22 July 2020
I have heard two interesting terms used recently. The first is ‘institutional paranoia’. This term was used in the context of the judgement on the Post Office in a civil litigation case. ‘A theme contained within some of the internal documents is an extreme sensitivity (seeming to verge, on occasion, to institutional paranoia) concerning any information that may throw doubt on the reputation of Horizon, or expose it to further scrutiny’ Postmasters (women and men) were treated appallingly and very unjustly. Some went to jail when they had done nothing wrong. Others lost their money, careers and livelihoods. Lives were destroyed. They have had to fight for justice for many years. The NHS also suffers from ‘institutional paranoia’ with its extreme sensitivity to any challenge of its reputation. It is exquisitely sensitive to any criticism and exceedingly defensive. The other term is ‘systemic injustice’. The ‘institutional paranoia’ with the obsession with image and reputation drives and underpins the resulting ‘systemic injustice’. ‘Systemic injustice’ was a term used by David Davis MP on Radio 4 when he was interviewed recently, referring to problems within the police service, but also to other institutions where justice was not forthcoming. There seem to be many situations of ‘systemic injustice’ in the UK. The behaviour is the same. People are harmed, not listened to and feedback, criticism and truth are rejected e.g. Hillsborough, Windrush, The Post Office, Tainted Blood scandal, Stephen Lawrence, Alison Bell, 1950s women, Gosport, Mid Staffs, Southern Health and many other NHS organisational examples. The latest Cumberlege report (8 July 2020) yet again identifies the many cases of harm where patients have not been listened to, and treated unjustly, in the NHS and the wider system. ‘We have found that the healthcare system – in which I include the NHS, private providers, the regulators and professional bodies, pharmaceutical and device manufacturers, and policymakers – is disjointed, siloed, unresponsive and defensive. It does not adequately recognise that patients are its raison d’etre. It has failed to listen to their concerns and when, belatedly, it has decided to act it has too often moved glacially. Indeed, over these two years we have found ourselves in the position of recommending, encouraging and urging the system to take action that should have been taken long ago.’ (pp.i-ii). ‘We heard about a system that…lacks the leadership to deliver coherent and fully integrated patient safety policy directives and standards. Mistakes are perpetuated through a culture of denial, a resistance to no-blame learning, and an absence of overall effective accountability.’ (p.7). Interview with Baroness Cumberlege Woman’s Hour 11 July 2020 1-23 mins. In all these situations and cases people have had to fight, and fight hard, for their voices to be heard and for justice, often for many years. Many are still fighting. There seems to be a toleration of wrongdoing and injustice at the core of our institutions and our government. That should not be.
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