Jenny Rogers on the pitfalls of assessing risk in the NHS

In the notorious case of the sacked dinnerlady, Carol Hill had sensibly told a parent that her child had been tied up and whipped by four other children, an incident allegedly downplayed by the school. Mrs Hill was dismissed for “breaking confidentiality”. Here we may speculate that a timid and inexperienced headteacher relied on a “rule” instead of common sense.

Last June a man died during the 16 minute “risk assessment” made by a paramedic outside the open door of his house

Such fear is endemic in the NHS and I recently observed it. Patient A (OK, my husband, and I have not exaggerated this at all) is in a much respected London hospital. He has come to the ward from accident and emergency with a broken arm but also has pre-existing problems, including chronic lymphoedema in a leg, which needs dressing every other day to prevent infection and to contain constant leaking.

A is amazed to discover that his friendly and attentive nursing team refuse to do this dressing. A, a model expert patient, offers to instruct them himself. The nurses quote “danger” and say, their pleasant faces visibly clouded, that they “dare not” and that there is no one available from the vascular department.

A’s choice: put up for several days with the increasingly unpleasant existing dressing with all its risks, or pay V to come in with materials from home. So V, an ordinary carer with no qualifications, swiftly and capably does the job while several highly trained graduate nurses look on, no doubt thankful that the dire perils of applying this dressing have been averted.

My friend K, desperate for decent food when recovering from an operation in another famous hospital, was sternly told by the ward sister that health and safety rules prevented a sealed Tupperware box of fresh fruit salad being stored in the patients’ refrigerator.

These were relatively small problems, but last June a man died during the 16 minute “risk assessment” made by a paramedic outside the open door of his house.

At the G20 protests last August, the policy of “kettling” was rigidly and aggressively implemented for five hours, preventing a heavily bleeding young woman from getting the help she needed.

What we want is intelligent risk assessment and people brave enough to allow compassion and common sense to prevail rather than hiding behind rules which do not exist or were never intended to be applied with such stupefying inflexibility. The press are quick to scorn individuals, but there is a far more important question about the culture of the organisations concerned and the examples set by their most senior managers. How recently, for instance, have you heard your chief executive admit he or she made a mistake?