Roger Kline: Blame culture out in the open

When something serious goes wrong in the NHS, the search generally begins for someone to blame. More often than not, the search ends with a health service manager who is named, photographed and, on a bad day, suspended.

The Kennedy inquiry set up after the Bristol baby deaths scandal said there must be a better way of doing things and set out to say what they might be. Central to its recommendations to the Secretary of State were that there must decisive moves away from the blame culture and towards one where real lessons can be learnt beyond occasional finger pointing.

The goal? A culture where there can be open discussion about clinical and management shortcomings, where criticism can be made without fear of victimisation, and where mistakes can be admitted and not covered up. This was already the goal of "clinical governance". That change of culture is now enshrined in numerous circulars, speeches and protocols across the NHS but not necessarily in universal everyday practice.

UNISON warmly welcomed the recommendations. At the same time we were well aware that too many managers still have many obstacles placed in the way of acting in the way they need, to safeguard standards of patient care in the NHS.

Too often managers are expected to work with inadequate resources, poor equipment, or in a bullying environment where flagging up concerns about patient care is seen at "special pleading". It is no wonder that at every level of clinical and general management there are stunning turnover rates, high stress levels and wobbling morale.

It was no surprise, therefore, that many managers welcomed a lesser known recommendation by Professor Kennedy that there should be a code of conduct for NHS managers.

UNISON welcomed the idea too and hoped the code would make explicit the duty of care owed by managers along the lines that clinical professional codes of conduct do.

It is unfortunate that the draft code that eventually surfaced gave too little attention to the crucial dilemma facing managers: how to flag up concerns at an early stage without seriously damaging their careers or those of the staff they encourage to identify problems.

There are some excellent points in the draft code for managers, but as currently written it runs the risk of not being taken seriously. Or even worse, it runs the risk of being used to discipline managers while doing little to ensure they flag up genuine concerns about for example staffing problems.

These are not abstract issues. If, as is reported, staff shortages were well known in the maternity wards at St Peter's Hospital in Surrey, why was it not possible to be open about the concerns before babies died and the media went on a blame hunt.

There are indeed NHS Trusts where a "learning culture" has taken root. There remain others where it has not. Moreover, the intense pressures on chief executives and other to hit government targets, and do so without creating waves, inevitably filters down to less senior managers. When those pressures are allied to a bullying culture, it is no wonder that some managers are caught on the horns of a dilemma.

See www.unison.org.uk/healthcare or call the UNISON helpline on 0800 597 9750.

Roger Kline, UNISON Health Group

UNISON EVENTS DIARY

21 July: Barrio Fiesta, London's huge Filipino festival at Lampton Park, Hounslow, Middlesex (nearest tube Hounslow central) entrance free – sponsored by UNISON

20 July: Respect Annual Anti-Racism Festival, Hackney

3 August: UNISON-sponsored race day, Doncaster. Contact Yorkshire & Humberside Region

For more information on all the above events, please contact Sara Gorton at UNISON on 020-7551 1258