We’re told the NHS is under stress in terms of staffing and finance. But if you’re a patient or health worker facing the harmful effects, how do you think it’ll go if you voice your concerns to NHS management? For example, how will junior doctors resist unsafe but escalating demands to cover service gaps?
Sadly, the answer is the NHS can be oppressive toward those who criticise or question. Dr Chris Day is a junior doctor who has suffered harm after reporting safety concerns in an understaffed intensive care unit several years ago. He blew the whistle to NHS management. His case shows again how the law fails to protect the public and serves instead to shield corporate misfeaeance. The recent tribunal judgment in the Day case illustrates at least six points that are of relevance to any who use or work in the NHS.
First, when the NHS fails it often blames a lack of money and / or particular individuals. But when individuals, whether patient, health worker or relative dare to point the finger at the institution, there appears to be no limit to the money some managers will spend when seeking to deny and conceal failings. These efforts can include tactics redolent of corporate fraud, including the destruction (or creation) of material evidence.
Second, this type of institutional corruption has been defined by Baroness O’Loan (Chair of the Daniel Morgan Independent Panel) as the denial or concealment of failings to protect institutional reputation. From the Day judgment and others, it would appear that Employment Tribunals (ETs) can take a similar approach – protecting institutional reputation by denying or downplaying even the most damning evidence.
Third, the higher courts seem to prefer to see and hear no evil. ETs are still not routinely videoed or even audio-recorded. This means that an ET judge can claim black is white despite overwhelming and solid evidence to the contrary. By not overseeing and auditing such nonsense, the higher judicial authorities become complicit as another of the layers that enable institutional corruption.
Fourth, this corrupting approach is of a piece with the recent Partygate misconduct at the heart of the UK government. No matter how many may have perished, our leaders in Government or the NHS seem quite prepared to profit from denying the undeniable.
Fifth, little of this will be a surprise to peoples who have been on the receiving end of such institutional misconduct, whether historically and abroad, or here and now. Colonialism may even have honed our institutions’ ability to sweep past the suffering of the UK population. The list of those harmed grows and grows – despite inquiry after inquiry including the Bristol Inquiry, Hillsborough Independent Panel, Hyponatraemia Inquiry, Gosport Independent Panel, Grenfell Inquiry and Infected Blood Inquiry. Together, the reports form a bibliography of regret all too short on reform.
Sixth, health workers have lost confidence in the hundreds of millions spent annually on their supposed regulation. The General Medical Council (GMC) is tasked with seeing that doctors behave with probity. Yet the Gosport Independent Panel had to criticise the GMC for its lack of candour with families and even the inquiry. A recent piece in the British Medical Journal excoriated the GMC for failing patients and doctors for 30 years. Imagine how it is that we live in a country where a doctor can be sanctioned by the GMC for a minor misinterpretation, and yet we have police that feel safe enough to circulate pictures of the Grenfell fire disaster with the racist caption “The Great Muslim Bake-off”.
Modern abolition movements ask us to think about institutions that are beyond reform – and how we might make more livable lives without them. It may be that the management of the NHS has passed that tipping point. Sustained too long by perverse legal judgments, such snowy-white management is perhaps beyond reform.
Whether we work in or use the NHS, it’s as clear as Day that we need to marshall our creativity to imagine a more just future; one that has no need of the current feudal system of NHS leadership; or the absurd tribunals inflicted on NHS workers who protest. Until we develop that thinking alongside other abolition movements, the Day case gives real force to the cry “No justice, no safety!”