Pocket phone

“Corruption is embedded in health systems”. Lancet 2019; 394(10214): 2119-2124.

On 9th December, local and national news reported on a four year child, with suspected pneumonia, who was pictured lying on coats on the hospital floor, apparently due to a lack of beds. The hospital’s Chief Medical Officer apologised, as later did the Health Secretary. People will take their own view on what this reveals about the state of the NHS, and whether it’s being starved to create the case for private “investment”.

The story is telling in other ways. The Prime Minister, when confronted by a picture of the child, is said to have initially refused to look at it, even pocketing the reporter’s phone. Some Twitter users sprang into action to discredit the picture and the child’s mother. Other sources disseminated a fake news story about an activist punching one of the Health Secretary’s entourage at the hospital.

In microcosm, you appear to have a common managerial response to harm in the NHS; first, the instinctive refusal to look at the evidence, and an urge instead to hide it; second, the discrediting of the concerns and those reporting them; third, the construction of a new and distracting narrative, disseminated widely; fourth, the apology once the media reveal the above.

More widely, our public services often seem captured by this approach to bad news. This week’s Lancet featured a major article on corruption in healthcare. The sector is reckoned to be both ripe for corruption and, in places, rife with it. The inquiries into Infected Blood, Gosport and Hyponatraemia illustrate the systemic problem in the UK. The inquiry into surgeon Ian Paterson will likely reveal similar lessons. Whistleblowers are vital to unearthing this corruption, but face institutions that have to be dragged through the four stages illustrated in microcosm above.

As the Lancet points out, this corruption harms health. Suppressing whistleblowers only emboldens corruption, meaning people suffer inferior care. It also fosters injustice because systemic inequity is similarly hidden.

There’s an unfortunate audacity to this. Managers can deny harms they know were avoidable, safe in the knowledge their political masters will instinctively pocket the evidence.