There is clearly a wide-ranging cultural problem within some healthcare trusts where staff seemingly are unwilling/afraid to speak out on management failings (whether administrative or frontline medical). This is especially worrying where patient safety is/may be compromised and, even worse, the NHS’s seeming unwillingness/inability to deliver on its promises to “learn” and “change”, solemnly delivered by the relevant Chief Executive to the media with monotonous regularity every time things have gone badly wrong.

Contrast healthcare with the aviation industry where the focus really is on “learning” what went wrong and why, and then implementing genuine “change” through regular industry-wide incident reporting and updated management/maintenance/production/training requirements in order to ensure, as far as possible, that the same issues don’t keep getting repeated and causing further avoidable pain and suffering and loss of life.

Why the difference? In aviation, generally (there are exceptions of course - like Boeing), the culture and regulation promotes and operates within an open and transparent and widely used process of reporting (including anonymously) without fear of retribution. The NHS should do the same starting with the job description of every CEO being required to include, at the top, their individual and personal responsibility and accountability for implementing adequate processes for staff to be able to report, without fear of retribution, all issues that potentially undermine or threaten staff and/or patients.

20 hours ago, Zombie said:

There is clearly a wide-ranging cultural problem within some healthcare trusts where staff seemingly are unwilling/afraid to speak out on management failings (whether administrative or frontline medical). This is especially worrying where patient safety is/may be compromised and, even worse, the NHS’s seeming unwillingness/inability to deliver on its promises to “learn” and “change”, solemnly delivered by the relevant Chief Executive to the media with monotonous regularity every time things have gone badly wrong.

Contrast healthcare with the aviation industry where the focus really is on “learning” what went wrong and why, and then implementing genuine “change” through regular industry-wide incident reporting and updated management/maintenance/production/training requirements in order to ensure, as far as possible, that the same issues don’t keep getting repeated and causing further avoidable pain and suffering and loss of life.

Why the difference? In aviation, generally (there are exceptions of course - like Boeing), the culture and regulation promotes and operates within an open and transparent and widely used process of reporting (including anonymously) without fear of retribution. The NHS should do the same starting with the job description of every CEO being required to include, at the top, their individual and personal responsibility and accountability for implementing adequate processes for staff to be able to report, without fear of retribution, all issues that potentially undermine or threaten staff and/or patients.

I don't fully agree. I've never worked in aviation but I have worked in the NHS all my working life and my brother works in the nuclear power industry, so I have been able to compare my working environment with his.

The big differences with the NHS is that it is seriously under staffed and is under a great deal of pressure from the government to meet their targets and requirements, including annual "efficiency savings" each year.

8.6% of all roles in the NHS are empty, that includes 5.8% of all doctors' posts and rising to 10.3% of all nursing posts. The only role that isn't short staffed is senior management and Trust chief execs. But the vast majority of empty posts are in patient-facing roles, people like me. It is hard to raise concerns when so much of your time is taken by making sure patients are safe and receive their required care. But even under these current impossible conditions, staff are still raising concerns. Clinical staff are very concerned to learn from all their experiences, it has been ingrained in us to do from the being of our training. For registered healthcare professions, reflexion on practice is part of our re-registration requirements.

But the NHS is under a lot of government requirements and targets that senior management see as the priority because of their consequences. One example is A&E departments that have dangerously high levels of demand. If an A&E department closes to admissions, even if only for a short period, because they have more patients than they can safely treat (And it is only closed to ambulance admissions, who are diverted to other hospitals) then that Trust if fined by the Department of Health for doing so. The Trust is fined if their A&E Department is at Level Black, that's the highest level of alarm that their level of clinical demand is approaching a dangerous level, then they are fined. There are a lot of these targets that if a Trust doesn't comply with or breaches then it is fined. So senior management are under a lot of pressure not to breach them, or else a Trust loses money and Trusts' funding is stretched to the maximum as it is.

Two of the biggest NHS scandals of recent years were because meeting targets was put above anything else, and those Trusts were also struggling with low staffing levels. The North Staffs scandal was, partly, because senior management were under a great deal of pressure not to breach A&E waiting times, so patients were being admitted from there as quickly as possible, often onto already over-full wards, that were under staffed. Staff raised concerns about this repeatedly but were ignored. Some senior management were even changing figures to reduce waiting times (Two senior nurses were struck off for it).

The Shrewsbury and Telford Hospital maternity scandal was due, in part, to serious under staffing in their maternity department, especially with midwifes and doctors, and the culture of the Trust to meet Department of Health targets to reduce caesarean section. Therefore, caesarean sections had to be avoided at all costs, therefore putting mothers and babies at risk.

Unfortunately, so much of the culture in the NHS is to meet or not breach the targets set by the Department of Health, because if they do it will cost them, and there are penalties for over spending too. This does not create a culture of openness. The NHS also has direct demands placed on it by politicians, to meet their own agendas, and if they are unrealistic there is nothing that can be done (The currents Secretary of Health has demanded a massive reduction in the Covid back log without any investment in more staff). There is also often a huge divide between clinical staff, those on the "front line", and senior management, it often feels that the two are working to completely different agendas. This too is a huge barrier to openness.

All my nursing career, which is over thirty years, people from outside the NHS keep saying that the NHS needs to "learn" from the private sector. But you are comparing completely different organisations with very different objectives and environments. I would love a completely transparent environment in the NHS, then the public would see how bad and over worked and underfunded it is, but there is no political will for that. Last month the government voted down an amendment that require the NHS, every two years to have an independent workforce audit and the results be published, then everyone could see how under staffed it is. That was all the amendment required, to find out and publish how under staffed the NHS is, not even to act on the results, but that was too much for the government.

I don’t want this to be a rant, and I’m not having a go at anyone, but I do want people to know how difficult the situation is.