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

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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5 Thoughts to “There is a toxic culture at the top of the NHS | Big Up the NHS”

  1. Great article as always Mike.

    I want to take this opportunity to wish you and Mrs Mike a Happy and prosperous New Year!! I hope most of your dreams come true and more to hope for!!!

    Best Wishes!


    1. Mike Sivier

      Thank you very much, and the same to you!

  2. Unfortunately the Turkeys are not going to vote for Christmas , they know full well that they would lose their jobs so they continue not doing them and taking home the money. What is needed is a top removal of all the organisations after 1984 so that we can return to a working model, but of course that would mean the loss of the thousands of high paid jobs that the move towards privatisation has generated. This is not what the government of any colour seems to be able to accept.

    1. Mike Sivier

      So the jobs of NHS directors are more important to them than the service they provide?
      Someone has their priorities mixed up!
      I certainly agree that perhaps these jobs ought to go, since they aren’t being done properly.


    Theresa May and Philip Hammond’s refusal to give the NHS a winter cash injection is sure to feature again today after the BBC reported a startling rise in “trolley waits” in hospitals. The data analysis (drawn from publicly available figures, so not even needing an FoI) found that nearly 475,000 patients waited for more than four hours in 2015-16 – up from just 97,000 2010-11.

    So what used to be unusual – patients arriving at A&E but then being forced to wait on trolleys and chairs before getting a bed – is now getting more normal. The percentage rise is from 2.7% to 11%.

    But just as waits are becoming routine, so too are huge salaries for temporary hospital bosses. The Times splashes its front page with a report NHS trusts have been ordered to end “eye-wateringly high” payments to stand-in bosses after it emerged they were getting wages that amount to more than £400,000 a year. Worse still, interim managers are sometimes employed through professional service companies, which could be used as a method of tax avoidance.

    In many cases they don’t work for a year, of course, as most are in-and-out emergency appointments to turn round failing trusts. But when interim hospital finance directors are being paid about £1,800 a day (the equivalent to £432,000 a year), they had better show serious improvement and the watchdog suggests they don’t.

    The Waugh Zone 7 Dec 2016

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