If you want to know why Jeremy Hunt’s failure-inducing changes to the NHS are being allowed to happen, read this – and the article from which it is taken.

The image is the risk register taken from the NHS performance report presented to the last NHS England board meeting in December 2016 – this month. As you can see, it mostly amber or red, meaning the NHS in England is in the deepest trouble.

Yet nothing is done, for the reasons outlined below.

If you live in England, are you really going to accept this catastrophic abrogation of responsibility?

All major NHS institutions from NHS England down are managed by a board consisting of Executive Directors (EDs) who do the actual work and Non-Executive Directors (NEDs) who are there to hold them to account.

The problem is that the EDs know full well that that rising demand, inadequate funding, a catastrophic manpower plan and health inflation will make it impossible to provide honest assurance to the board, but to say they cannot deliver a safe solution is professional suicide.

On the other hand NEDs cannot afford to hear that there is no safe solution. It means that they have failed and in all likelihood NHS Improvement will replace them.

This is where the rot sets in

All board members know that the real state of affairs but they are not allowed to admit it. Yet they cannot lie, or at least be caught lying, or they will certainly be for the chop. In board meeting EDs choose their words carefully, glossing over the negatives and emphasising the positives. They are overoptimistic about the likely success of recovery plans.

The NEDs don’t believe a word but it is not in their best interest to challenge too hard, especially when is no solution that will be acceptable to the government. Indeed they will often exert considerable pressure on EDs to get them to say what they need to hear. This is where NHS bullying culture originates. NEDs accept the assurance in the knowledge that when it all goes pear shaped they can say they were misled and will have an obvious scapegoat to blame.

So boards are made up of intelligent people who know the score but can’t see a solution, who dance round their handbags misleading each other, desperately hoping they will make it to retirement or the next job before it all falls apart.

This climate of deceit and bullying filters down to middle management and ultimately poisons the whole NHS.

We desperately need senior people in the NHS to admit what is happening. I hope this will start with clinical board members – Medical and Nursing Directors in particular. They have duty to protect patients under their respective professional codes of practice.

It is about time for them to grow a backbone, and to speak out – before it is too late.

Source: There is a toxic culture at the top of the NHS | Big Up the NHS

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