OPINION: THE BIG QUESTION - What are the inherent barriers to transparency in the NHS? The Government has announced its intentions to introduce an ’early warning system’ in the NHS to try to prevent cases such as that of serial killer GP H



Commission for Health Improvement

’Historically there was a culture in the NHS that it wasn’t good for

people to know, that the public would only panic if they heard about

things that went wrong. The portrayal of health matters in drama and

news has also made doctors wary of communicating openly. Public demands

for openness and the increasing role of professional communicators in

the NHS are driving the service to be more transparent, but you don’t

change that sort of culture overnight. There is a problem in medicine

which doesn’t exist elsewhere, which is that it’s difficult for a

patient to know how good their treatment is. If an eye operation gives

you 80 per cent vision then how are you to know whether that is good or



Cohn and Wolfe

’The vast majority of professionals in the NHS deliver a very high

standard of care. However when clinical errors occur, the culture and

structure of the NHS can act as barriers to transparency. Professionals

may be reluctant to come forward because they fear litigation,

disciplinary action or the disapproval of their peers. Historically

there have been so many different mechanisms for reporting and

correcting errors, the Government has responded by introducing a raft of

initiatives. With these changes in policy and the health service, we

need to counsel our clients to minimise the potential issues and

maximise the opportunities these present.’


Greenlines Health Care

’It’s a swashbuckling profession and doctors have an engrained attitude

of their own supremacy and infallibility. Junior doctors won’t blow the

whistle because if they do then they risk their careers. The only way

the system will change is through litigation, I am absolutely convinced

about that. There is a colossal increase in litigation now and you have

lawyers specialising in clinical negligence. There is also a lot to be

said for more guidance coming out of the Royal Colleges. A doctor will

say: ’this is in my clinical judgement’ and no one else will argue. Even

when you talk to physicians who come in after a doctor has made a mess

of it, there will never be any criticism of previous surgeons. Doctors

have clinical freedom, there is no challenge to that and doctors will

always say that every patient is different.’


Glaxo Wellcome

’There is something of a myth about the infallibility of doctors, which

is something we as patients also want to believe in. You cannot fix a

problem until you admit that the problem exists. In the NHS, any

admission of mistake gets pored over, put under the public spotlight and

has to be defended by a minister on the Today programme. Patients are

becoming more informed and assertive. We can get advice over the

internet now and, instead of accepting what the doctor says without

question, many people are now discussing matters with their doctors on

an equal footing. People are also picking up on issues such as the

rationing of prescriptions according to postcode and are looking at what

treatments are made available in other European countries.’

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