'Too much reassurance is dangerous for the NHS'

Faultlines in the NHS – and most large organisations – include underfunding, under-staffing, paperwork and fragmented organisation. Photograph: Rob Griffith/AP

I have been trying to fathom what, deep down, has caused the many disasters that have beset the NHS in the past few years. I know there are many surface causes, such as underfunding, under-staffing, the chasing after targets, the continuous shift of government policies, the paperwork, the fragmented organisation, the standoffs between managers and clinicians, the professional jealousies of GPs and hospital doctors, and the slippage in standards of care.

These are all faultlines common to most large organisations. But most large bodies close up their faultlines, sometimes by knocking people's heads together. However, this doesn't work in the NHS. You mustn't make waves or blame anybody else. If you do, you get into the bother that Jeremy Hunt is in, trying to find scapegoats for the out-of-hours fiascos.

What you have to do in healthcare is to reassure everybody that everything is going to be all right. Reassurance is deeply embedded in the practice of medicine. Doctors have to reassure their patients that they are not going to die. Hospital managers have to reassure their local communities that their hospital is safe. The regulators felt they had to cosy up to, and not be too beastly to, the trusts that they are supposed to be regulating. The royal colleges have to persuade their patients that the expertise of their members is second to none. Doctors protect each other's backsides. The nurses' leaders have to claim that all nurses are angels of mercy. Successive governments have to reassure citizens that they are making the NHS better and better. The medical profession has to trumpet forth that "the NHS is the envy of the world".

Everything, we have to be reassured, is for the best in the best of all possible worlds. The outcomes of the need for reassurance are endless cover-ups.

Mid Staffs and its aftermath have shown that it is not the best possible world. But we still want to believe it. And so we may continue to lap up as much reassurance as we can get in the future, even though the reassurance/cover-up will almost certainly be false. Last week, we had Dame Barbara Hakin of NHS England claiming that improvements in the NHS 111 service mean that "over 90% of calls are now answered in under a minute". All the NHS 111 troubles are teething problems, apparently. Anybody moderately sane would realise that the combination of almost untrained call handlers and rather dodgy computer-generated scripts would result in mayhem. The system is fatally flawed, and should be withdrawn immediately.

Yet ministers have been wheeled out to defend the system, because it is a flagship of Tory cost-cutting Department of Health policy. It is just like the days of the national plan for IT during the dying years of the last government, when ministers defended stoutly an approach to NHS IT that was top down and fatally flawed. In the end, it imploded. As many of the present government's current policies will implode.

Surely, we must lose the habit of being reassured, and letting bad practice go on for years, as in the Bristol Royal infirmary and Mid Staffs. There have been too many long-drawn-out disasters. It was the patients who suffered from the delays.

There have been too many people in the upper echelons of healthcare who gave false reassurances for too long, to defend their own hegemonies. I worry that many of them are still in place, and will have got into the habit of it, and will carry on giving false reassurances, as they have always done. And I fear that some of the new people have already got into the habit themselves. It is in the nature of healthcare that this should happen, because reassurance is at the heart of healing. At the top level, it should be resisted. Prompt protest by whistleblowers is the only cure.

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