Accountability and responsibility in the NHS (or any complex organisation)

Accountability and responsibility in the NHS (or any complex organisation) 

One repetitive meme of the Cure campaign and those affiliated to it (often the British equivalent of the US Tea Party who believe all public services are wasteful, incompetent and self-serving) is the notion that there is no accountability in the NHS. This necessitates the creation of new criminal offences because as Will Powell put it:

We need laws in the NHS that would deter neglect. It's because there is no accountability that some healthcare professionals are less caring.

Others state that the lack of sweeping sanctions and sackings "from ward to board to Whitehall" (to quote Deb Hazeldine) is down to a conspiracy to defeat justice by deflecting blame from any one individual.

All this would be very worrying if it were true, but thankfully it is not. The NHS like any complex organization has systems in place to avoid the entire responsibility resting on one person's shoulders except where absolutely necessary. The same is true for an airline, another complex organization where safety is critical but delivered by a number of people. The reason for this is that the inevitable human failure should not result in catastrophe - the system should involve sufficient checks that one person's error is picked up by somebody else. No conspiracy, just good risk management. More than one person checks which leg is to be amputated. Good practice, not an attempt to deflect blame.

So rare circumstances apart, like the transgressions of Beverley Allitt and Harold Shipman, when something goes wrong more than one person has failed. When a blood transfusion is given to the wrong patient, more than one person must have failed. Indeed Cure are implicitly acknowledging this with their call "from ward to Whitehall". How they reconcile these contradictions is frankly quite baffling.

They have been part of a smear campaign against Andy Burnham, even though he instigated an inquiry into Mid Staffs within a month of becoming Secretary of State for Health. The notion that the Minister for Health must fall on his sword if there are any failings in any hospital under his watch is utterly ridiculous, given the nature of healthcare in a structure like the NHS.

There are plenty of mechanisms for accountability in the NHS. Naturally, there is due process to consider. The existence of crime does not mean there is no accountability for criminals. The acquittal of some accused of crime does not mean that there is no accountability. The continued perpetration of crime doesn't necessarily mean that punishments aren't sufficiently draconian, unless you hold up states like Saudi Arabia as models of criminal justice.

So despite the continued protestations of Cure, accountability in their usage does mean "blame", and more than that "punishment". Retribution rather than correction. Looking backward rather than looking forward.