“Systems so perfect that no one will need to be good” – that was T.S. Eliot’s warning about relying purely on systems, but it would not be a bad summary of the Francis report. This warning about the dangers of a systems-obsession obliterating personal responsibility goes to the heart of what makes the NHS work and able to sustain political change and an ever increasing burden upon it – people, not systems. Another word for this is professionalism, and is a challenge to all politicians to ensure this value is enshrined at the heart of the NHS.
Back in 2006, when my father was President of the British Orthopaedic Association, he delivered a lecture entitled ‘A New Professionalism’ for doctors. Why? It was to address the increasing alarm and distress of clinicians from across the medical profession who had seen, since around 2000, a shift in culture in the NHS. He warned about the ballooning increase in managers, the move from focus on clinical priorities to management priorities; the dangers of the target and tick-box culture which undermined an individual doctor’s ability to care for their patients and use their medical judgement; an NHS focussed on Dispatch Box statistics, not patient care. His was one voice, but far from a lone voice.
When I was a parliamentary candidate, I remember going for a routine medical appointment and talking about the NHS with the doctor I was seeing. He was not a party political man, but my consultation ended with him pleading with me to use the little political influence I then had (as an ant in the political jungle) to raise the concerns being voiced by doctors about the changes that had come in under the New Labour Government that treated patients like products on a conveyor belt, and professional doctors like inanimate cogs in an output-statistics machine. This doctor was desperately concerned.
That was all around six years ago. Already doctors were raising the alarm about the culture shift. Since then, a number of reports commissioned by the then Government have come to light highlighting the importance of professionalism, and referring to such alarming factors as “ A pervasive culture of fear in the NHS” – and professionalism can’t thrive in a culture of fear.
These reports were strangely hushed-up by the then Labour Government and were only exposed by Freedom of Information requests from the think tank Policy Exchange.
Interestingly, Don Berwick, who has been appointed by the Prime Minister to ‘make zero-harm a reality in our NHS’, seems to have been then head of the Institute for Health Care Improvement, which was the author of one of these suppressed reports which commented in 2008 that: “The NHS has developed a wide spread culture more of fear and compliance than of learning , innovation and enthusiastic participation in improvement… virtually everyone in the system is looking up to satisfy an inspector or manager, rather than looking out to satisfy patients and families.”
This report was presented to Labour Government Ministers and David Nicholson but it never saw the public light of day. Many may now wish it had.
The additional tragedy on top of the horrors at Mid Staffordshire, is that it has taken this long for us to recognise what doctors and others have been saying about the culture shift over which, sadly, New Labour presided, and to do anything about it.
In facing this tragedy, it is no time to play party politics. But neither is it fair on all those patients, their families, and the medics trying to raise the alarm, not to face the facts about how this target based culture and the erosion of professionalism came about, that has had such diabolically tragic consequences. Yes, tragedies demand Statesmanship from the nation’s politicians, but that means refusing to evade hard truths. Only then can lessons really be learned.