15 June 2019
I have recently read ‘Denial: The unspeakable truth’. A difficult and uncomfortable read. I was made aware of this book through the Radio 4 programme ‘The age of denial’ (https://www.bbc.co.uk/programmes/m000357l/episodes/player). The author Keith Kahn-Harris considers denial and denialism. Denial and denialism are closely linked, and denialism is “…dangerous” (p.4) and “…deeply poisonous” (p.ix). Denialism is defined as an “…expansion, an intensification, of denial. At root, denial and denialism are simply a sub-set of the many ways humans have developed to use language to deceive others and themselves. Denial can be as simple as refusing to accept that someone else is speaking truthfully. Denial can be unfathomable as the multiple ways we avoid acknowledging our weaknesses and secret desires. Denialism is more than just another manifestation of humdrum deceptions and self-deceptions. It represents the transformation of the everyday practice of denial into a new way of seeing the world and – most importantly to this book – a collective accomplishment. Denial is furtive and routine; denialism is combative and extraordinary. Denial hides from the truth; denialism builds a new and better truth.” (p.2-3) Does the NHS, and structures around and external to the Fortress NHS exhibit denialism? The NHS certainly exhibits denial. An NHS whistleblower in a blog (Alexander, 2016) described the regulator, the Care Quality Commission, as being part of “…the NHS denial machine”. A research participant, a cognitive behavioural therapist, wrote that the NHS culture was “Complicated; Unhelpfully competitive; Delusional. Though this seems to be negate those who do a lot of good work despite it all, so if I was to add a fourth, it would be ‘Heroic’. [Delusional?] Elephant in the room stuff. The culture is deluded and deluding by pretending the [Negative] behaviours described…don’t exist. Like a family that has a terrible secret that is not discussed and has a shared delusion that everything is OK” There is a fierce resistance to any ‘bad news’ and negativity, and a great desire for ‘good news’. A risk manager referred to the “…good news factory”. “It is very tempting to join the club and be part of the ‘good news factory’. I dip in and out of that. Trying to protect the organisation, but also trying to protect the interests of patients and staff as an advocate…They [Directors] don’t care about anything else as long as not reported.” R “Talk a bit more about the ‘Good news factory’. Is that a term you use normally?” “Not used it before. It’s like, no... Somebody told me, ‘Iced cake syndrome’. Lovely on the outside, mouldy on the inside. Part of a culture being led by the government. Present a pretty picture fed up to the voters. Underneath it’s a bit of a shambles.” An HR manager said “It’s a ‘stopping bad news factory’…rather than ‘good news’”. “There are many cultures within NHS organisations, but a common denominator with each is defensiveness”. Certainly the denial is a collective accomplishment within the NHS and the structures around it. It is most definitely combative. This is particularly seen when organisations come up against whistleblowers or ‘truth tellers’, the term Graham Pink prefers (A time to speak: Diary of an NHS whistleblower, 2013). ‘Truth tellers’ are ruthlessly pursued and systematically attacked for raising concerns about ill-treatment of both patients and staff. Careers are destroyed. Many NHS staff, particularly senior managers, will go to great lengths to avoid facing reality. The NHS constantly presents a “…new way of seeing the world” and “…builds a new and better truth” with attempts to redefine reality. There is The Great Pretence that things are, what they are not. That Pretence is indeed deeply poisonous and dangerous as it prevents any positive change and improvement.
1 Comment
2 June 2019
On the day of the European elections The Telegraph editorial wrote, referring to Mrs May, that ‘Her resistance to facts is absurd’. Sadly, this statement could apply to many politicians in this country, of all persuasions. This same resistance to facts and ‘knowing’ is also constantly seen within NHS services. In that same paper is the headline ‘Autistic NHS patients ‘were tortured by staff’. The Panorama programme about Whorlton Hall (22 May 2019) told us that whistleblowers were ignored and no action was taken to address complaints about the quality of treatment delivered (https://www.bbc.co.uk/iplayer/episode/m00059qb/panorama-undercover-hospital-abuse-scandal). Anyone who watches the Panorama programme has to be appalled at what was done to vulnerable and terrified people. The Patient Experience Library recently shared the link to the ‘Report: Review of Maternity Services at Cwm Taf Health Board.’ These are the conclusions (https://www.patientlibrary.net/tempgen/194266.pdf). ‘Clearly, the review of the process for handling and responding to complaints and concerns and governance is a priority; interviews and engagement with women and families revealed serious issues about the way that concerns and complaints were investigated and responded to. Issues included:
In both situations people were not listened to and there was a failure to respond. There is a very strong resistance to any ‘bad news’ or criticism in the NHS. When there is resistance to facts and ‘knowing’ it is indeed absurd, as improvement then becomes impossible. |