We cannot imagine a health and care system where those responsible for making decisions about care and treatment, and those enacting those decisions, are not professionally regulated. This accountability seems central to the delivery of safe, high quality services. Yet professional regulation fails to prevent tragic failings. There are many examples of this including those exposed through the Thirlwall and Paterson inquiries, the cases at Gosport War Memorial Hospital and the examples from Mid Staffordshire NHS Foundation Trust.
These failings are because an organisation’s cultural environment is a powerful driver of behaviour, and any professional regulation must operate within this wider context. We know when these drivers clash, culture nearly always wins out and care can be compromised.
This leaves some professionals feeling forced to deliver care or take action they believe is wrong. It leaves some professionals with no choice other than to leave. Others, of course, find ways of doing the right thing despite what colleagues and the wider environment tell them, often at the expense of their own health and wellbeing. None of these outcomes are good for patients, staff or taxpayers.
With this in mind, we welcome the intention behind the ‘Leading the NHS’ proposals. These proposals represent action to influence the leaders who create the environment in which care is delivered. Naturally, we particularly endorse the intention of creating ‘a culture of openness and honesty in which all NHS staff are encouraged and supported to raise concerns’. The ability to raise concerns is a central characteristic of a positive environment which protects patients, services users, and members of the workforce.