5th January 2016

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News and Comment from Roy Lilley
Twitter followers may have seen the Tinkerman posted a series of brief film-clips on what he intends to do to us this year.  One caught my eye.  He's going to set up some sort of 'no blame unit' to encourage whistle-blowing.  He says, modelled on the airlines.
There is no doubt whatever; whistleblowing remains, stubbornly, at the top of the NHS' list of things to fix.
It is a complete mystery to me that highly educated men and women treat each other so badly.
I know... there's a difference between someone with an axe to grind and a point to make and it's not always easy to tell.  Not all whistle blowers are blameless and whistleblowing can disguise a deeper culpability.  Some whistle-blowers get whistleblowing a bad name.  There is a difference between immunity and impunity.
Something else I know; if you don't fix whistle-blower issues, genuine or not, fast, you can end up with a file of letters and memos that needs a donkey to cart about.  Whistle-blowing festers and everyone loses the plot.
Another mystery... I have never understood why managers don't crawl on bended knee from one end of the organisation to the other, begging staff, asking them; 'Please, is there anything I need to know?'
The Tinkerman seems to believe the airlines have the answer for the NHS.  They don't.  The imperative on the flight deck is to get home in one piece.  The imperative in NHS can be to make sure a career stays in one piece.
We must dig deeper.
The report into the Bristol baby debacle spoke, eloquently, to the heart of the issue:
"The culture of blame is a major barrier to... openness.  The system of clinical negligence is part of this culture of blame. It should be abolished. It should be replaced by effective systems for identifying, analysing, learning from and preventing errors and other sentinel events."
The GMC and the NMC have sprawled themselves across the landscape of healthcare.  We are no safer.  They have forgotten we really only want them to keep a register of who is who.  The employer can do the rest.  Without changing how the professions are regulated, nothing will change.
The NHS is a very risky business.  As I write something will be going wrong; through ignorance, carelessness, tiredness or wilfulness.  It is inevitable and the purpose of speaking up, shining a light, is to enable us all to learn, reform and improve.  Mistakes are the norm but it is not normal to ignore them or cover them up.  
I see whistle-blowers as improvers.  Whistle-blowers are not criminals but we treat them like they are and take away their jobs, livelihoods, dignity and pride.  It is the obfuscaters who are the real criminals.
Denmark dumped its medical malpractice procedures in 1992 and improved patient safety by a simple change; they focus on the patient and how to avoid injury next time. Many Scandinavian countries do the same, as does New Zealand.  Learning from overseas is something the NHS is very bad at.
We know what we're doing now doesn't work and a new DH department won't work either.  By the time the whistle is heard in Whitehall the damage is done, the evidence corrupted and the chance to learn, lost.
Fear of disagreeing with the establishment is the chill in the system and as Harvard's Detert and Burris tell us; guarantees of anonymity don't work either.
Allowing anonymity only serves to emphasises the risks involved in speaking up.  When complaints become known you can almost guarantee the witch-hunt that will follow. 
To encourage others we have to abandon 'investigations' for 'analysis'.  Being transparent from the start is a whole new paradigm.
We all know anonymity cannot be guaranteed.  Who said what and when will emerge.  People are good a putting two and two together.
'My door is always opendoesn't work, either.  It's a long way from the bedside to the board-room and being seen on the management floor is a risk.  Corporate NHS is disconnected from the business end of the NHS.
A better answer?  Local, open management, non-threatening, listening, transparency and the power and resource to act, there and then, to right wrongs and fix failure.  No blame and a relentless focus on the patient.  Obsessively asking; 'what can we do, together, to make this a better place'.  

Being seen, senior management omnipresent and ubiquitous at the front-line, accessible; realising blowing a whistle doesn't only end the game, it can also be the start of a new one.
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>> I'm hearing - as we closed to publish; the Junior Doctors are going on strike, probably next week.  This will destroy the reputations of all the protagonists and the patients will be lost among the placards.
>>  I'm hearing - rules are changing; no more 'black alerts' when hospitals are dangerously full.  Apparently they attract too much media attention.  I thought that was the idea?
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