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Why wouldn’t an NHS employee tell the truth?
Why wouldn’t they own up, blow the whistle or wave a flag when something has gone wrong?
The easy answer …is ethics.
The practical answer …is fear.
In a vast, high-volume and extraordinarily complicated service, there is something you can bet on… things will go wrong.
- Patients are different.
- Symptoms are ambiguous.
- Information is incomplete.
- Staff are tired.
- Technology fails.
- Beds are unavailable...
... someone mishears something, overlooks something or makes a judgement call that later proves wrong.
The choice is not between an NHS where mistakes happen and one where they don’t. It's between a service that learns from mistakes and one that hides them.
That's why I have mixed feelings about the Public Office (Accountability) Bill… aka…the Hillsborough Law.
The Bill applies directly to NHS bodies. It would impose duties of candour, transparency and frankness, require ethical codes of conduct and introduce criminal sanctions for serious failures.
The intention is entirely understandable.
Hillsborough, infected blood, Horizon and repeated NHS scandals show what happens when institutions close ranks, protect reputations and force families to spend years extracting the truth, but…
… there is a danger.
If admitting an error brings the roof in, people will minimise what happened.
They’ll record less, choose their words carefully, wait for certainty and persuade themselves that the outcome was unavoidable or someone else’s responsibility, or… shut up… look the other way.
More regulation can make that worse.
Regulation creates BLAME…
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Bureaucracy
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Liability
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Anxiety
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Minimisation
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Evasion
First comes another policy, reporting process and mandatory training programme.
Then comes liability; who knew what, when did they know it and which rule did they breach?
Liability creates anxiety…. anxiety leads to minimisation… minimisation ends in evasion.
Not necessarily a wicked conspiracy….
… more often it is defensive language, delayed disclosure, incomplete records, selective memory and the understandable instinct to protect yourself when you suspect the organisation will not.
BLAME does not stop mistakes. It stops people talking about them.
So how should the NHS prepare for Hillsborough?
Not by waiting for Royal Assent and commissioning another e-learning module.
Every trust should rewrite its disclosure protocols.
The question is no longer;
‘What are we legally required to disclose?’
It will be;
‘What does absolute candour require us to volunteer?’
That means...
... preserving records, disclosing inconvenient evidence, correcting errors quickly and ensuring lawyers and communications teams do not polish explanations until nobody appears responsible for anything.
Trusts must also review indemnities, insurance arrangements and access to independent legal advice.
The Bill potentially increases individual exposure...
...an executive, manager or clinician may find that their interests and the trust’s interests are no longer identical.
They must know who represents them, who pays and whether the advice is genuinely independent.
Then there are families.
The proposed expansion of non-means-tested legal aid at inquests, where a public authority is involved, could transform the balance of power. The government estimates legally aided cases could increase from a few hundred a year to as many as 11,400.
Families who once faced teams of publicly funded lawyers alone, may arrive with experienced representation, better disclosure requests and sharper questions.
The NHS should welcome that scrutiny, but... prepare for it.
There must be better record keeping, earlier disclosure, properly supported witnesses and investigations designed to discover what happened rather than establish a defensible corporate position.
Above all, staff who disclose mistakes honestly must be protected.
The alternative to BLAME is LEARN;
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Listen to the people involved.
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Examine the whole system.
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Act on the underlying causes.
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Restore trust with patients and staff.
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No reprisals for honest disclosure.
A blame-free culture is not a consequence-free culture.
Deliberate concealment, recklessness and dishonesty still require action, but…
… human error in a pressured system requires learning.
The Hillsborough Law is intended to uncover the truth.
Unless the NHS makes telling the truth safe, it may merely make frightened people better at hiding it, and…
… you cannot frighten people into being candid.
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