A just culture for the NHS: Cicely Cunningham writes...

 Since starting this campaign, I have often been asked the question: “What would success look like for Learn Not Blame?”

To start with, I struggled to answer this question. There seemed to be many answers which applied in different situations. A world where front line staff who make mistakes are not thrown under a bus by their colleagues and organisations. A world where patients and families are heard, their questions answered, their desire for learning met. A world where doctors could go to work and know that their care was getting safer, because there was a commitment to listening to staff, acting on concerns and not repeating the mistakes of the past.

But this can all be summed up in one phrase – a “just culture”.


“Just culture” is a phrase that seems to be in the ascendancy at the moment in debates about healthcare. It’s often described as the “opposite of a blame culture”, but describing it this way suggests that it only applies when things go wrong. To me, a “just culture” should be the prevailing way of working and thinking. Quite simply, to me, it means a culture that values and cares for every individual as a human being.


It follows then that this applies equally to those for whom the NHS cares, and those within the NHS doing the caring. 


I recently read with sadness – and a degree of recognition – the comments of a doctor in a British Medical Journal article: “It [the NHS] just doesn’t care. It chews people up, spits them out, and then gets another well meaning chump to replace them.” The feeling that you are just another cog that enables the machine to keep turning, that you are dispensable, that your own life counts for nothing compared to the requirement of the service. I know innumerable stories of colleagues refused leave for their own weddings, let alone anyone else’s. Chastised when they went out of their way to help a patient, because things weren’t done in the “right way”. Refused compassionate leave for a funeral because the family member who died didn’t meet a bureaucratic definition of “close family”.


This pales into insignificance when compared to the treatment that many harmed patients and families face from the NHS: a closing down to enquiry, denial of problems, dismissal of concerns and then defence. Often, legal teams brought in to initial meetings – where families just want to discuss how the organisation can learn from what happened and make sure it doesn’t happen again. At our Learn Not Blame launch event, Scott Morrish, dad to 3 year old Sam who died avoidably of sepsis, spoke of how he felt after the death of his child. Having to fight to get the answers he needed about Sam’s care, he described a profound loss of trust in the NHS, an institution that he felt should having caring at its heart, yet which treated him with coldness and a lack of concern.


While the constant small slights felt by staff in their working lives do not compare to the experience of those who have lost children avoidably or suffered harm themselves , the remedy is the same. A just culture seeks to redress the hurt that people feel, by asking “who is hurt? What do they need? And whose responsibility is it to meet that need?” If we ask these questions every day, we can see a change in the world.