in the ‘Never Events’ that never happened, thanks to well-trained, motivated and caring staff.
This blog is not in any way seeking to dismiss or diminish the harms that have occurred. They need to be heard, they need to be part of our DNA. We need to have sorrow that a system that is set up to care and cure, sometimes fails so badly. Instead of care and cure, healthcare can be inhumane and harmful.
But I am increasingly concerned by some of the rhetoric and the hostility, whether in main stream or social media. that seems to exist towards the NHS as a whole and to individuals, inside and outside the NHS, who are trying to make a difference,
This rhetoric, this tone, is, in my view, counter-productive. Others may disagree. That’s fine. But consider that I have pondered writing this blog for some time, but have been unwilling to risk invective, off-hand dismissal and accusations of ‘typical arrogant doctor’. I’m not sure that’s a healthy state of affairs. I hope everyone wants to make healthcare better – but that involves everyone listening, even to those with whom we disagree.
So what am I worried about?
Why is the NHS so rubbish? It should have copied industry [insert name here] years ago.
Although I don’t have any issue with the NHS learning from other industries, I do have a problem with this simplistic, and idealistic view of safety. The very industries that the NHS is supposed to be copying are very clear that simply copying a model of working is doomed to failure. Repeating this mantra, worse repeating this mantra even when it is challenged by experts from those industries, just becomes unhelpful noise.
NHS staff aren’t experts, don’t believe them.
NHS staff get it wrong sometimes. With the benefit of hindsight, any decision that leads to a bad outcome can be found wanting. In many cases, patients are far more expert in aspsects of their care than their healthcare professional. I’ve got no shame in using the internet, a patient or a colleague to help me out. But, neither of these mean that the people working in healthcare day in, day out, doing the job they are trained to do, aren’t experts in their field. If you tell me often enough that I’m rubbish at my job, may be one day I’ll believe you. Who does that benefit?
I’ve had a bad experience. Therefore, the whole NHS is delivering the same bad experience.
This is a straightforward fallacy. It would be completely wrong to disregard the hurt that people have suffered. But it is wrong to then extrapolate this to every organisation, every unit, every member of staff working in the health service.
Let me give a clinical analogy. I work as a neuroanaesthetist. A relatively common condition is a bleed around the brain which is made worse by people taking warfarin. Neurosurgeons have been known to grumble about warfarin and the damage it causes. Their experience is essentially that warfarin is harmful. But, give them a decent night’s sleep and a good coffee, and they will admit, that they never see the patient who didn’t have a stroke thanks to their warfarin.
But somehow, when it comes to commentary about healthcare it is almost unacceptable to point out the good things, even whilst acknowledging the bad.
Doctors / nurses / managers / [insert staff group] only care about their reputation / financial targets. They don’t care about the patients when it goes wrong.
NHS staff, like every other human being on the planet, are… human. They have their strengths, their weaknesses, their foibles, their mixed motives. I can’t speak for every member of NHS staff, and maybe I just work with a fantastic group, but my experience is that the reason I and my colleagues do the jobs we do is because we care. We want to make things better for our patients. Sometimes that’s through direct clinical care, sometimes it’s through the incredibly difficult balancing act of NHS management. Nobody wants to see people not getting good care. Much of the time, most of us are frustrated that we can’t give better care. We undoubtedly need to get better at open dialogue with people when things go wrong, and if you want to hear more on this, try the excellent trilogy of podcasts from @murrayawallace on openness, learning and blame [available from Patient Safety Learning]
This feels like quite a negative blog. Maybe it is. You might not agree with my perceptions – but they are mine to hold.
If even one person pauses and thinks a just a little bit about framing the discussion about how we improve healthcare more constructively, perhaps this blog will have achieved something.