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Smash the 'club culture'

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VOL: 97, ISSUE: 31, PAGE NO: 33

Ray Rowden, RGN, RMN, MHSM

We now know the full story of events at Bristol, and grim reading it is. The inquiry reminds us that this sorry tale goes far deeper than a collection of individuals in a trust - it is an indictment of the whole governance of the NHS and Department of Health.

We now know the full story of events at Bristol, and grim reading it is. The inquiry reminds us that this sorry tale goes far deeper than a collection of individuals in a trust - it is an indictment of the whole governance of the NHS and Department of Health.

What is particularly worrying is that Professor Ian Kennedy, the inquiry chair, was not able to assure the public that similar service failures were not occurring in the NHS today.

The inquiry found a 'club culture' in which people felt unable to express their views and where the trust's top nurse was described as 'a Rottweiler'. It also found that she did little to represent the profession at board level. In fairness, in the macho management culture of the NHS at that time it was often difficult for the nursing director to represent nursing.

But the inquiry goes well beyond the trust and exposes the weaknesses of an entire system. What were the health authority and specialist commissioners doing? What did the region do? Where was the DoH? Where were the medical royal colleges and other august professional bodies? In truth, the system let down the children and families.

So will the government act on the report? There is the risk that the plethora of new regulatory bodies, such the National Institute for Clinical Excellence, the Commission for Health Improvement and The National Patient Safety Agency, will breed confusion about who does what as it is not always clear how they will work within existing regulatory frameworks.

Health secretary Alan Milburn should get all parties around the table without delay. The logical body to take an overview is CHI, which should have the authority and resources to deal with ailing services quickly and effectively.

The inquiry report insists that audit should be more rigorous and transparent. This must happen. We may not yet have perfect audit tools, but we can improve what we have. We must remember that effective audit is multiprofessional. Too much of it has been uniprofessional and carried out behind closed doors.

Finally, we must ensure that all areas of health care develop effective mechanisms to protect professionals who have the courage to blow the whistle on poor practice. In Bristol, the UK career of Professor Stephen Bolsin, the anaesthetist who dared to speak out, was all but wrecked - he had to move to Australia to seek gainful employment. In Oxford, the career of Collette O'Keefe, the senior nurse who raised concerns, is in tatters.

We cannot allow this. We need a truly independent agency that offers proper support to such people, one that has the power to overrule any trust or royal college. The children and families affected by this tragedy deserve no less.

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