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Jan 15

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The one about how the blame game means never having to say you’re sorry…

We live in a litigious society and some NHS Trusts have recently been criticised for allowing compensation lawyers to sponsor patient information leaflets in return for advertising their services. The question is, does the defensive, opaque and antagonistic mindset that almost inevitably results from constant fear of litigation truly serve the human need to understand what went wrong and then fix it?

Last October my father was given a terminal diagnosis. His decline was nasty, brutish and (mercifully) short but – although his death was inevitable – we did not, in the end, ameliorate his suffering as well as he deserved. His last days were unremittingly uncomfortable. Nursing him at home, we were hopelessly out of our depth.

After he died I felt I had a moral obligation to explore why he had been repeatedly refused a bed in our local hospice. He wasn’t close enough to death apparently, although I feel he proved his point rather elegantly in the end. Mercifully a cabal of friends with medical experience and our own GP helped me see that I did not have to take on this battle and that it was no more than the usual imperfect experience in an imperfect world.

I had cause to thank them again recently when the Care Quality Commission – responsible for overseeing the quality of care in our hospitals and care homes – published a report revealing many relatives involved in post death inquiries were dealt with insensitively; their input was given less weight than that of professionals, they were not kept appraised of developments and teams investigating were frequently defensive and antagonistic, with families sometimes turning up to meetings to discover lawyers present. The underlying drive for such unattractive behaviour – apart from a decent dose of incompetence in hopefully rare cases- was presumably the fear of expensive litigation. The other driver, as I see it, is an employer’s fear that overt criticism of individuals will lead them to litigate for workplace bullying or similar which is another unattractive consequence of the blame culture we live in, leading to a situation where no problem can be laid at the door of any specific individual.

‘Thank goodness I escaped all that,’ I thought to myself and then – a week later – I was pitched right into an NHS complaint of my own. Fortunately in my case, the stone-walling, blame-shifting, information withholding mindf*** I was subjected to was for nothing other than an admin balls-up concerning the scheduling of an elective operation. It was farcical in contrast to the experience bereaved families are put through. But still…. It happened at a time when I was ill. No-one submits to major surgery willingly; you have to be quite unwell to think it’s a good idea and I was, which made what happened a bit rubbish.
When I dared to ask for a litany of misleading information interspersed with yawning silences followed by a last minute delay to be sorted I was plonked onto a ‘complaints’ path without my knowledge or permission, meaning any effort to fix my problem was transmuted into an effort to bury it six fathoms deep. The person designated to deal with my ‘complaint’ whose job responsibilities seemed to centre largely on ordering the stationery with customer care added in as an afterthought, was keen to absolve his employer of responsibility by any means open to him. We will call him ‘Paperclip Boy’ to protect the guilty. ‘His first tactic was to deny the existence of a problem. I suppose it was worth a go but when I presented him with ample symptoms of an – as yet undiagnosed – problem he tried another tack, launching into a brief ‘investigation’ which led him to declare that the only ‘problem’ was my lack of ability to understand anything I had been told. When I pointed out that I am not known for my abject stupidity and I thought it strange his investigation did not include ‘asking me what actually happened’ I insisted on a meeting which he later declared was his idea. At the meeting, I laid out what I knew and had researched and he promised another ‘investigation’. By then, despite their best efforts to cover their tracks, my understanding of the balls up was pretty good and the meeting was mostly an exercise in working out what they could no longer deny. A mealy-mouthed apology letter swiftly followed, in which Paperclip Boy avoided all personal responsibility but was quick to name individuals outside the admin team to shoulder the majority of the blame. By then, my ‘complaint’ was primarily about how my ‘complaint’ had been dealt with, so I was still unimpressed because this aspect, focusing on the behaviour of Paperclip Boy himself, was ignored.

The post script is I had the operation I needed. It went fine and I have nothing but gratitude and admiration for the consultants and clinical team responsible for my care. I despair over the admin team though. Even the pre-op assessment was a farce, with five cancellations including a letter scheduling it for three weeks AFTER my surgery date. Thank goodness it wasn’t them doing the surgery.

So, the bottom line in this case is clearly the admin team is not fit for purpose but, when I examine my own quite disproportionate distress, the serial ineptitude upsets me considerably less than Paperclip Boy’s clumsy attempts to offload blame. But maybe, as a society, we are the makers of our own misfortunes?

If employers imbue in their employees the need to avoid blame at all costs, then the victims of mistakes inevitably suffer twice. If complaining simply compounds distress it is time to think again.

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