The Mid Staffs disgrace sets a challenge for all professionals
28 February 2013
The Robert Francis inquiry into the Mid Staffs trust makes it clear that blinkered cost-cutting was behind the failings in healthcare standards that caused hundreds of unnecessary deaths. It also confirms that practitioners’ warnings about inadequate frontline staffing levels were treated with absolute contempt when layers of bureaucratic management right up to HMG failed to follow them through. This, together with covert threats of reprisal if they spoke out publicly, went on for so long that it eventually broke the spirit of practitioners who, over-whelmed by the unequal struggle, felt obliged to be complicit with bad practice. It was commercialism in a high risk public sector at its very worst that also exposed the principal weakness of contemporary professionalism that must be put right.
Francis makes no less than eighteen very detailed recommendations concerning standards, governance and performance. In my view, however, as was pointed out in earlier reports, the key requirement is for frontline staff to be listened to and their needs met in order for them to be able to take a professional pride in their patient care as well as the reputations of their units and wards. But this still leaves the question of how best the whole culture and hierarchy of NHS management, itself, can be transformed.
I had agreed with Dr Peter Gooderham (of the nascent Centre for Professional Integrity (CPI)) who, immediately prior to his so sad passing, advocated the professionalizing of NHS management with a code of ethics, standards, discipline and sanctions. However, this could clearly take very many years to develop and mature; in the meantime something must be done to help move things in that direction and to ensure that more Mid Staffs cannot take place. This problem is not limited to the NHS, of course, it also applies to other high risk public service sectors. For example, engineers must never forget the Hatfield rail disaster and the Nimrod aircraft crash where, in both cases, deaths were due to a similar blinkered cost-cutting combined with the complicity of engineering professionals. But, quite clearly, as things stand, the NHS problem is by far the most serious and urgent and should be given top priority by all professionals who are concerned about upholding the principle of professional integrity.
In my opinion, what has been happening in some NHS trusts over these last two decades is as damaging to present-day medicine as the corruption of the early 19th century that Dr Thomas Wakley fought against with his Lancet journal. Knowing the power of the early 19th century private medical establishment, he decided that its wrongdoings would, initially, have to be exposed anonymously by those who were close to what was happening. That was how Wakley started to “lance the boil” of jobbery, nepotism and corruption and helped to transform it from a private interest profession into one in the public interest. It was one of the most important events in the history of our learned professions.
In an earlier BMJ Personal View article (BMJ 2009:339:b3055) I had suggested that professionals of different disciplines needed to collaborate with each other in order to uphold the principle of professional integrity and proposed the creation of the CPI. The CPI approach to the present problem is based on the volunteerism that was an integral part of the public interest history and fabric of this country. It sees out-of-house, volunteer professionals, working in pairs, making themselves available to discuss in the strictest confidence a matter that seriously concerns a hospital trust professional. Firstly, they would satisfy themselves that it is based on objective evidence and can be unequivocally substantiated. They would then mutually discuss with that professional how he/she wishes it to be handled and the way it can be raised so as to protect his/her career. It should be noted that the hospital professional will remain in strict control of the whole procedure as he/she would have intended had there been no personal threat. The procedure recommended by the BMA would be followed, starting with careful approaches to line management and only publicly disclosed by the CPI if, and when, after mutual consideration, it is deemed necessary in the public interest. But the whole intention behind this approach is to make it abundantly clear to NHS trusts that an open culture, with proper respect for the public interest duty of professionals, is the only option for managements in the future.
It could be argued that having to turn to fellow professionals to help to assert one’s own professional integrity is demeaning. However, the whole history of the professions was built on volunteers coming together to create their learned bodies and their own culture firmly based on the principle of professional integrity. And in my view, as corporate power became ever-more concentrated and powerful, it was inevitable that cases would arise when concerned professionals of different disciplines would need to collaborate with each other in order to ensure that this precious principle was preserved. The CPI, therefore, appeals to all professionals, particularly semi-retired/retired doctors and engineers, to support this reassertion of true professionalism for the 21st century. Email me: email@example.com
Let Mid Staffs be the wake up call for all professionals!
Competing interests: None declared
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