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There are signs the blame game pendulum is beginning to swing back from managers towards clinicians. While feeding managers to media wolves is the default response to a major tragedy - witness Mid Staffs, Maidstone & Tunbridge Wells and Baby P - clinicians rarely seem to be to the fore when it comes to being names and shamed. But there is increasing talk in the NHS of the need for clinicians to be held to account. To take Mid Staffs as an example, what did clinicians do when they saw receptionists triaging patients? In the past few days two health service big hitters - CQC chair Barbara Young and NHS commissioning supremo Mark Britnell have both publicly challenged the notion that managerial defenestration is an adequate response to system failure. The role of clinicians in when the system fails the patients highlights the distribution of power and responsibility between managers and clinicians. The interaction between the two is complicated - if a doctor feels disempowered, does that give him an excuse to abdicate responsibility?
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From The Editor
Richard Vize is editor of HSJ. Follow Richard on Twitter twitter.com/RichardVizeHSJ
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Readers' comments (5)
Anonymous | 20-Apr-2009 4:52 pm
But this ignores the culture of oppressive management that ignores clinicians when they point out the lack of proper clinical governance and then ostracises and threatens when they persist. We know what happens to whistle blowers - they get removed from their post (one way or another). The problem with places like North Staffs is that any old solution will do as long as boxes get ticked and emasculate anyone who gets in the way. Would you risk you health, welbeing and income?
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anonymous | 21-Apr-2009 7:34 am
Zero-sum gaming has characterised much of health and social care for too long - it is the respnsibility of Local strategic Partnerships to exceed the experactions of leadership and focus on what really matters - here's one starting point - hospital to home discharges have always been complicated when the patients accommodation is unstable or unsuitable or where the ecology of the family and friends support is stretched too far or not assessed properly - the death of Victoria Climbe, Tony Anne Byfield and I suspect Baby P have one commonality - In each case housing and homelessness triggered contact with public services. Having a dependant child means you'll get some sort of help.
The homelessness legisaltion is tricky - placing the burden of proof to establish vulnerability/intentionality wholly at the applicants door, is adversarial in nature and has primacy over all other social welfare duties.
So, lets start agian:
Zero-sum outcomes are also known as no solution agreements where corporate governance and parenting responsibilities are transfered to the patient and customer as choices.
Other types of agreement are known as 'splitting agreements', 'brother inlaw agreements' (or I know a man who can) and 'there and back' agreements - these are the technical dynamics that may determine whether or not a contract for service are unfair - EC Law is pretty clear on this matter and states that there must exist a 'congruence of wills and a faithful expression of interests' to form an agreement, if as seems the case there is a 'waggering agreement system' in operation - a notion that we're working towards something of value in the future ie Better Health Care then it is question of whether or not this type of behaviour is against the pubic good and interest.
I'm an amateur in these matters but enough of one to know that a judicial review, by the likes of say. Lord Wolfe, would go along way to (i) establish the broad legality of current practice and (ii) align the definition of competition being used to health and social care and not gambling.
The Secretary of State for Health must be made aware of these difficulties and all health and social care professionals must act on the conviction of their courage and raise these matters with him.
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Anonymous | 21-Apr-2009 1:30 pm
The blame can not be on one group or the other, everyone needs to take collective responsibility for the failures in an organisation, both managers and clinicians have their role to play and if one is dominate against the other then you will get silence and inertia. However, there is an issue that professionals that whistle blow are subjected to the most appalling and derogatory process, e.g Dispatchers programme of undercover nurse, undercover teacher, until the NHS is open and transparent and encourages clinicians and managers alike to raise issues in the public then the silence that fell in North Staffordshire will continue and people will not put their heads above the parapets, save for the very few brave souls who risk a lot to bring some shocking and despicable behaviours out in the open.
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Anonymous | 21-Apr-2009 1:41 pm
As I understand it the problems at Stafford in A&E arose because of the reluctance of senior management to shell ot for adequate consultant workforce, rather than because of the failing of individual clinicians. The problem was solved by appointing sufficient consultant workforce, but not till after the damage had been done during a period of financial turnaround.
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Paul Tovey | 21-Apr-2009 3:13 pm
It would be good to re-understand that people in a context of social pressure (led by Gov't) and a view of "what must be" often bend with that pressure - especially if they are prone to group conformity ..
I've seen Board level decisions taken in a conformist way that defied better sense ... Executives in a rush to perform will brush aside patient considerations because the pressure is on them to perform and bed in Govt policy ..Roll out roll out - bugger who gets flattened ..
Criticality can go out of the window or become silenced by the thick mood atmosphere that some Execs exude ... Bottled rage with dark lightning bubbles at Exec level is more than socially unpleasant - its solidly repressive of fault finding ..
I've seen Non-execs go quiet around it .. I observed this as a member of the public in sessions where it was barely possible to make any kind of impact from a public perspective ..
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