Cover-Up Culture in the NHS seemingly everywhere?

[SpicyMoth]

It's a couple days old, but I've just come across this LBC video with a phone in from a retired NHS consultant. Many others then emailed in to corroborate that they experienced the same.
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To briefly summarise, he's talking in relation to Lucy Letby and how there is definitely a "cover-up culture" within the NHS that goes up to the highest levels that even he himself has experienced when trying to speak out about things.
To the extent where even genuine mistakes will be covered up for reasons such as "Well the patient only had six months left to live anyway".

When watching it, my boyfriend piped up to say that when he spent time in the NHS as a cleaner it was the same.
Even something as simple a piece of equipment looked like it needed replacing or was about to break or let's say there could be a potential hazard such as mould? They didn't want to know, and they'd do nothing about it when he said something.
(This was mid-COVID btw, so even scarier to me to be honest. Especially when you consider everyone was supposed to be following specific rules re; cleanliness and anything he brought up was ignored!)

On top of that, we also had the Triggernometry interview with Hannah Barnes yesterday evening re; GIDS, and it very much went along the same lines.
People speaking out and being ignored. Concerns being raised. There being talk, and conversations and agreement that certain things may not be working but nothing ever happening.

Even with Letby, I saw in reporting that people were suspicious for ages before higher up's finally did something or police got involved, I'm unsure which off the top of my head right now.

Before this recent horrendousness I perhaps ignorantly assumed/hoped that the Tavistock stuff was just down to a vocal few being captured by ideology in that specific department, but now I see it seems to be more of an NHS-wide issue, and in regards to anything and everything, not just gender.

How in the flying fuck did we even get here?

Implementing a culture of psychological safety rather than blame and litigation would save lives and mental health but it’s too far gone to be saved now.

Unfortunately this has been going on for decades, not just in the NHS but social services. As I know from family experience which made the last months of a family member far worse that it need have been.

And expereinced more recently, similar attitudes in my local authority and the housing association.

In fact it has been going on so long, many employees are now quite blase about taking complaints as they know senior managers will do anything to misdirect formal complaints, often for no other reason than to be able to say, they have only received a tiny number of complaints in any one year.

Dont forget it was primarily this attitude that contributed to Grenfell. Or rather could have prevented Grenfell when incompetent builders and suppliers should have been challenged but weren't, even though residents has raised concerns.

Jed Mercurio wrote a whole drama series (or two) about it. It has been an open secret for years

It does seem as if there's corruption amidst too many of the powerful in the NHS. I first realised it when confronted with NHS Trusts openly creating policies to wedge male rapists in women's hospital wards with potential victims. Only those of a predatory mindset could ever sanction that - yet here we are.
I hope the managers from the Letby murder case are made to face legal action in the light of their evident culpability. The NHS needs a clear out of people like this.

This cover-up culture has been going on for years in the NHS, you only notice it when something goes wrong with treatment. The NHS has become a corporate entity where execs rule, reputation management is everything and patient safety went out the window a long time ago.

Complaints go nowhere, bad staff are protected, moved or promoted to the detriment of the decent staff, the CQC is worthless, the Ombudsman upholds only 1% of complaints. Thousands of people try to expose what's going on, including journalists. No-one is listened to and nothing changes.

There will be many more of these scandals being covered up.

I felt this in education.

Some years ago the head announced a new whistle blowing policy, clearly directed by HQ but it was stifling.

Basically, if you had a complaint about senior leadership you had to go through the head.
If your beef was about the head, you had to go through the head.
There was leave to go through the governors but the governor chair was besties with the head.

I had a major grievance. Seriously major.
Absolutely no support whatsoever.
Matter quashed.

Thank God I was in a union and had been for many years.

Union was horrified but not surprised as the union rep was familiar with the school and its practices.

It was very awkward and embarrassing but I was right. They were wrong.

Sadly I ended up resigning as I felt so awkward and embarrassed, even though I was right and HR concurred.

Tory government implemented in the full in every sector!

Health, social, education highlighted here.

Lift the lid off any of our institutions and find appalling veniality and corruption.

I just can't fathom at all how things have gotten so bad that things like Letby can happen - It's absolutely bonkers to me that what it basically boils down to is people wanting to "look good" and "not wanting to have too many complaints" , Keep your head down, get promoted, don't have to deal with it.
Like.. What?

Are humans as a species really that self serving? Is it just that bureaucracy and wanting to have a few red marks as possible has won out over common sense and empathy?
Why are people in these positions of power in complaints departments to begin with if they're willing to compromise on morals, health and safety in the name of possibly getting a promotion by having no complaints?

And above all what baffles me the most, is the complete contradiction in the notion of having less complaints makes a person or their department "look better".
How the hell is it not suspicious that there are so few complaints going through?
Why does it look good to have few complaints?
Surely if you wanted to "look good" it'd be better to actually have complaints, and to have responded to them promptly and appropriately, and well?

It this just how things are? How can it even begin to be changed when it runs clearly so deeply?

Agree it's all horrendous, and permeates every aspect of public sector. Obviously it's in the private sector as well but that's more about money.

Some of it comes from being genuinely over worked and over pressured. Both at home and at work. When your clinic is overbooked and your struggling to get through final patients and your nursery closes at 6pm - there just isn't the headspace to deal with problems. Everyone is treading water to avoid drowning. There is no capacity for anything beyond surviving today. Ward managers don't want complaints because they don't have time to deal with them. Staff don't have the mental bandwidth to notice things they should, or to follow up hunches / pay attention to others. They have to assume colleagues are competent because the alternative is doing their work as well. It's "fight or flight" every day.

Beyond the obvious underfunding and recruitment challenges, I also think this culture is driven by home pressures as well. The normalisation of dual income mortgages means both usually work - caring responsibilities for children or elderly parents or managing your own ill health etc are squeezed. The result is a daily / weekly schedule with little "give". Always rushing, always high cortisol.

Much is wrong with our society - the cover up culture is a symptom.

I think a large part of this kind of mess is the sheer size of an organisation. It means there is no accountability, no form of relationship between patients and HCPs for the most part.

Leadership matters hugely in organisations, but the NHS is so enormous that it doesn't even really have visible leaders.

People really need to read consultant Peter Duffy's "Whistle in the wind" book about how he was hounded out of his job by NHS managers for complaining about incompetence and laziness of some of his colleagues. It's grim reading but casts a light on why so much goes wrong in the NHS.

The fragmentation into so many different trusts doesn't help, as staff in one trust just glibly blame another trust to divert the blame to someone else.

The idea that someone's GP has overall "responsibility" for their care is now laughable - they fob you off to different trusts, and even within their own GP surgery, you're passed around different GPs like a piece of meat with no opportunity for any consistency or continuity of care. Presumably, that's so no individual GP can be blamed for missing something or misdiagnosing something - when you have "collective" responsibility, the blame is shared and no one is disciplined because they can't determine any individual responsible!

The more senior the manager in the NHS the more concerned they become with protecting reputations, whether that be their own or the hospital or trust and that sometimes comes ahead of patient safety.

Remember when an NHS hospital told the police that a patient was mistaken about being raped because there had been no male patients on the ward, only for it to turn that there had been a male patient on the ward? IIRC, they'd dallied over handing over the CCTV evidence as well.

Somebody upthread mentioned Bodies by Jed Mercurio. These last few have had me thinking about The Wire and its central theme of institutions putting all their effort into seeming as if they are working, at the expense of actually working. We've got hospitals that think it's worth risking rapists and murderers being loose on the wards as long as the police and the press don't find out. It's actually unbelievable typing that, but it's all already been borne out. I think the NHS has a huge cultural problem but I don't think this is confined to the public sector.

Thanks for the recommendation @Badbadbunny, I've added it to my "to buy" list!

Couldn't agree more
Shocked and horrified by what Letby did but not remotely surprised by the reaction of the senior management. I've worked in the NHS for 25 years, management at that level is rotten to the core, 100% self serving toxic culture with no care toward patients or clinical staff.
Over and over again the NHS produces scandal after scandal, this has really depressed me but what depresses me even more is that there is no end to it if the NHS continues to exist in its current form

When clinical governance was introduced into the NHS a quarter-century ago, there was much talk of a blame-free culture and learning from e.g. pilots/air controllers (i.e. other environments where mistakes cost lives). Everything was going to magically change!

Except that what didn't change was the people. I think there are a few things that often go wrong:

• Nurses feel put upon by management, so close ranks to protect each other
• Doctors and nurses are like car drivers and cyclists: plenty of mutual antipathy
• A lot of managers are not very bright
• Targets are unrealistic, so there's a general culture of trying to put a positive spin on a shit situation.

Tory government implemented in the full in every sector!

Sorry - but that so misses the point. A lot of problems in the NHS started under Blair, as did the rip off that is now higher education.

And the number of Labour authorities where you could end up being totally isolated and bullied out of your job if you dared complain.

And anyone who bothers to follow issues in social housing will know this is an ongoing issue.

Some of it is to do with people being disinfranchised from their jobs, and not in any way saying back in the old days every thing was better. But when you had a system of apprentiships or being an article clerk, people were often committed to an organisation and would work more collaborately to achieve ends (sometimes obstructed by unions as much as helped).

Nowyou have people who have been totally inadequately educated parachuted in as "graduates" who probably cant even tie their own shoelaces taking decisions that are way above their intelligence let alone life experience. (Thanks again Tony!)

Added to which there are still deeply entrenched prejudices so that even if you have a whistle blowing type system, too often that system is run by someone who will only accept as valid information from someone they trust. And as they are usually over promoted middle class white men, they doubt the word of a woman, let alone anyone from a BME community.

When I was a nurse, I reported bad practise and bullying by a manager and got demoted.

I reported a doctor repeatedly making prescribing errors and was told I was bullying him. The incident forms were deleted.

I reported a nurse neglecting/abusing patients and was told I was bullying. I went straight to the NMC and the nurse was struck off.

I worked in low level management and had massive concerns about a mentally ill nurse working on the wards. I was told that was discrimination and basically to shut up. She killed herself on duty.

I worked alongside many incompetent staff and they just get moved into management positions to shut everyone up.

How does experiencing that not make you feel completely hopeless?
I don't even have words, that's just terrifying...

I feel like part of me knew it was bad, but didn't want to accept it was as bad as it is... I feel like I have such a doomer perspective on this type of thing now - It seems so impossible that things will ever be different...

@SpicyMoth for a while, I battled away thinking I could change things - that's the only reason I took the management job. But you can't. It's too ingrained. I quit and took myself off the NMC register.

I was on a local NHS Trust Board for a couple of years. I heard some really shocking things
The emphasis was on meetings and meetings about meetings, it was considered that an issue had been addressed if a meeting had been scheduled about it.
The cover up culture was also awful

The emphasis was on meetings and meetings about meetings, it was considered that an issue had been addressed if a meeting had been scheduled about it.

There seem to be some people who can go through a whole life time of working like this and never ever have to face the consequences of this Alice in Wonderland concept of the world.

The worse thing is those who know what they do is just to screen out reality but are so fixated of being a good corporate person nothing else matters.

I think it's the introduction of KPIs as a way of creating measurable objectives for senior management that does this.

Instead of 'people get treated' it's 'Achieve a waiting time of no more than 6 weeks for all referrals' - but there are 1200 who have already been waiting for more than 18 months.

For the manager to achieve their target and therefore their progression/increment, they've already failed it by the time the meeting's over.

How to deal with it? Well, some of those people might have died, might have moved away, might have forgotten all about it. So let's send them all a letter saying they need to confirm they still wish to remain on the waiting list by sending an email to a specific address/calling a particular number (but not stating nobody's manning the phone outside 2.15 and 3.27pm every other Tuesday). When it's an elderly care clinic or one that has a high number of very poor/homeless/less likely to use email/deaf people.

So a lot don't respond or attempt and give up - they're off the list. Then switch to only sending requests to book appointments by email or text when they don't have either and could well give up if they do because the booking system is abysmal, what with not being designed to be easy to use from a patient's point of view.

That can take almost all of them off - and then the few remaining get bumped back to the GP for re-referral if they have to cancel a 7.15pm appointment Saturday evening because they need transport. We're down to a handful of long waiters and they get overbooked onto a clinic where some give up at 5.45pm, they get taken off the waiting list because they've been told to repeat all the tests the GP did before referral (which resets the clock) and the medics are under pressure to do something like 'lose weight and let us know when you're under 22 BMI' - after which point they find they've been discharged back to their GP if they do manage it.

Anything that involves targets and data has the scope for gaming it or falsifying it - especially when the numbers are what determine the increased salary for the managers.