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NHS leaders note: organisational culture is key

BMJ 2014; 349 doi: (Published 28 July 2014) Cite this as: BMJ 2014;349:g4814

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Dear Sir/Ma/am

Thank you for publishing such an intriguing piece (Kulkarni K. BMJ 2014; 349: g4814). It clearly communicates and explains underlying feelings endemic amongst healthcare professionals in NHS England. Unfortunately, even if the bumbling rhetoric expounded from Westminster and countless NHS trusts in England became translational into decent common sense one fears (and countless colleagues fear) that it is too late.

The damage through the blind pursuit of foundation trust status, four hour waiting times in A&E and countless financial and clinical target setting has demolished lateral thinking on an individual clinical level, e.g. the countless new initiatives in some A&E departments, and therefore on a collective, managerial, corporate and ultimately patient care stage.

Our NHS has historically been one of hard work, long hours and tough bosses, tough working conditions but one of kindness, compassion and the meticulous destruction of these, e.g. managers so quick to respond to patient complaints that any drivel is written up to appease patients irrespective of the facts, coffee, tea and milk (that cost peanuts) stripped away, cheaper sutures enforced into surgical practice as a cost saving measure (but trusts then simultaneously employ a highly expensive world famous researcher to boost its chances of foundation trust status), consultants having poured their guts into their hospital for thirty years are waved goodbye by no one more senior than a newly qualified nurse (instead of senior management) than it is time to consider pulling that plug (NB: these examples are not specific to any person, trust or organisation).

A story was once told of a newly appointed consultant general surgeon receiving a phone call from someone in human resources (back in the good old days), inquiring as to the correct spelling of his name. Odd, this surgeon thought. However, on arriving to begin a long consultant career this surgeon was trying to find a car parking space. To this surgeons surprise, above a patch of concrete, was a stake rammed in the ground having this surgeons names in bright letters making it clear that this parking space belonged to one person, and one person only. Fast forward thirty years and this same consultant cannot find a parking space, gets fines if an expensive permit is not bought, and has to arrive even earlier to work to secure one (NB: this situation is not specific to a single consultant and is not identifiable to one).

This is an example of how senior consultant surgeons are treated, let alone nurses, porters, cleaners and the countless humble folk that go about their jobs quietly and never get to feel they belong to a team of people making sick people get better. It is that simple.

The NHS in England is on its knees regarding almost every single facet required to treat people in a proper and decent manner, e.g. both patient and staff. As someone who has worked in both NHS England and NHS Scotland it is clear the situation in NHS Scotland is fortunately less grave, less concerning and less fraught in uncertainty, e.g. the closing of Charing Cross Hospital last week could never happen in Scotland in that sort of blatantly savage, greedy and ultimately immoral fashion. One thing that might swing Scottish Independence to a "Yes" vote is the fear of an abominable situation in NHS England being repeated in NHS Scotland.

Competing interests: No competing interests

08 August 2014
Simon Lammy
ST1 Neurosurgery
Institute of Neurological Sciences
The Southern General Hospital, Glasgow, Scotland, UK