Apartheid and the NHS

What’s the link between South Africa’s shift from apartheid to democracy and cultural change in the NHS? The UK’s parliamentary and health service ombudsman, Rob Behrens, thinks the latter is not only essential, but is actually the easier of the two challenges.

How would he know? Well, in his recent BMJ interview, he compares his experience of being the highest level independent adjudicator for problems in our healthcare system with his earlier career challenge as a UK representative, supporting South Africa’s fundamental transformation.

Hard hitting observations

Behrens doesn’t hold back in sharing his thoughts on the problems facing the NHS. The sub-heading of the BMJ feature states: “A toxic culture of defensiveness and hostility pervades the NHS, and despite many patient safety reviews nothing has fundamentally changed.”

That should make everyone pause, sit up and take notice. Yet, the seemingly endless stream of reports which arise as the output of inquiries into major failures typically lead to dismay, shaking of heads and wringing of hands – but not to change.

Throughout the interview, Behrins goes well beyond the headline of failure to learn from previous problems. He casts the spotlight on hostility and tribalism among clinicians, along with defensiveness and failure to listen to patients and their families. “This leads to a perception that organisational reputation and professional reputation are more important than patient safety. And that is very dangerous.”

It’s important to note that he also to the high-stress impacts of the pandemic, workforce shortages and the further problems related to current industrial action. He observes how these considerable pressures have contributed to an embattled attitude of “bunker-ism”. “I understand that everyone has a massively busy job, that ministers, managers, and clinicians are doing the best that they can. But that doesn’t alter the fact that there are things that are fundamentally wrong that need to be tackled.”

It would be easy to let these comments add to the gloom around the state of our NHS.

The way forward

Thankfully, the ombudsman consistently returns to his theme, that the changes required are merely difficult – not impossible. But this requires attitudinal change with dedicated effort. He summarises the required shift in mindset as being “a disposition to learn rather than just to move on.” This paradigm shift has implications for both leadership and medical education.

“The key thing about leadership is empowering the people who work for you to do the things that need to be done. You can’t do it on your own. You can’t be a general without an army. You have to make sure that your people are with you…”

Medical education must go beyond simply teaching the natural sciences and technical procedures. It must also include the multi-faceted social-scientific aspects of being a doctor. How to have difficult conversations in a constructive manner. How to engage colleagues to recognise and accept shortcomings, whether that be of the system, the team or as individuals. How to plan and achieve real, sustainable change. These abilities are essential at all levels, from front-line junior doctors, through to senior management and to politicians.

Overall, Rob Behrens’ interview is a message of hope, encouragement – and challenge.

What steps are you taking to being part of the solution and the way forward for the NHS?

Stephen McGuire – Managing Director