14 April 2019
I was particularly interested in the description of the ‘Fortress NHS’ by David Seedhouse as one of the research participants described the NHS as ‘The Citadel’. “It can be a career ending move to, um, raise concerns with NHS managers. Basically another element of the culture is, you ‘keep the lid on’, you ‘don’t expose your dirty linen in public’. And if people want to do that, you attack them professionally, personally, you make them go and see psychiatrists. You, if they beat you at an industrial employment tribunal, you pursue them for costs. There is no end to what the NHS will do to people who try to break open The Citadel.” R - Please could you tell me a little more about The Citadel? “The Citadel is the notional home of the big secret that the NHS cannot do better than killing an awful lot of people and treating tens if [not] thousands, largely elderly, in an appalling manner...The Citadel is a metaphor for the NHS - picking up on AJ Cronin's title. Its primary purpose is to protect itself even though the public believe it is there solely to make them better. When individuals see what's going on in The Citadel and try to advertise it they will generally be repulsed. [They] broke down the walls of The Citadel because among other things it suited a new ruler to help…to break them down. Now many of the insiders are wondering how to respond to being on display; first response, pretend nothing has happened and hope that the walls can be rebuilt” Of course secrets often go together with lies, and there are a number of references to ‘lies’ in the literature. ‘The NHS is likened to East Germany with the Stasi security police, with their use of ‘...euphemisms, double speak and downright lies’ (Riddington Young et al., 2008, p.14). There are ‘big lies’ (Taylor, 2013) and myths, lies and deception (Davis, Lister and Wrigley, 2015). The facts need to be denied and the ‘…political spin machine goes into overdrive’ (p.40). Lies take different forms to justify actions and the ‘…first casualty was truth’ (p.39). There is misrepresentation and concealment.’ (unpublished – Pope, 2019, ‘The NHS: Dysfunctional cultural characteristics’). On 8 April 2019 Andy Cowper in the Health Service Journal wrote ‘Cowper’s Cut: The price of financial lying’ - ‘The NHS will have to pay the price for cultivating a culture of financial lying and cheating and incentivising the wrong things’. What is clear is that ‘The Citadel’ and ‘Fortress NHS’ and the secrets within it are fiercely guarded and protected. People go to great lengths to prevent the exposure of ‘dirty linen’. Secrets are kept unless people are able to break down the walls. ‘The Citadel’ is a dark place.
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