PPL blog: Moving beyond the culture of blame

PPL blog: Moving beyond the culture of blame
posted 01 September 2014

By Chaellene Davidson, Analyst Consultant, PPL

The culture of the NHS has been questioned over the last year in the midst of political debate and major system reform. As a consequence, NHS staff and managers have been deplored for fostering a culture of blame rather than accepting collective responsibility. Much of the recent debate has been focussed on those who work in and manage health services but what responsibility do we, as citizens, have to protect the NHS?

Culture can be described as something a group of people “have” or something a group of people inherently “are”, but using either definition, it is undoubtedly a public affair and public feeling around the NHS runs high. As the NHS is part of our heritage it is also indicative of our nation’s cultural priorities. Some could argue that the establishment and preservation of a tax-based public system underpins a cultural commitment to provide financial insurance against the potentially catastrophic costs of ill health - to citizens and to the economy as a whole. However, this alone is not a cause for self-congratulation. It is important that protecting the NHS doesn’t become a cover for ignoring blatant issues that affect the lives of patients and service users. Poor performance should never be tolerated but pride in the ethos of our NHS does not have to equate to an acceptance of sub-standard care.

There will never be a one-size-fits-all answer to addressing the challenges facing the NHS. The requirement to prioritise services, treatments and allocations in order to manage the twin pressures of growing demand and diminishing resources means that the totality of demand cannot be met.   Furthermore, priority-setting is subjective and dependent upon value-based judgements, so it is unlikely, if not impossible, that everyone would manage demand in the same way. The ethical dilemmas created mean that stakeholder engagement, transparency and evidence-based guidelines are critical tools for guiding policy-makers. 

Maybe a step towards creating a culture of collective responsibility is fostering a collective understanding of the issues facing the NHS and their root causes. Increasing the level of collaboration through innovative contracting approaches, service redesign or co-production with service users will not remove every challenge faced for every party involved. However, better collaboration can encourage system-wide communication and learning that changes the focus from challenges and barriers to opportunities and solutions.  

There is no ‘I’ in team, but it’s hard to ignore the ‘promise’ in compromise.