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It’s time for a more open and honest NHS


By Jyoti Shah
Consultant urological surgeon
24 December 2018

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Transparency could inspire loyalty and commitment in NHS staff, something the service sorely needs, says Jyoti Shah.

In 1948, Nye Bevan entered a Manchester hospital and bravely announced a free UK-wide healthcare system, the National Health Service. His vision was simple and laudable – free care at the point of delivery.

As the system evolved, the Government in 2003 introduced the four-hour waiting-time target for patients in A&E departments.

In the same year, Sir Bruce Keogh campaigned for the publication of comparative data on surgical outcomes with cardiothoracic surgeons leading the way. This was met with scepticism and fear. There was a concern that surgeons would pick less risky cases and that the data might be misrepresented.

However, survival rates improved. Transparency led to a benchmark for performance, which became a driver for quality improvement and reflective practice among surgeons. Some surgeons even stopped certain types of surgery.

Transparency is about allowing the public full access to the information it wants; not just what the health service chooses to make public. It’s about honesty. Was the NHS transparent when it was revealed that some NHS trusts were spending up to £900,000 a year housing patients in luxury hotels?

Was the public aware that some trusts spend over £400,000 in six months just on photocopying – in the digital age? Having this data in the public domain would at an earlier stage could help fuel reforms.

In the 1980s, several people died in Chicago after taking the painkiller Tylenol, which had been laced with cyanide. The drug’s manufacturer Johnson & Johnson was highly praised for its transparency and crisis management.

It recalled the products and issued public warnings, losing millions of dollars. It even established a hotline for worried customers. Johnson & Johnson put safety before profits and emerged a leading brand for honesty. This is where the NHS should be.

As one of the worst scandals in NHS history, Mid Staffs, has become synonymous with negligence. However, from this was born a legally binding ‘duty of candour’ on all staff to admit mistakes and learn from them. In this case, transparency was morally the right thing to implement and this has led to change.

More recently data has become available about many services, such as GP practices, cancer surgery and bariatric surgery; all of which enable patients to make choices. Such transparency drives competition, improves services and keeps the NHS at the cutting-edge of science.

But this openness needs to be improved within organisations. Genuine and honest relationships between levels of the workforce will foster confidence, boost morale and encourage staff to speak up without fear of recourse.

It will also reduce complacency. It will inspire a sense of loyalty and commitment, which the NHS sorely needs.

Delivering transparency requires courage, as demonstrated by Sir Bruce. It will seriously redress the balance of power away from professionals with patients choosing their care, where they want, when they want and by whom they want.

Jyoti Shah is a MacMillan consultant urological surgeon

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