Ep 68. Who holds the NHS accountable?

Well, I suppose my experience comes from working 20, 25 years in patient safety, and recognizing the, the critical importance of listening to and responding to the perspectives of patients, particularly if things go wrong, if there's avoidable harm.

And, and often, uh, patients and families will immediately hold the clinician that's, that's been part of that team, that's provided the care as accountable.

And clearly, that's the case.

You expect professionals to provide safe and effective care.

I think what patients and families don't always understand, and, uh, um, and I think society's increasingly recognizing, is the complexity of providing care, and that it isn't just the immediate clinicians that, that you see.

It's the whole infrastructure behind you.

You know, is the organization, does it have the right culture? Does it have the right leadership? Are clinicians provided with the resources that they need to provide the right care, whether that's, you know, have they got the right information about the right patient? Have they got the right IT equipment? Have they got the right medical devices? You know, are those, uh, are those facilities available? So I think immediately, particularly if something goes wrong, uh, patients and families will, will look for accountability to the professions that are providing that care.

And sometimes that might be a little unreasonable 'cause it, it, they may just be working in an unsafe system.

So there are, there are professional accountabilities undoubtedly, but how do you hold the system to account? And then you start moving up that hierarchy, leadership, organizational hierarchy.

So, you know, the boards of those organizations and then NHS England that funds it and sets strategy.

So I think there's layers of accountability and I think some, particularly some patient organizations who are campaigning for better healthcare based on harm, like say Cath Sansom, who are running Sling the Mesh, they're recognizing that the changes that need to be made are policy, they're government, they're funding, and they're NHS England level.

Can I just-

So I think there's an increasing recognition that there are layers.

Jagtar, do, do you concur with that, that it's, it's all a bit more complicated?

Right.

Um, many years ago, I went to a conference, uh, and a learning, uh, point to me was, as an ex-fire officer, when you put a problem in front of me, I put water on it, and it goes out.

That's a binary answer to every question.

Uh, but I've learned over time that every question is very complex, so complexity theory is the way that I would answer it.

Yes, Helen's absolutely right.

There are structures, there are systems, there are methods of holding people to account.

However, if I go back to m- my fire learning, who was accountable? I was accountable 'cause I was the chief fire officer.

I was responsible for everything that happened on my, on my watch, and I don't feel that accountability in the NHS.

I don't feel that, uh, board members feel that they're responsible for the disproportionate disciplines and under arrest for Black and Asian people.

I don't feel that individual accountability is taken seriously, and part of this question is about trust.

How do you build trust? You can't build trust with your patients, you can't build trust with your staff if you don't feel that personal accountability, and you don't take learning from every incident.