Rachel Clarke: A blame culture has made the NHS less safe, not more

The NHS is not fit for the 21st century,” was the headline in the Daily Telegraph this weekend, reporting on an interview with Professor Ted Baker, the new chief inspector of hospitals.

It seems like only yesterday that another Professor—Stephen Hawking—felt compelled to raise concerns in the press about the current state of the NHS. If you recall, Hawking’s critique of Jeremy Hunt’s predilection for statistical cherry-picking prompted an extraordinary barrage of tweets from the health secretary, admonishing one of the world’s greatest scientists for his cluelessness on the matter of, well, scientific methodology.

Ted Baker’s interestingly-timed intervention prompted a barrage of headlines itself. Baker painted a picture of A&E departments with disgraceful unsafe practices—of “wholly unsatisfactory” arrangements that “endanger patients, as well as denying them basic privacy and dignity.” It’s almost as if he thinks we’re somehow choosing to “keep piling patients into corridors where staff cannot even see them” or forcing patients to queue, hour upon hour, in ambulances outside log-jammed hospitals. In fact it felt like he went further and directly blamed healthcare professionals for the hellish conditions that patients and staff alike endured last winter, condemning our culture of “learned helplessness” that leaves our patients abandoned, unmonitored, and without even essentials like oxygen.

There is much blame doled out in the interview: previous NHS staff, current NHS staff, archaic NHS systems, bad managers, bad previous governments. No one, it seems, is immune. Except, that is, the one glaring exception. The one cherry Baker chose not to pick, so to speak.

Nowhere in his remarkable blame riff is there any mention of the funding climate in which frontline staff and managers alike are struggling—fighting tooth and nail, frankly—to keep on delivering a halfway decent standard of care for our patients. We are trying so unbelievably hard. But we already have one of the lowest numbers of beds per capita of any country in Europe, as well as being one of the most under-doctored. And, of course, we have a government, currently, which has chosen to subject the NHS to the most draconian and sustained funding squeeze in NHS history. Right now, the NHS in my region is having to cut even more beds, hundreds of them. It simply cannot afford to do otherwise—like every acute trust in the country. That’s not really going to help the patients stranded, bedless, in corridors, is it?

Of course NHS reform is needed. Of course we need greater community capacity and better integration between hospitals and primary care. But in omitting to mention the political context to his argument—the political choice to provide the NHS with inadequate resources to safely manage not only winter, but all year round rising demand—Baker comes across, I’m afraid, as an oddly partisan chief inspector of hospitals. Why the omission? Why blame the NHS and its dog, yet fall silent when it comes to acknowledging the political choices to underfund and understaff the NHS into a skeleton service in place of excellence?

Does Baker really think an admonishing letter to trust CEOs, telling them to jolly well stop leaving patients in corridors, is going to do anything other than incense us all? Where else would he suggest we put them? Anyone would think he is giving the Department of Health comms team a helping hand in the pre-emptive deflection of blame for the looming winter crisis away from the government and onto anyone else but Theresa and Jeremy. But let’s remember what blame culture achieves. First, it demoralises and undermines frontline staff. Then, it makes us feel hopeless and impotent. We stop trying to speak out, we become cowed and silent. And now, all that bullying and blame has managed to make the NHS less safe, not more, by allowing a culture to flourish in which no one feels they can change anything, let alone risk speaking out for the sake of our patients.

I’m a hard working NHS hospital doctor, and this interview made me feel angry, demoralised, hopeless, and incredulous—all in the same moment. That is not leadership and it is certainly not conducive to high standards of patient care.

Rachel Clarke is a specialty doctor in palliative medicine based in Oxford. Twitter @doctor_oxford

Competing interests: None declared.