• Mike Durkin says “grown up” conversations between managers and clinicians are not always happening as hospitals come under intense pressure
  • He says staff are still afraid to raise safety concerns
  • Comments come as many accident and emergency departments have been overwhelmed since Christmas

One of the NHS’s most senior regulators has warned financial and demand pressures have left the health service like a “rabbit in the headlights”.

Mike Durkin also said staff were still afraid to raise concerns over safety.

Mike Durkin image

Mike Durkin

Mike Durkin said ‘grown up’ conversations between managers and clinicians were not always happening

Dr Durkin, the national director of patient safety at NHS Improvement, said “grown up” conversations between managers and clinicians are not always happening as hospitals come under intense pressure.

His comments come as many accident and emergency departments have been overwhelmed since Christmas, with huge numbers of patients waiting more than four hours to be seen. Hospitals are also under pressure to deliver strict financial targets.

Speaking at an event at the King’s Fund on Tuesday, Dr Durkin said: “We are rabbits in headlights now with financial issues and waiting issues… and safety is being sort of, not being lost, but it’s there, and people are afraid to raise that as an issue.

“I think that’s because people don’t feel they will be listened to by the operational management at the top of the office. Because the operational management is under pressure to just deliver the solution, just fix the problem.

“This nearly always goes back to understanding the ethical responsibilities of the individual in any decision making process, including the operational management.

“So this debate about operational issues, I’ve got to be careful what I say now… this debate about operational responses is equally important for the board of a hospital and the managers of a hospital as it is for the anaesthetist or the surgeon who needs to say ‘I’m sorry it’s not safe to carry on’, because we don’t have a particular piece of equipment or we don’t have a particular bed available in ITU or HDU.”

He continued: “That’s a responsible and grown up debate, and there needs to be a responsible and grown up conversation that happens all the time. I’m afraid that the evidence is such that people seem to be scared to raise [safety] as a conversation.

“So for me that would go back to that principle, if we understood each other’s ethical responsibilities and duties then we’d probably come back with a proper answer.”

Speaking at the same event, health secretary Jeremy Hunt accepted there were some “unacceptable” and “extremely worrying” incidents reported over the last week, but said it was not appropriate to describe the situation as a “humanitarian crisis” as the British Red Cross has.

He also said that providing safe care was the “same path” as the one needed to reduce costs.