Honesty is the best policy in management

Whenever I have been responsible for managing a government department or a company, I have wanted my staff to be honest. All the best organisations are transparent, reporting accurate and relevant information in a timely way. They pour over cases where quality falls short or harm is done, both to compensate the customer or client and to make sure such an error cannot occur again. Remedy begins with honest reporting of the incident. Management does not normally penalise the employee who reports the mistake, but works with them to put it right. It is a bigger offence to suppress the error or seek to cover up the damage, than to make the mistake in the first place.

We see how well honesty and transparency can work by looking at good airlines. An airline knows having a 100% safe flying record is crucial to the health of the business and to the wellbeing of the passengers. Pilots and flight crew are required to report near misses, flight errors, and malfunctions in the aircraft. Each one is investigated thoroughly. Where the error could repeat a generic remedy is inserted in the manuals or programmed into the aircraft systems where this can work.

It is good news to see that Jeremy Hunt, the Secretary of State for Health, is seeking to bring this culture of good management into the NHS. The NHS has great power to do good, but it can also do harm. Serious conditions can be missed by sloppy diagnosis. Individuals can be harmed or even killed by giving them the wrong drugs or the wrong quantities of drugs. Operations can miscarry, leaving a person in pain and difficulty. Recent enquiries have shown examples of very bad care and treatment which are now coming to light.

Mr Hunt is right to carry a torch for greater transparency and honesty. He is right to demand that all medical and surgical errors are reported and properly considered. He is right to demand high standards of cleanliness, infection control and quality through our hospitals and surgeries.

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87 Comments

  1. Richard1
    Posted February 12, 2015 at 5:53 am | Permalink

    Indeed he is right. It is extraordinary that Labour if they win the election propose that Andy Burnham, the minister responsible for the NHS she the mid staffs scandal and tradegy, should be reappointed to that post. It is unthinkable that in the private sector someone who had failed so badly in his responsibilities would just be able to walk back into a job like that. There needs to be much more accountability for abject failure in the public sector and in politics.

    The delay in the Chilcott is (a very bad) joke in this regard.

    • Mark B
      Posted February 12, 2015 at 1:55 pm | Permalink

      Believe me, many people who fail in the Private Sector get re-employed, and usually on better terms and conditions. Some even get to have their business bailed out by the Taxpayer, and end up living a happy and quite life.

      • Hope
        Posted February 12, 2015 at 5:53 pm | Permalink

        Guido highlights the “deed of variation” (used by the Miliband family ed)…… Worth a read to assess the man’s calibre in what he believes and how he talks about others.

        All this guff is only relevant to the politicos. When will they learn what is relevant to us, the people, and how they waste our hard earned taxes ie EU and overseas aid. How does Cameron come up with the idea that it is right to spend 1.7 percent of GDP on our security while he creates wars and spends 0.7 percent on overseas aid- when the last report on the topic clearly demonstrated that most of overseas aid is wasted, the EU get to spend a sixth of it without any say from the UK citizens who earned it or politicians who give it away! Is this what PPE courses at Oxbridge teaches its pupils?

  2. Lifelogic
    Posted February 12, 2015 at 6:01 am | Permalink

    Indeed full open reporting of incidents is vital to prevent recurrence airline style. In fact we get endless cover ups, lies to the relatives and attempts to avoid legal claims.

    Personally I would make patients agree to standard low levels of no blame compensation and take insurance if they wanted more cover most just want the truth not money. That way they could be more open and save all the jobs of the people who spend their time trying to settle litigation actions. It would often save years of stress for those affected too. Also putting lots of lawyers out of work which is nearly always a good thing for everyone else and productivity.

    • Jerry
      Posted February 12, 2015 at 2:43 pm | Permalink

      @LL; “Personally I would make patients agree to standard low levels of no blame compensation and take insurance if they wanted more cover most just want the truth not money.”

      Lifelogic, you are quite right to point out the problems that arise from the imported compensation culture, but I suspect that most people who make compensation claims and the like already know the facts…

      What I would do is somehow create a claims system that doesn’t involve the legal profession, or at least bans those so called ‘No win, no fees’ claim schemes that are all but designed to encourage the weakest of claims that simply get paid out by the legal departments or insures of those being claimed off, as fighting the claim could end up costing far more in the way of non recoverable costs.

    • Bazman
      Posted February 12, 2015 at 7:07 pm | Permalink

      Would that include employers such all companies or just airline crashes and medical claims?

    • Bazman
      Posted February 12, 2015 at 7:47 pm | Permalink

      The patient is to pay for their own insurance against bad practice? LOL!
      Will this apply to you insuring a tradesman against burning down one of your properties?

      • Lifelogic
        Posted February 12, 2015 at 10:46 pm | Permalink

        Indeed if they want to use the NHS (free at the point of use) they should have to accept these terms. If not they can go privately or insure themselves.

        • Jerry
          Posted February 13, 2015 at 9:49 am | Permalink

          @LL; But the NHS is not free, it’s paid for via the tax system, so those who use it have paid in the same way as those who go privately or use medical insurance and very few of the latter ever pay the true costs of their treatment, just as those using the NHS don’t.

        • Bazman
          Posted February 13, 2015 at 4:53 pm | Permalink

          The customer or patient has to pay for their for their own insurance against shoddy or dangerous work instead of the person carrying out the work? Are you deluded or just stupid what incentive is their for the work carried out to be correct? Nothing exists like this in any other business or industry and for good reason.

  3. Lifelogic
    Posted February 12, 2015 at 6:27 am | Permalink

    There is of course far more wrong with the virtual monopoly NHS than just this however. The free at the point of use system prevents nearly all fair competition from setting up. Rationing is done by delays and inconvenience which are designed into the system intentionally to deter customers.

    Quack (treatments that can clearly be shown not to work or even have a sensible mechanism to work) and vanity medicine is provided at public expense supported by unscientific Prince Charles types and indeed many MPs or lobby groups. The NHS is largely run, not for the benefit of patients, but for the benefit and convenience of the senior staff. The best illustration of this is the excess deaths at weekends – the NHS clearly things these death are acceptable so that they do not have to put the correct staff on at weekends. I cannot imaging many would accept more planes crashing due to lack of weekend staff. Yet the NHS kill clearly several people every weekend in this way.

    If the NHS is so good as the BBC & lefty loons keep telling us then why do we not introduce a system of “free at the point of use” food, cars, clothes and houses rationed by endless delays and other tricks just like the NHS.

    Perhaps Miliband will do, he is after all daft enough to try.

    But then the Coalition are still wasting tax payers money on endless & entirely pointless quack treatments after 4+ years.

  4. Mark B
    Posted February 12, 2015 at 6:40 am | Permalink

    Good morning.

    I am afraid, despite Mr. Hunt MP attempts, he will fail. Not only is it too little too late, but he is trying to tackle a problem from the wrong end.

    We now live in a ‘injury claims culture.’ Where just about every other advert, in between all those begging ones , ask people to get in touch if they have been injured. These Ambulance Chasers’, pardon the pun, need to be stopped.

    Why ? Because the problem is management. They put pressure on staff because no one wants to get sued or drop down in rating polls and lose personal income and career advancement.

    I have witnessed many cases in hospitals of bad nursing. And I personally have many stories to tell that will both shock and appall some readers. I will of course not recount them here, but the issues surrounding our healthcare system is more akin to that of something more sinister that you would find between 1939 and 1945.

    People, especially the old, are really frightened now of going into hospital. And from many of the things I have seen and experienced, I can well understand why.

    • waramess
      Posted February 12, 2015 at 4:48 pm | Permalink

      I thought that Hunt had sorted this problem ages ago when he announced that the NHS would no longer have whistle blowing gates written into severance contracts.

      Maybe this is just an anouncement designed to make the Torys look good before the election.

      One way or another I think you are completely right, Hunt has absolutely no chance of delivering

  5. Mondeo Man
    Posted February 12, 2015 at 7:18 am | Permalink

    It depends on what job you have.

    Errors are common. In some jobs one can back-space and re-type, use the rubber on the end of the pencil… why are Tippex doing so well ?

    In other jobs the error cannot be recovered. This is not to say that the error should not be reported but that the workers will seem to make more errors than those who can use a rubber to put things right and who are under no obligation to report.

    Two or three minor errors in a safety critical job will get a person suspended, reviewed and quite possibly sacked.

    This is why people in such jobs might wish to keep quiet about things.

    This is how it used to work – things sorted out at ground level by the Sergeant Majors and Matrons who really did used to run the country (and I don’t recall dirty hospitals then.) Discerning enough to report real failings when they mattered – not every piffling thing which is the culture now.

    I’m not talking about the NHS here but in my own field there is now an atmosphere of distrust between colleagues. Even colleagues who fail to report a colleague who made a mistake are getting sacked.

    So now we spend much of our time writing reports and the managers are snowed under investigating trivia instead of dealing with productive work.

    Like it or not police constables, sergeants, nurses, car mechanics have to be trusted to know what they’re doing and treated like adults – much tougher now that diversity targets have lowered entry standards.

    The stifling top-down political micro-management is one of the things annoying people – especially from a class not known for competence itself.

  6. Bazman
    Posted February 12, 2015 at 7:45 am | Permalink

    For many organisations transparency is not what they are about energy companies being a good example. If we saw how they make their money and their tariffs where easily understandable they would be in trouble.
    Many pay lip service to health & safety penalising anyone who speaks the truth about the reality of their practices.
    The death/injury rates and diseases caused by work related activities have not fell by employers good will alone and if you want to argue they have lielogic we have covered this one before without your reply as per usual.

    • Mark
      Posted February 12, 2015 at 7:46 pm | Permalink

      If there were more transparency with energy companies then government energy policy would be in trouble. That’s why the last government legislated to require OFGEM to obfuscate.

    • Mondeo Man
      Posted February 12, 2015 at 11:19 pm | Permalink

      Bazman – Of course. Profit is made in the grey areas.

      So everything is made grey.

  7. oldtimer
    Posted February 12, 2015 at 7:56 am | Permalink

    You are right, Do it. Test it. Fix it. These six words sum up a sound basis for any activity. The problem for those in charge of large, complex organisations, such as the NHS or a big business, or a complex product, such as a Rolls Royce jet engine comprising some 33,000 parts, or a large system, is in identifying the real cause of any perceived problem. If that is not achieved then the “solution” will turn out to be no “solution” at all.

    • Mondeo Man
      Posted February 12, 2015 at 11:21 pm | Permalink

      Old Timer

      Complexity suits government.

      Simple solutions (to them at least) equals redundancy.

  8. Bernard from Bucks
    Posted February 12, 2015 at 7:59 am | Permalink

    Honesty is the best policy, however everywhere in society today we encounter the opposite.
    Not your ‘good old fashioned’ dishonesty, but a more subtle strain.
    We encounter politicians being ‘economical with the truth’ as with the last forty years of our membership of the EU. We now have government departments hiding information with the all-common excuse of ‘security. We are seeing more ‘secret courts in the country and of course there is always the mighty BBC avoiding the truth by bias and omission.
    True honesty is now sadly a thing of the past … honest.

  9. Ian wragg
    Posted February 12, 2015 at 8:16 am | Permalink

    Chilcott report? CMD must rate as one of the most dishonest people on this earth. He generally is diametrically wrong on most topics but pursues his agenda regardless.
    ” we are paying down the deficit” “we are reducing debt”. ” re Lisbon Treaty, I will not let things rest there.
    It is easy to see why politicians are despised.
    Immigration down to 10’s of thousands when he knows he has no control
    Pathetic

    .

  10. lifelogic
    Posted February 12, 2015 at 8:23 am | Permalink

    One of the main problems,of running businesses (apart from government that is) is that the staff rarely tell the boss the truth, just what they think he wants to hear.

    • Jerry
      Posted February 12, 2015 at 3:07 pm | Permalink

      @Lifelogic; “staff rarely tell the boss the truth, just what they think he wants to hear.”

      Indeed but that is so often a failing of the Boss, not the staff…

    • Mondeo Man
      Posted February 12, 2015 at 11:30 pm | Permalink

      And that is how the world goes around, Lifelogic.

      David Cameron is telling us what he thinks we want to hear.

      Except reality is different. Dung rolls down hill. So people at the bottom get to smell it and to eat it.

      I hope the people don’t buy this “the economy is doing really well” baloney because our kids have NO CHANCE.

      It really is time to stop voting to keep people out rather than what they really want in.

      AAAAAAAAARGH !!!!

      • DaveM
        Posted February 13, 2015 at 7:39 am | Permalink

        “Dung rolls down hill. So people at the bottom get to smell it and to eat it.”

        This is the problem though – in my world, increasingly it rolls UPhill.

        God forbid the union-protected “ordinary worker” should make a human error. It’s always the management’s fault these days, for under-training, issuing the wrong equipment, and so on.

        So the managemnet becomes so paranoid that it creates a stifling number of forms to fill in, procedures to follow, training courses, etc etc, that no-one actually gets any work done.

        • DaveM
          Posted February 13, 2015 at 7:39 am | Permalink

          Pardon my spelling.

        • Jerry
          Posted February 14, 2015 at 8:04 am | Permalink

          @DaveM; “God forbid the union-protected “ordinary worker” should make a human error. It’s always the management’s fault these days, for under-training, issuing the wrong equipment, and so on.”

          Well yes, but that is not so much a problem of union protection but the now over zealous, over powerful H&SE, caused by the anti-union pendulum swinging to far, when once a problem would have been found between union and management (and yes that might have meant a work-to-rule or strike) what happens now is the H&SE inspect (before or a after an accident) and if the management have not complied with the letter of the often over zealous H&SE regs all hell breaks out, a fine at least, the company -or part of- closed down until full compliance, perhaps even management and/or (unionised) staff being prosecuted.

  11. alan jutson
    Posted February 12, 2015 at 8:23 am | Permalink

    Honesty is the best policy, unless the management is unfit for purpose, enough said.

  12. Old Albion
    Posted February 12, 2015 at 8:26 am | Permalink

    To which NHS does Mr Hunt refer ?

    • Mark
      Posted February 12, 2015 at 7:49 pm | Permalink

      I don’t think that there is much difference on this point whichever country of the United Kingdom you consider.

  13. Jerry
    Posted February 12, 2015 at 8:35 am | Permalink

    Can’t argue with a single word you say John, nor what Jeremy Hunt said, the only comment seems to be that many a party political MP/PPC must feel so frustrated at times, if only political parties had the same “best policy management”…

  14. Bert Young
    Posted February 12, 2015 at 9:15 am | Permalink

    Success in any organisation depends on the effectiveness of its supervision – from the top to the bottom . The reporting lines must be clear and quick ; those making decisions must have appropriate experience and the trust of others above and below them . Large organisations are normally unwieldy often with blurred reporting lines ; when broken up into specialised groups their efficiency improves and , with this , its morale . The NHS – the largest employer in Europe has long suffered from over-size and the importation of individuals at Board level without relevant experience ; it has equally suffered from political interference .

    The management of the health industry effects everyone ; it cannot continue as it is presently organised . Tinkering around the edges is no solution it must be tackled objectively and from the top down .

  15. JimS
    Posted February 12, 2015 at 9:31 am | Permalink

    Oh that this attitude was more common.

    I recall a Common’s select committee being told by a defence contractor that there was a ‘climate of fear’ in the MOD, this after the Chief of Defence Procurement was told by his ‘senior’ staff that a major project that had been ‘on time’ last quarter would now be two years late! Despite CDP’s public anger at being duped the organisation automatically ‘repaired’ the damage by reporting that there was no ‘climate of fear’ because staff surveys consistently showed that everyone was happy.

    Cover-ups go all the way to the top. Why exactly did we have to give away our national sovereignty? Why exactly was it necessary to substantially change the demographic of this country? Why exactly was it necessary to import Islam when it has done no good anywhere else in the world? Will we ever be told or just when it is too late?

    • Jerry
      Posted February 12, 2015 at 3:14 pm | Permalink

      @JimS; Indeed Jim, more to the point, why did we have to import any religion, why did we have to export our culture (never mind our imported religion) and thus change other countries demographics? You might like to ponder on those questions too…

      • Mike Stallard
        Posted February 13, 2015 at 2:08 am | Permalink

        Slick, but think on this: where do most of our immigrants come from if not the dear old British Commonwealth? We must have done something right. I do not see many Eastern Europeans praising Communism. I do not see many Asians praising the Japanese Co-Prosperity Sphere. And as for the last German Empire…
        Cricket anyone?

  16. margaret brandreth-j
    Posted February 12, 2015 at 9:47 am | Permalink

    You are 100% right when you talk about honesty John.Truth telling is the most important factor when peoples lives are at stake. Central to this is reading in between the lines. In the NHS we are bound to document almost everything, yet this cannot happen at all times in the middle of abusy schedule or a crisis ( which there are many). What is said can also be different from what is written down and upon investigation the one who edits information , changing context slightly gain and again in an organised fashion can present this as evidence , which is far from the truth.
    There is also perception of what is said and with the multitude of overseas input , the nuances of language may infer one thing when another is meant. This has always been , but is more problematic than ever before. Many years of being truthful myself and to myself have taught me that the ones who get away with lies survive with large salaries and pensions. Can we change people from the inside?
    We have another problem;medicine management . Every personal is an individual and it takes experienceto know when a person needs help When I was a student we were always taught to treat the patient and not the laboratory results. Now Clinical Comissioning groups tend to treat the lab results and are scared of acting outside protocols to investigate problems. A modern way is to look at computer like symptoms and if they do not fit into little boxes then they are not treated.We are de humanising people and making management thinkthat they know all about medicine as they have a few written down signs and symptoms.

    • margaret brandreth-j
      Posted February 12, 2015 at 4:12 pm | Permalink

      I hope that this piece is not too incoherent. It was written with too much emotion to be crystal clear.

      • Jerry
        Posted February 12, 2015 at 4:49 pm | Permalink

        Margaret, no problems, you made very coherent points and were crystal clear because your heart felt emotions came over – it was clearly no “rant”.

  17. Brian Tomkinson
    Posted February 12, 2015 at 9:59 am | Permalink

    JR: “Honesty is the best policy in management”
    How about in politics?

    • DaveM
      Posted February 12, 2015 at 12:54 pm | Permalink

      Ha ha. Touche.

  18. william
    Posted February 12, 2015 at 10:09 am | Permalink

    Yesterday, I came out of Southampton General hospital after my third procedure on tumours on my liver, after a diabolical overnight stay in a geriatric ward. Six hours to get painkillers, no tranquillisers. Yesterday morning, it took 5 hours before finally they took a blood test. Then, another hour wait for an unnecessary 2 page inpatient report. Nobody was in charge, there were nurses everywhere, but NOT ‘your nurse’, young doctors chatting to each other, as if they were at a party, not to mention an army of cleaners etc. doing very little. A floor manager,was there none.Any private company that treated its clients like this would be out of business.

    • Jerry
      Posted February 12, 2015 at 1:32 pm | Permalink

      @william; “A floor manager,was there none.”

      Well yes, many have been calling for a return to the old style NHS, with a Matron and deputies on every ward, what we always get though is another swath of middle management that seem welded to their desk or clipboard.

      “Any private [health] company that treated its clients like this would be out of business.”

      Indeed but no private company would have an open door policy to any and all who need medical treatment, and many would never choose to run an A&E department – also each and everyone would likely have pay a lot more than they pay via the tax system, almost certainly if one has any pre-existing conditions.

      No one is saying that the NHS is perfect, but nor are the private health companies.

      • william
        Posted February 12, 2015 at 4:10 pm | Permalink

        @Jerry. Indeed, but private sector management systems, which put the customer first, not the staff, would make a better fist of A&E and running hospitals in general. The ‘Blob’ in education, as attacked by Michael Gove, is perfectly replicated in the NHS, which is apparently a religion like Scientology, based on a myth dreamt up in 1947 whereby healthcare is ‘free’ and best supplied by a monopolist. With proper lean ,efficient management in place, not from the existing bods, clearly, I reckon there is 5-10 percent to be saved. Why has there been no productivity growth in the NHS over the last 15 years?

        • Jerry
          Posted February 12, 2015 at 8:34 pm | Permalink

          @william; “but private sector management systems, which put the customer first, not the staff, would make a better fist of A&E and running hospitals in general.”

          But there has been a sort of private sector management in the NHS for the last good few years, isn’t that what the “internal market” was all about, bring in what was claimed to be best private sector management practices. Also, just who would decide which ‘customer’ to put first, someone complaining that they are on the wrong ward or the someone fighting to save the use some part of a part of their body or even their life.

          I would suggest that many of the same problems would still occur and would the ‘customer’ really have more of an ability to complain and get a resolution – unless of course the ‘customers’ care was also funded by the private sector but then to complain then might risk being able to obtain adequate health insurance if you are judged a poor risk!

          “a myth dreamt up in 1947 whereby healthcare is ‘free’ and best supplied by a monopolist.”

          Actually a “myth” dreamt up during the darkest days of WW2 by all parties. Oh and some health insurance policies can be rather monopolist too, not just were you would get treated but also who might get treated.

          “Why has there been no productivity growth in the NHS over the last 15 years”

          Probably because the NHS has been a political football for those number of years and more, subjected to too many top-down reorganisations etc, not because the NHS as part of the public sector is unmanageable or monopolist.

  19. Bill
    Posted February 12, 2015 at 10:22 am | Permalink

    It is surely the fear of litigation which hinders openness. Doctors and nurses do not want to be held accountable to angry and bereaved relatives, nor do they want ambulance-chasing lawyers making their lives a misery. In my view, the system which placed a moral obligation on doctors through their Hippocratic Oath had many merits. My father was a doctor and as a child I well remember the symbol of the Oath on various documents and objects. The Oath was taken seriously as far as I can see. In the end, you must be able to trust your doctor and cannot rely on complicated managerial and compliance procedures to guarantee your safety.

    All this leads me to agree that Jeremy Hunt is moving us in the right direction but let’s also ask that the medical profession renews its commitment to act always in the best interest of patients. And this, of course, raises issues of abortion and assisted suicide…

  20. English Pensioner
    Posted February 12, 2015 at 10:25 am | Permalink

    I have a friend who was a Ward Sister in a hospital until she retired some 15 or more years ago. She recently had to go into the same hospital for a hip operation and was appalled at the sloppy attitude of the nurses and lack of cleanliness on the ward. She kept some notes and when she was discharged, wrote a letter to the Chief Executive of the Trust pointing out what she considered to be serious shortcomings which would not have been tolerated in her days. Things like failure of nurses to wash their hands after dressing her wound, lack of cleanliness in the ward with poor cleaning standards, poor control of the medicines/drugs resulting in her being offered the wrong drug on one occasion. I think she listed about a dozen items and how they would have been dealt with in her days.
    She got a reply from an underling saying, in effect, that they don’t do things like that these days. So, in parts of the modern NHS, hygiene, cleanliness and drug control are no longer important, no doubt leading to a rise in hospital acquired infections and drug errors. I hope the Minister succeeds in his campaign as action is definitely needed in some hospitals.
    Clearly all hospitals are not the same; I recently had my cataracts removed at Stoke Mandeville Hospital and was very impressed by that part of the hospital and the care taken by the staff, etc ed

  21. mickc
    Posted February 12, 2015 at 10:29 am | Permalink

    You have been around long enough to know that any association with a mistake of any kind means career death for lower ranking employees.

    This is particularly the case in our “blame culture” society where people are looking for free money, sorry, compensation, and being a “victim” can be profitable business, both for the “victim” and the litigation industry.

    There is no hope at all that there will be an open culture in any large organisation, particularly one in the public sector.

    To expect otherwise demonstrates cynicism, or naivety; I leave it to others to decide which is displayed by Mr. Hunt.

    • alan jutson
      Posted February 12, 2015 at 12:52 pm | Permalink

      mickc

      Ah Yes, the compensation culture.

      Just had a phone call asking me to confirm I had a car accident 3 years ago.

      I asked where they got that information, was told road traffic accident information.

      They asked me to confirm what car I was driving, I answered I have two, you tell me which one.

      They asked, was I the only driver at this address, answered does that matter, you have said it was me.

      They asked three more times for all sorts of info, to which I replied it should be on your record, if what you say is correct.

      They finally gave up and said they would take me off of their list, I said that would be a good idea, as I am listed under the Telephone service to stop nuisance calls, and they were breaking the law.

      Thought I would string them along and waste some of their time, I am retired I have all the time in the World.

      But clearly they do it, because it pays financially to both sides, against the Insurance Companies.

      Just a scam of course, no accident at all.

      • mickc
        Posted February 12, 2015 at 2:30 pm | Permalink

        Regrettably, the insurance companies are the prime movers in this trade.

        They sell claims to solicitors, the car repair to the garages, the medical inspection to the doctors…….and increase the premiums to the drivers!

        And, of course, car insurance is compulsory, so a nice little scam all round, but the consumer suffers!

  22. BeeCee
    Posted February 12, 2015 at 10:51 am | Permalink

    Honesty may be the best policy but unfortunately it does not seem to have found its way into the world of politics.

  23. Bernard Otway
    Posted February 12, 2015 at 11:03 am | Permalink

    Here is what happened to me from the NHS
    In 2009 one day I hurt my arm badly and went to my GP,he looked at my arm and then took my blood pressure which was 229/179 ,I was given a prescription for the arm and of course
    blood pressure pills,my South African doctor friend in the Uk when I told him this story said
    with a reading of that high the doctor should have called an ambulance immediately and he was astounded.the next mistake I found out was in 2012 I went to my dentist who referred me urgently to the university dental school in Croydon because I had bad dental hygene problems,a form had to be filled in by me with my medical history the lady teaching dentist who saw me took one look at my form and said THIS is your big problem
    which was that I had been taking Amlodipine which can cause gums to grow and teeth to loosen badly which mine had AND that once this had started after 3 months it is irreversible,she said it was common knowledge and doctors were all advised to counsel
    patients about this to watch out for it,and stop taking it and have an alternative prescribed
    up to the age of 64 I had all my teeth on 7/01/2015 I had my last 9 teeth extracted and believe me I hardly needed injections as they were very loose,and I now have dentures
    which I am finding difficult to get used to I shall turn 70 in 5 months time .That GP has lost me my teeth,to me this means that I now dont trust the NHS nor BIG PHARMA
    as they have known about this a long time.

    • Margaret Brandreth-J
      Posted February 12, 2015 at 7:39 pm | Permalink

      NICE GUIDELINES recommend Calcium channel blockers of which group Amlodipine belongs to after 50 years of age and at an earlier age Angiotensin converting enzyme inhibitors.These can be interchanged and there are a few alternatives, however all have side effects and it must have been a case of priorities and co morbidities. When a blood pressure is so high usually Nimodipine is the drug of choice, yet all will suffice. Obviously this Dr acted quickly to save your life yet I would have preferred it to be monitored under secondary care.

      • Iain Gill
        Posted February 12, 2015 at 11:21 pm | Permalink

        Yes treatment of high blood pressure in the NHS is random, haphazard and massively different in different parts of the country, and amongst different GP’s.
        In one part of the country a GP accidentally coming across a very high blood pressure will admit to hospital, for immediate investigation, cardiologist opinion, most appropriate intervention, and so on. The fashion and peer pressure amongst GP’s in these locations would make any GP not doing this feel a lot of pressure to fix their ways.
        The exact same symptoms at the other side of England are pretty much ignored by the NHS, not only do the GP’s pay no attention there is nowhere for them to refer for same day hospital investigation even if they wanted to. Collectively the NHS has decided not to bother with the active approach in these places.
        Some parts of the country with this history, once on medication you will be called in regularly for monitoring, in other parts of the country you can go years on medication with no interaction with your GP or NHS.
        Best practise in the rest of the developed world is for people with these kinds of problems to be directly under the care of a cardiologist, and the way the UK allows GP’s to run these patients with no consultant review clearly fails. It’s an attempt at care on the cheap which doesn’t even deliver cheaper care, and the quality of outcome is rubbish.
        Handing more power to GP’s is just reinforcing regional fashions amongst GP’s in these things, decisions based on next to no science. Real buying power needs handing over to patients where it belongs.
        Many of my friends have had to go private just to get the appropriate medication prescribed, the average NHS GP practise only has one 24 blood pressure monitoring machine with a long waiting list to use it, and repeatedly cancel appointments to use them.
        The NHS for me doesn’t deliver the basics on healthcare, it is a complete and utter waster of my taxes. It has let many of my best friends die far too early, and I would be dead already if I’d not been switched on enough to spot what was going on and gone private at great expense out of taxed income at key points.

        • Iain Gill
          Posted February 12, 2015 at 11:24 pm | Permalink

          “one 24 blood pressure monitoring machine” should say “one 24 hour blood pressure monitoring machine”

  24. Roy Grainger
    Posted February 12, 2015 at 11:08 am | Permalink

    The price for such transparent honesty in the NHS will of course be a large increase in ambulance chasing lawyers pursuing compensation claims.

  25. bigneil
    Posted February 12, 2015 at 11:43 am | Permalink

    “Honesty is the best policy in management” – -pity it doesn’t apply to the PM – He will forever be known as a liar. Cutting immigration to tens of thousands – EU referendum – NOT paying EU demands for money – Cutting “aid” to India. He is so untrustworthy I no longer believe his name is David Cameron. More like Satan.

  26. Timaction
    Posted February 12, 2015 at 11:44 am | Permalink

    Is it also true that Mr Hunt has changed the definition of a major incident in A&E’s to ensure we don’t have so many reported through sheer numbers by the press in the lead up to the election?
    Mass migration has consequences on all our public services not discussed by the legacy parties. Housing, education, health all reaching critical levels! So much for honesty.

  27. Kenneth R Moore
    Posted February 12, 2015 at 12:15 pm | Permalink

    It’s largely just another pile of steaming nonsense from the tweedledee legacy party or the Conservatives. We have seen this kind of back to basics guff before and nothing ever ever substantially changes. It’s just Jeremy Hunt making a noise.

    Just another minister throwing the poor voters a little scrap of common sense just before an election..only to have it cruelly taken away when the saps realise they have been duped (again).

    A bit like Nicky Morgan saying she is going to bring back the three R’s and learning tables by repetition. I seem to remember Gillian Shepherd saying the same things over 20 years ago!.

  28. Kenneth R Moore
    Posted February 12, 2015 at 12:32 pm | Permalink

    It would be more honest if Conservative mp’s would stop shoe horning the phony phrase ‘long term economic plan’ into every sentence (as they have been instructed to do so by the whips office). I don’t believe that Dr Redwood has been able to bring himself to utter this dishonest phrase which must be to his great credit.

    There is no plan other than to build the economy on borrowing by creation of a pyramid scheme and try to bury the disastrous news about the dire state of our current account deficit.

  29. rick hamilton
    Posted February 12, 2015 at 12:46 pm | Permalink

    At least Jeremy Hunt has actually started his own business and made a success of it, so he might have some inkling of what is needed. He has also lived in Japan and therefore knows what good service is, in a country where ‘the customer is king’.

    In my experience of the Japanese health service there is great efficiency with state of the art technology and every hospital treats patients as valued customers instead of nuisances to be patronised. Quite simply they recognise who is the source of their income. Their NHS covers the majority of the cost but patients pay a contribution which is capped for chronic or life threatening conditions, and becomes very small for low income or elderly patients. This focuses peoples’ minds on what health care actually costs and makes them more attentive to their own health and fitness. They can also choose whichever hospital or clinic they wish according to location, reputation and specialisation.

    As a matter of principle, having the government provide an essential service ‘free of charge at the point of delivery” sounds like a guaranteed recipe for waste and inefficiency. Which is probably why no other country I can think of has copied it.

  30. CHRISTOPHER HOUSTON
    Posted February 12, 2015 at 2:08 pm | Permalink

    I may eventually stand corrected. But I believe Labour, Conservative, LibDem Local Authorities and some of their parts including NHS have in the past successfully negotiated legal gagging clauses in regard to customers who have claimed compensation. But perhaps and only perhaps worst of all, secret deals involving considerable amounts of money with wrongly suspended or dismissed medical staff have been reached.

    The point is not whether Whistleblowers will have increased protection in the NHS but why they should need it in the first place. Who are these people who dare to threaten,harass, and fraudulently dismiss British people doing their duty? What laws allow them to get away with it? How many of them are serving a prison sentence?

    A good start to custodial sentencing could be an investigation into the times of Ex-PM Brown when hospitals were encouraged to lessen their waiting lists for certain operations.
    The upshot of this, I heard via the grapevine, repeatedly, was that when major operations were scheduled which might last many hours involving a proportionately high numbers of staff, that instead, an “investigative operation” was mounted lasting a short time, the patient then being “sown up”, with the rest of the operation taking place even months later. The “sown up” detail was very important not least in clinical terms but importantly it took that operation off the waiting-list ( as if it had been completed in full ) but did not add to any other “waiting list” as it was “in progress”.
    If the aforementioned has indeed been done ( in many instances and in several ..locations ) then all concerned other than the victims should be jailed forthwith. In jail, they should not be gagged.. as this would be an unusual punishment. Indeed, the authorities may be able to negotiate with them, as is reportedly done with other people serving time, to whistleblow other criminal acts of other staff for say a review of their own sentencing.
    One cannot get to the essence of a problem in a massively bureaucratic and enormous organization like the NHS where SOME salaries involve a not inconsiderable amount of money which also has a local political input, with a feather-duster. it requires deep-cleansing at every level.

    Reply Very generalised allegations or suppositions are not fair. Of course the conduct you describe would be unacceptable, but did it happen anywhere? That is why Mr Hunt is demanding more transparency and support for those who inform about bad practice.

    • CHRISTOPHER HOUSTON
      Posted February 12, 2015 at 5:40 pm | Permalink

      I take your point. It is also not fair “support” by the government can only mean the whistleblower may retain his job in the short term and certainly cannot ensure future normal career progression . Workplaces are states within a state and that is a major problem in itself.
      So, perhaps a very large sum of money say 15 years of a doctor’s salary or more can be the REWARD ( sometimes offered by national newspapers when searching for persons who have committed horrendous crimes ) to any NHS staff member who provides detailed information leading to the conviction of wrong-doers.

  31. CHRISTOPHER HOUSTON
    Posted February 12, 2015 at 2:25 pm | Permalink

    Correction “Sewn up ” not “sown up”. Propagation must have been on my mind

  32. The PrangWizard
    Posted February 12, 2015 at 2:32 pm | Permalink

    I wish Mr Hunt every success in his attempts to get change in the NHS in England. I hope the PM is providing full support.

    Yesterday in a TV interview a doctors’ receptionist described mornings at her general
    practise surgery – ‘the phone never stops ringing and the waiting area is full of patients – it’s terrible’, she said. She went on to say that she was the ‘barrier’ between the patients and the doctors; she did attempt to row back on that but I think it did indicate how she and probably the doctors too, thought. And, she said, ‘when appointment slots are filled, what can I possibly do’?

    The discussion was about the ‘8 o’clock rush’ which we know leaves patients angry and receptionists frustrated, and a training programme was being promoted for receptionists on how to handle these emotions. This was not a pretty sight, seeing a person set in her ways with no way out and with the only solution, merely counselling. And of course it wasn’t being arranged to help patients.

    I am fortunate not to have had need of doctors for many years, so forgive my naivety, but where it does not happen already, would it not be possible for doctors to collectively man the phones for their practises for the first hour or so, and maybe again later in the day, making appointments for each other for the urgent or important cases; ‘reception’ can then be asked to ring the other patients back to arrange later dates, maybe on some coded priority system.

    It may take a while to bed in, but they can responsibly prioritise and provide reassurance
    with authority to patients who may need nothing more than this, and it will reduce pressure on receptionists where they are being expected to do too much. Patients who are presently suspicious should also gain confidence in the service they receive. There will be many too who will learn they don’t need the doctor as often as they think.

    I would like to think that in time many of the problems currently experienced by the
    practices, and the worries and anger of patients will thus diminish. If there is a ‘them and us’ attitude within practices it will help there too.

    • Jerry
      Posted February 12, 2015 at 5:33 pm | Permalink

      @TPW; “would it not be possible for doctors to collectively man the phones for their practises for the first hour or so, and maybe again later in the day, making appointments for each other for the urgent or important cases;”

      Wasn’t that the idea behind the original NHS direct service, medically trained (nursing) staff taking calls, thus having real world medical experience, and not just being reliant on a computer algorithm, to be able to decide if the caller needed an ‘Aspirin’, a doctors appointment or an ambulance – was it not only a couple of weeks ago that there were reports across the media of how the current NHS 111 service was not only sending people inappropriately to their doctor but were also advising people to attend A&E, if not having ambulances sent.

      Thus money saved from changing NHS Direct into a lower skilled call-centre has probably cost the NHS far more in needless or trivial doctors, A&E or ambulance visits, either directly or because people became mistrustful of the new NHS 111 service…

    • Margaret Brandreth-J
      Posted February 12, 2015 at 7:54 pm | Permalink

      I am a Nurse Practitioner and have watched standards deteriorate for many years, however I have recently been a patient myself and the standard of attention to my needs was quick, efficient and effective. Last week I thought the end was nigh, today I have hopefully many more years. 10/10 to Penine Acute Trust and my senior GP.

  33. agricola
    Posted February 12, 2015 at 2:39 pm | Permalink

    You highlight an interesting analogy of flying and hospitals. I can comment on the former having done quite a bit as both passenger and pilot. Flying in all it’s forms is strictly controlled as are the people who do it. The results of getting it wrong can be quite dramatic and open to all to view. There is also a strong commercial incentive for not getting it wrong. Just to give you a comparison, I am about to take to the air again after a thirty year break. I have to have a medical and then go to a suitable centre to get up to date and be assessed as to my capability. Were I in the same situation with a Ferrari in the garage I could just jump in it and take my chances having kept my driving license current. The aircraft have to go through a rigid inspection regime as well. In aviation everything is done ,based on past experience, to avoid getting it wrong. No one will tell you it is perfect, but every effort is made to make it so.

    In some UK hospitals, despite the very high level of expertise in all the professions involved, it still seems possible for things to go badly wrong and then for the incident to be swept under the carpet as the ex patient is on it’s way to the mortuary. In recently highlighted incidents the problem has been allowed to grow until there are literally hundreds of victims. Aviation from incident one, would do it’s damnedest to eliminate the problem. The medical world in the UK does not seem to have the procedures in place to minimise any repetition. Even worse any whistle blower who highlights a problem is penalised for bringing the profession into disrepute. The most lasting beneficial action that Jeremy Hunt could take would be to oversee the creation of a system in medicine that parallels that in aviation. Thank you for a well thought out submission.

    • graham1946
      Posted February 12, 2015 at 7:31 pm | Permalink

      Yes, indeed. The medical profession is actually the only one which can literally ‘bury it’s mistakes’.

      But then again, do airlines have managers and politicians above them forever telling them to cut costs, or do they, as I believe and you seem to confirm, do what is necessary to maintain safety?

      • agricola
        Posted February 12, 2015 at 9:32 pm | Permalink

        I have only ever been a customer in civil airlines so I am not privy to what the management pressures might be. I do know however that the Civil Aviation Authority ( CAA ) set the rules within which airlines work in the UK, as do the FAA in the USA. The CAA have the ultimate pilot check over and above the airlines in house checking system. I believe that maintenance schedule advice rests initially with the equipment manufacturers and the airlines follow this based on record of performance. There is almost certainly a two way flow of information to achieve the safest result. Were I a politician I would want to listen and facilitate, knowing that interference would be at my peril.
        I would think that politicians find it easier to interfere on the military side of aviation. Not on a day to day basis but more on direction and what to spend.
        My own aviation activity is now governed by a relatively new, set of rules, Europe wide. Apart from in the UK which I believe is slow to commit, but as I live in Europe I will go with the flow. At least aviation has a common language in English, even if it can sound a little strange at times over the airwaves. I look forward to getting airborne after such a gap.

  34. forthurst
    Posted February 12, 2015 at 2:43 pm | Permalink

    Presumably, Mr Hunt’s initiative is a response to Labour’s NHS GE platform strategy. Does JR believe it will result in a measurable improvement in healthcare?

    Reply Mr Hunt embarked on this course from day one in the department, because it is the right thing to do. Yes, I do think it is improving healthcare. cdif infections are down for example in many places.

  35. graham1946
    Posted February 12, 2015 at 3:14 pm | Permalink

    The difference between airline standards and the NHS is that airlines, manufacturers and pilots are run on safety first, not money first, which is the obsession of politicians. Get politicians out of it altogether, they don’t know what they are doing and do more damage than enough, just to show they are ‘doing something’. One such ‘something’ was Nursing 2000 which has been a disaster.

  36. mike fowle
    Posted February 12, 2015 at 3:20 pm | Permalink

    The problem with the NHS is surely that it is politicised. Mistakes and so on are covered up because whichever party is in office wants to brag about how well it is doing. Medical staff don’t answer to patients but to ministers and civil servants. Until the public understand that it is to their ultimate benefit for there to be a culture of openness, things won’t change, but at least Jeremy Hunt is trying to change the culture.

  37. Terry
    Posted February 12, 2015 at 3:34 pm | Permalink

    Of course he is right but will the respective Unions allow their members even to be accused? Will they accept transparency so that those guilty are named and shamed when they are at fault? I do not think so.
    The problem with the NHS is that it is too much in the Public Sector. And like all Public Sector monopolies, it is controlled by Trade Union power.

    Transfer all control and all power to the people that count, the medics and we could see a proper health service to be proud of.
    Until then we are at the mercy of the unions that run it. Now, is that fair?

    • Jerry
      Posted February 12, 2015 at 5:58 pm | Permalink

      @Terry; Nice anti-union rant!

      Funny how it’s often the unions (and professional boards etc.) pushing for transparency you call for, could it be that when scapegoats are not being found the real cause is bad management and or political interference and that is why we do not get transparency? The NHS ran for many many years with much stronger unions, with less middle managers and career seeking top-brass, without so many of the problems we have now.

    • Bazman
      Posted February 12, 2015 at 7:44 pm | Permalink

      Like banking? Blaming the unions is just deluded, will you be including the doctors union the BMA? I doubt it.

      • Terry
        Posted February 13, 2015 at 3:22 pm | Permalink

        I’d rather speak for myself if you don’t mind. Yes, I would include the BMA because they are in the same grouping. Self-policing never works.
        And that even includes the Chilcot Enquiry. What a travesty is that outrage. The whole system is rotten and is far from democratic and desperately needs a cleansing overhaul.

        • Jerry
          Posted February 14, 2015 at 9:41 am | Permalink

          @Terry; “Self-policing never works.”

          Indeed, so who is effectively policing top and middle managers – no one it seems other than concerned staff and their unions and until the recent NHS scandals those staff and unions were often punished or had NDA’s put into their contracts.

          “The whole system is rotten and is far from democratic and desperately needs a cleansing overhaul.”

          Indeed, the current system is, but that is no reflection upon the true ethos of a NHS (as set out by all parties back in the early half of the 1940s) that is available and free at the point of need…

      • Terry
        Posted February 13, 2015 at 3:34 pm | Permalink

        Me, deluded, blaming the Unions? Why would you think that?

        How else would there be so many non-jobs created within the NHS (Non medical Diversity managers and ward managers, for instance)? Why is there never a cull of the dead wood? Why are there so many “Managers” and not enough frontline staff? lack of funding because there are too many non-jobsworths? Empire builders thrive in the NHS because they have the unions behind them.
        A million employees to look after 60 million UK patients? Don’t you think that is OTT? Red China has less per head.
        Had the Politicians stuck to Bevin’s original visions, we certainly would have a wonderful NHS, instead of the political football it has become. And it will get much worse before it gets better.

        • Bazman
          Posted February 13, 2015 at 9:35 pm | Permalink

          The unions are to blame for the front line, the large number of nurses leaving, the increased workload on less staff and the wasteful top down organisation creating all of these ‘managers’ Terry?
          These are the real problems not organised labour trying to improve their and their patients lot. Who do you propose to police all of these empowered staff. Doctors? We have seen the result of that in the GP part of the NHS. Sociable hours and high pay for them, bad service and large costs for the country.
          China is a third world country, a dictatorship. Get real

        • Jerry
          Posted February 14, 2015 at 9:44 am | Permalink

          @Terry; “so many non-jobs created within the NHS (Non medical Diversity managers and ward managers, for instance)? Why is there never a cull of the dead wood? [..//..] Empire builders thrive in the NHS because they have the unions behind them”

          But that was nothing to do with the unions, far from it, that all started with the introduction of the internal markets etc. and we all know who did that – and no it wasn’t Labour, although New Labour did carry on regardless…

  38. ian
    Posted February 12, 2015 at 3:52 pm | Permalink

    Mr hunt might as well talk to the brickwall, what i can see about it every politician is now a magician.

  39. Iain Gill
    Posted February 12, 2015 at 6:58 pm | Permalink

    The docs should be obliged to give patients their very best advice, and not be limited by having to stay within NHS parameters. So for instance tell a patient that is going to be allowed to die for want of an operation they could get by going private, the patient should be told asap, tell them to sell their house if they need to because then at least they will be alive next year.
    If a diabetic patient is in an area giving very low percentages of insulin pumps they should be told to move to another area where higher percentages of pumps are given.
    If you are admitted to A & E in a hospital with few cardiologists, but need an emergency stent, you should be told the address of a hospital with 24/7 cardiology cover and told to just get a taxi there.
    And so on.
    That would be real honesty.

  40. Jon
    Posted February 12, 2015 at 8:18 pm | Permalink

    Standing back I see an overall theme going on of late related to the Magna Cata, the not understanding the difference between tax avoidance and evasion, the HMRC sending the message that tax evasion won’t get you prosecuted and if caught you can just pay a fraction of what you should have, Select Committees becoming more important on a scrutiney level but with no ministerial powers.

    Ministers seem today to be spending far less time on scrutinising policy, more time delegating to quangos and regulators. Perhaps spending the available time made available by doing so, on sound bites. That leaves a deficit in our democracy referring to the Magna Carta. The cross bench Select Committees could take on that ministerial responsibility that has been delegated by them.

    Should the minister responsible want to roll up their sleeves and take responsibility, perhaps like Jeremy Hunt, then they should have the override to do that. If not as is often the case, thinking of the FCA, then the Select Committee should inherit those ministerial powers.

    There is a democratic deficit building here through delegation to quango’s and regulators that needs to be addressed. The HMRC stance on tax evasion is one of many.

  41. Mark
    Posted February 12, 2015 at 8:23 pm | Permalink

    I suspect that we might do better with the system they use in New Zealand to handle medical negligence. Lawyers aren’t involved, and payouts are capped for non-medical issues (patients are free to take out additional insurance if they have large incomes at stake). It is run by a specialised tribunal (the Accident Compensation Corporation). It results in more patients who make claims being compensated (albeit rather smaller sums), and more information about failures being collected. This permits analysis of problems. The disciplining of staff is not directly related to the claims process, separating the issue of the success or failure of the claim.

  42. ian
    Posted February 13, 2015 at 2:27 am | Permalink

    The 0.85 two year fix mortgages is on it way and if you wait a bit longer they will pay you every month for taking out a new mortgage. As for growth at 2.5 per cent, i think that low when you consider 100 billion extra borrowing a year, 250,000 extra overseas people a year and the extra millionaires and billionaires a year also mortgage rates going down and now fuel and so on going down, in fact i think it very poor rate of growth and GDP being held up with houses prices with lower mortgages and drug and prostitution. great. Also the magician fiddling the books for all the big players. I am sure that i have left a lot out.

  43. ian
    Posted February 13, 2015 at 2:34 am | Permalink

    In normal times we would have been hitting 50% growth.

    • Bazman
      Posted February 13, 2015 at 5:56 pm | Permalink

      Of what your nose? 50% growth in the economy is not real.

  • About John Redwood


    John Redwood won a free place at Kent College, Canterbury, and graduated from Magdalen College Oxford. He is a Distinguished fellow of All Souls, Oxford. A businessman by background, he has set up an investment management business, was both executive and non executive chairman of a quoted industrial PLC, and chaired a manufacturing company with factories in Birmingham, Chicago, India and China. He is the MP for Wokingham, first elected in 1987.

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