And we would expect a bureaucracy to work in another manner why?

The NHS has been accused of “a culture of cover up” after an inquiry found that more than half of investigations into needless deaths are carried out by colleagues of those under scrutiny.
A report by the NHS Ombudsman found that nearly three quarters of hospital investigations into avoidable harm and death claimed there were no failings in care given – when in fact there had been serious errors.

That’s just what bureaucracies do.

12 thoughts on “And we would expect a bureaucracy to work in another manner why?”

  1. It’s also the incentives thing. No competition means that you can’t go elsewhere. No-one has their own money invested in it. No-one gets fired for doing a bad job with the investigation.

    I worked at a pharma company for a while and we had a memo around about whistleblowing and a story about how another company had their license suspended by the FDA for ignoring some dodgy things going on, which effectively put that company out of business as their reputation was also shot and their customers went elsewhere. The very rich lady that run the company and owned a large stockholding didn’t want to be a not-very-rich lady.

    How many NHS managers lose their jobs if someone does their own investigation and finds the investigation was inadequate? Or for anything?

  2. Or to put it in a more Worstallian way, “bureaucrat responsible for investigating complaints about NHS care says that more resources should be assigned to investigating complaints about NHS care.”

    more than half of investigations into needless deaths are carried out by colleagues of those under scrutiny

    That is, person competent to evaluate care appointed to evaluate care.

    A report by the NHS Ombudsman found that nearly three quarters of hospital investigations into avoidable harm and death claimed there were no failings in care given

    The Ombudsman conducted a review into NHS handling of 150 of her own cases. This is not a representative sample of NHS complaints generally.

    Tim, suppose we had the sort of multiple-provider system you favour. How could a general review of the providers’ complaints procedures be conducted? Can you give us an example of such a review in another country?

  3. Can we get the Air Accident Investigation Board to take over the NHS Ombudsman’s role? This article from last year first alerted me to the way medics don’t seem to investigate things as rigorously as the aviation world, though the idea is at leasr a decade and a half old.

  4. Competence is not a requirement in order to thrive in the NHS because arsecovering is raised to an art form.

    it’s not just in state-run enterprises either, it appears to be the case in most large corporations. Certainly I can recognise this sort of behaviour described by the Oilfield Expat in relation to the Socar platform fire.

  5. Tim, suppose we had the sort of multiple-provider system you favour. How could a general review of the providers’ complaints procedures be conducted? Can you give us an example of such a review in another country?

    Here’s how it worked with me in France recently. I went to see a doctor regarding a serious heartburn issue. I felt that his consultation with me was rushed and it turned out he gave me misleading instructions regarding a test I was supposed to get carried out at an analysis centre. I therefore went to see another doctor instead, who was much better. Later, she wrote a letter explaining my symptoms and treatments tried which she told me to take to any gastrologist of my choosing, but she could recommend two, one of whom spoke English. I chose one of them, showed him the letter, and he performed an endoscopy that found, thankfully, nothing wrong.

    Firstly, I was free to choose another doctor: no need to register with a GP, I just turned up in each case. Secondly, I could change the doctor if I was not happy with the first. Thirdly, I was free to go to any gastrologist I liked, without any referral from a GP: the letter was just to save time and provide clarity. If I had a complaint about any of these people they have in place both their own and the state complaints procedure. But more importantly, I was free to go somewhere else and deny them my custom. That does more to uphold standards than any complaints procedure.

  6. Tim Newman–Seconded. Choice beats complaints procedures every time.

    The only exception would be if the NHS has killed you right off and choice no longer comes into it. Not for you anyway.

  7. Bloke in North Dorset

    Tim N,

    Don’t you make a small payment when you see your equivalent of the GP, around 5 euro IIRC

  8. The sentimental attachment of the British public to the bureaucratic and socialist National Death Service is something that puzzles me. You would think that public opinion would be becoming more critical of it, as more Brits use health services in Germany, France, Spain etc; but it isn’t. The NHS has many pockets of excellence, but so much of it mediocre.

  9. Don’t you make a small payment when you see your equivalent of the GP, around 5 euro IIRC

    For those enrolled in the French social security programme, they get something like 90% of the costs reimbursed (depending on who they have seen). So they have to pay something yes, none of it is 100% free. My first doctor charged me 30 Euros, which I paid in full and claimed back later through my own insurance, but I think anyone else would have had to pay a nominal amount.

    The most important thing in the French system – which is also the reason why it is bankrupt, but nobody seems to have noticed that as it still functions – is that the GPs are not gatekeepers to the specialists: you can book an appointment with a gastrologist right off your own bat, and have the state insurance system pick up most of the bill. So you go to a GP if you need advice or are not sure what is wrong with you, but otherwise you go right to the specialist.

  10. Would also be interesting to look at cases where something was found to be wrong and look at how many nurses were thrown under the bus while doctors walked away with a slap on the wrist at the most. Doctors policing doctors is never going to be impartial

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