“Just how easy is it to speak about things that have gone wrong?”, asked health secretary Jeremy Hunt in a speech he made last year about improving transparency and ending the blame culture in the NHS. Mr Hunt is himself failing badly on this critical benchmark for greater openness. The Guardian this week has revealed that half a million pieces of medical correspondence, including test results and diagnoses for life-threatening conditions like cancer, sat undelivered in a warehouse between 2011 and 2016. Yet it has taken almost a year for the full extent of this failure to emerge.
Mr Hunt was first made aware of the problem in March last year. But he did not inform MPs until July last year, in a 138-word written statement that mentioned neither the scale of the problem nor the potential harm to patients. The incident was confined to a single paragraph buried in the Department of Health’s annual report. While it appears a team was set up in early summer 2016 to look into the problem, much of the undelivered correspondence did not arrive at the GP surgeries of affected patients until November and December last year. No explanation has been offered for why it has taken nine months from Mr Hunt being informed to urgent correspondence finding its way to patients and their doctors. The idea that letters containing test results and diagnoses for life-threatening conditions can go missing for years is a frightening prospect for any NHS patient. According to the government, 500 patients may have suffered serious harm as a result of the missing correspondence.
The way that Mr Hunt and his department have handled this affair seriously undermines his pitch to be an ardent advocate for patient safety. It bears all the hallmarks of a government whose primary concern is not the health of NHS patients, but sneaking out bad news in order to avoid an embarrassing story. Mr Hunt has rightly drawn lessons for the NHS from the airline industry, which radically improved its safety record by improving transparency. He has introduced grading of hospitals on the openness and honesty of their reporting cultures. But he has failed utterly to hold his own department to the standards he expects of hospitals.
It is critical that affected patients are swiftly identified and offered an apology and financial compensation. But patients who have suffered as a result of NHS mistreatment often say that what’s more important is knowing what’s happened to them will never be allowed to happen to others again. This means tough questions need to be asked within Mr Hunt’s department about what went wrong, and what needs to change. How could such a monumental failing go unnoticed by so many for so long? How could the Department of Health fail to hold the responsible private company – which it part owns – accountable for basic standards like the successful delivery of internal correspondence?
These issues will remain relevant when and if the NHS ever completes its much-delayed transition to digital patient records. Mr Hunt said he wanted the NHS to become paperless by 2018; that goal now looks a long way off. There is nothing to suggest a paperless NHS means a more competent NHS when it comes to communicating with patients and updating their records. NHS IT projects have a terrible track record: the last ill-fated attempt to create electronic patient records was abandoned after nearly £10bn had already been spent on it. The creaking IT infrastructure at many hospital trusts has resulted in several serious data failings, including at St George’s in London and the Leeds Teaching Hospitals Trust, often resulting in cancelled operations.
Communications and IT failures are far from the only risk to patient safety. The current NHS funding crisis has crippled the finances of many hospitals, leaving them with staffing levels that fall far below those recommended as safe by the inquiry into the devastating failures at Mid Staffs. Indeed, its chair, Sir Robert Francis, has warned the NHS now faces an “existential crisis” that makes another scandal on this scale inevitable.
Mr Hunt is perhaps the first health secretary to put patient safety so firmly at the heart of his rhetoric. But rhetoric cannot save patient lives. This week’s revelations of cover-up could not run more counter to his agenda to improve transparency in the NHS to reduce avoidable deaths. Mr Hunt must reflect on why – far from modelling the culture he expects from hospitals – he and his department have so badly failed to practise what he preaches.
The Guardian view on Jeremy Hunt: he must practise what he preaches | Editorial
