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Time to stop NHS blame culture and learn from failures, say MPs

Health and Social Care Committee report calls for radical overhaul of NHS compensation system in England, which it says is ‘not fit for purpose’

Health and Social Care Committee report calls for radical overhaul of NHS compensation system in England, which it says is ‘not fit for purpose’

Blame culture in the NHS needs to be eradicated and replaced with one where system-wide failures are recognised and learned from, MPs have said.

A Health and Social Care Committee report, published today , has called for a radical overhaul of the NHS compensation system in England which it says is ‘not fit for purpose’ and ‘promotes individual blame instead of collective learning’.

NHS culture adversarial with too much

Health and Social Care Committee report calls for radical overhaul of NHS compensation system in England, which it says is ‘not fit for purpose’

Blame culture is a familiar concept to nurses, with incidents of using reporting systems like Datix increasing during the pandemic
Picture: iStock

Blame culture in the NHS needs to be eradicated and replaced with one where system-wide failures are recognised and learned from, MPs have said.

A Health and Social Care Committee report, published today, has called for a radical overhaul of the NHS compensation system in England which it says is ‘not fit for purpose’ and ‘promotes individual blame instead of collective learning’.

NHS culture adversarial with too much focus on individual failings

In the report the committee said the system is focused on clinical negligence which, by definition, seeks out individual failings and is adversarial.

‘If NHS Trusts, medical professionals, patients and their families are to engage in a thorough investigation into what is often a traumatic and tragic event, the whole investigation cannot be premised on a search for individual blame,’ the study found.

Blame culture is a familiar concept to many nurses, with incidents of using reporting systems like Datix increasing during the pandemic. But even before COVID-19, the fear of speaking up lead to dire consequences.

The Nursing and Midwifery Council (NMC) said it backs any changes ‘that allow candour and learning to flourish’.

Executive director of professional practice at the NMC Geraldine Walters said: ‘We believe in a culture of openness and learning that encourages professionals to be honest when things go wrong, and gives them the chance to address concerns. It’s about strengthening practice for the future, not punishing people for past events.’

Support honesty for better nursing care, says Freedom to Speak up Guardian

Helene Donnelly, who blew the whistle on poor care at Mid Staffs while working as an emergency nurse at the now-defunct trust, said blame culture leads to potential failures and missed opportunities for learning.

Helene Donnelly

‘It is absolutely the case that often failures in quality of care are a result of systemic and wider cultural or resource problems, and not individual error,’ said Ms Donnelly, who now works as a Freedom to Speak up Guardian at Midlands Partnership NHS Trust.

‘However, either way, it is vital that all staff at all levels feel free to speak up and are genuinely thanked and supported when they do. This honesty will lead to safer patient care and better wellbeing for staff.’

It’s a message echoed by professional and clinical advisor in patient safety at Imperial College London Suzette Woodward, who said the move away from blame culture was ‘vital’ to creating a system that treats people fairly.

Build much more supportive culture for nursing workforce

‘It is vital that healthcare moves away from individual blame to studying the way systems function in our complex adaptive system,’ she said.

‘By doing so, it means we can address the system components that impact on individual ability and performance and builds a much more positive and supportive culture for those that work in healthcare.’


Further information

House of Commons Health and Social Care Committee (2022) NHS Litigation Reform


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