Intended for healthcare professionals

Rapid Response:

Ockenden: The NHS needs a radical overhaul of safety and leadership culture

Dear Editor

Kirkup report, Francis report, now Ockenden – the history of patient safety and leadership failures in the NHS repeats itself. Eventually, ‘lessons are learned’, some managers resign (equals: blame culture), ‘see you later’ at the next scandal report-publication press conference. The CQC, in the eyes of some a tiger without teeth, watches from the side-lines, scratching its head and wondering why it fails to spot such failures for years. Whistleblowers find themselves between a rock and a hard place – an NHS Trust that refuses to listen, giving them no other choice than blowing the whistle to save patients' lives, and the complete lack of protection when the same Trusts comes down on them in revenge like a ton of bricks. Something is rotten in the NHS.

It would be tempting and easy to blame individual organisations and people for these failures. But: the fish stinks from the head. There seems to be no political will for genuine change at the Department of Health, or the government. What is needed is a radical overhaul, one that is led, endorsed and resourced from the very top, of patient safety culture in the NHS; in the same way that overhauls have transformed the airline, nuclear power and other high-risk industries. One hallmark of these safety approaches is to implement systematic challenge of hierarchies and provide empowerment of staff to speak up without fear in the interest of safety, which is regarded as paramount over all other interests. Patients and carers are natural partners in such an approach. The Human Factors and ‘Just Culture’ approaches have to take centre stage, rather than be seen as a ‘can have’ in overcoming the lack of management accountability that we see through the entire NHS hierarchy. Regulation of managers is one step in such accountability, together with healthcare regulators taking a stronger stance on their members who victimise whistleblowers. Unfortunately, many organisations still run a callous, grotesquely Stalinist management culture [1], one that stops staff from speaking up and, defending the indefensible, uses deep pockets of taxpayer’s money to pay expensive law firms to punish and silence whistleblowers. The bullying that comes with such a culture is costing the NHS billions of pounds every year [2]. Nearly one in four NHS staff experience bullying from managers or colleagues, as reported in the NHS staff survey year on year [3]. Many NHS staff have lost their careers, and some even lost their lives, in trying to speak up for safety, for patients. The Department of Health must lead an urgent, substantial change towards a better leadership and safety culture.

Invaluable immediate steps from the Department of Health on this journey would be to grant whistleblowers immunity from prosecution by their own organisation, guarantee an independent and fair investigation of any concerns about their disclosure, and provide justice for those whistleblowers who have suffered in the past.

1 Campbell D, Weaver M. Hospital hired fingerprint experts to unmask whistleblower, report finds. The Guardian. 2020. (accessed 12 Apr 2022).
2 Kline R, Lewis D. The price of fear: Estimating the financial cost of bullying and harassment to the NHS in England. Public Money & Management 2019;39:166–74. doi:10.1080/09540962.2018.1535044
3 National results across the NHS in England | NHS Staff Survey. (accessed 12 Apr 2022).

Competing interests: No competing interests

13 April 2022
Christian Harkensee
consultant paediatrician
Narinder Kapur, London. Terrence Skitmore, London
Newcastle upon Tyne