Wilful neglect – is ignoring it collusion?

Pilots who consume alcohol and potentially endanger their passengers, or farmers who deliberately breach food hygiene regulations, like many other professionals face are severe penalties that include loss of license and livelihood, and even potential imprisonment. Should nurses or doctors be any different?

The response to the Government’s plans to criminalise wilful neglect, including in some cases with prison sentences, have been met with predictable outrage by the medical and nursing colleges, who have called it a ‘headline-grabbing exercise’ (BMA). That may have been the press’ agenda, but is it really unreasonable for the Government to hold to account those engaging in wilful neglect?

Making wilful neglect a criminal offence was just one of a number of recommendations made by Don Berwick in his review of the Mid Staffordshire Hospital Inquiry. Berwick’s report also stressed that there are very few examples of wilful neglect in the NHS and (perhaps ironically), called for an end to the ‘blame game’ against NHS staff.

To say nurses and doctors will live in fear of prosecution is scare mongering. Mid staffs happened because of multiple system failures, not because of particular individuals, that was not wilful neglect on the part of clinicians – but individuals allowed disgusting circumstances to prevail. It took relatives and statistics to expose the problem. The fact the staff did not speak out is indicative of a wider cultural issue.

wilful neglect

Structural deficits such as staffing levels and quality, budget constraints, poor leadership and work environments collude to leave NHS staff feeling ‘got at’ by health ministers, the press and often by their local organisation leaders too;  many of whom appear to criticize the NHS far more frequently than they praise it.

Berwick, in this and many other reports he has authored, is consistently right about culture; and we do need to change the culture in some NHS organisations. We also need to create environments where clinicians to feel safe enough to say ‘No, this is not right’.  There also needs to be a route to expose and deal with individuals and systems that wilfully neglect patients – whether clinicians or not!

Critics have expressed concern that it will further reinforce a climate of fear, and unless clarification about what constitutes ‘wilful neglect’ by an individual or group of individuals is made explicit this may be the case. This should not, however be used as an excuse for not taking action. Instead of creating a perceived need to fear accountability for wilful actions, perhaps leaders and influencers should  focus on what sits outside of acceptable practice. This will enable the vast majority of clinicians who do a good job, often despite difficult circumstances, to concentrate on patients and care delivery.

There are also places where honesty, transparency and willingness to deal with difficult behaviours and unacceptable practices prevail. They focus on willful improvement to prevent willful neglect ever happening.

Instead of getting caught up in the hype of potential prosecution, perhaps the question we should ask is ‘how do we identify and root out the few in our professions who are prepared to engage in wilful neglect’?