Reality check needed for NHS to face the truth

Emerge blinking from the industrial hulk of the Manchester Central Convention Centre, wend north along Deansgate, and, just beyond the cathedral, you’ll find yourself at the Glade of Light: a living memorial to the lives taken in the May terrorist attack seven summers ago. Where garden encircles marble. Marble encases memory capsules personal to the 22 people who never returned home. It’s sad, soulful, and deeply beautiful.

Designing memorials must be fiendishly difficult. Simultaneously a public work of art, a personal reflection of those it marks, but above all a way to help the individual and collective processing of pure emotion.

The need to process complex, human emotion is eternal in the delivery of healthcare. Healthcare is the most emotive industry there has ever been, and ever will be.

Emotional inevitability

It’s the scene of our own birth and deaths, our witnessing of the physical and mental pain experienced by those closest to us. And for those working in it, it’s even more: the fulfilment found when you can fix others, the powerlessness of when you can’t.

These are emotions that are never going to go away: however much we spend it will never be enough, pain will always persist, and death will always have the last word. The only thing we can control is how we make sense and work with such emotional inevitability.

How do we do this? Let’s nip back to the Convention Centre and this week’s gathering of leaders, the largest in the NHS calendar.

Those attending will all have a list of what scares them, what bedevils their days and keeps them awake at night. It’s not hard to put a draft together: the burnout experienced by their staff, the inevitability that restricted budgets will mean poorer care, the fears for their own job if they don’t deliver, the increasing distance from the reason they came into this in the first place.

Collective delusion

This is not the ConfedExpo agenda, nor has it ever been. Instead, digital front doors, maximising capacity, connecting data, interfacing systems. Robots loop an exhibition floor laden with giveaways of stylish umbrellas and beverages appropriate to the hour.

You won’t be surprised to discover I struggle. Struggle with the lack of soul, the vastness of the emotion lurking under the barely-scratched surface, and the creeping fear that I too am complicit in what could best be described as an exercise in collective delusion.

Organisational silence reappears time and time again in NHS history.

You’re missing the point, I’m told. This is a break. A chance for hope. An ability to provide distance from the day-to-day and precisely not to dwell on it. Think of it as respite care for NHS chief executives. NHS Disneyland.

Organisational silence

Maybe. Yet the reality is that we know that organisational silence – the collective phenomenon of saying or doing very little in response to significant organisational problems – reappears time and time again in NHS history. We could go back to the voices of Barbara Robb in the 1960s, or Robert Francis barely over a decade ago. But in 2024 we don’t need to.

“There is a culture which puts the reputation of trust in the NHS above the issue of patient safety,” said Rob Behrens, the NHS ombudsman, last August following the sentencing of Lucy Letby for the murder of seven babies.

The NHS has a “culture of defensiveness, lack of openness, failure to be forthcoming, and being dismissive of concerns” reported the Infected Blood Inquiry last month, where 30,000 people in the UK were given treatments infected with HIV and hepatitis C, resulting in 3,000 deaths.

Cultural malaise

We didn’t talk about this in Manchester this week. Scour the ConfedExpo agenda for either of these specific cases, or the cultural theme that unites them, and – barring an honourable single head-nod to an hour on Martha’s Rule – you’ll come away empty-handed.

Conferences like this are symptoms, not the cause, of a much deeper cultural malaise. A culture that chooses to suppress emotion rather than open it up, that prefers to dwell in a place that is fundamentally unreal rather than confront the cold light of day. These are traits of failed organisations the world over. Without major cultural change, the NHS will simply be added to the list.

The plan cannot possibly be to wait for a fresh-faced politician to save us. More than any other group, whether such change happens rests on the actions of exactly those who walked through the Convention Centre’s doors.

So if not here in Manchester, when does the NHS start to face the simple truth that it doesn’t like the truth?