The NHS is awash with managers who are obsessed with reputation management - David Behrens

The Post Office isn’t the only master of the dark art of ‘reputation management’. The NHS is also awash with obsessive managers who will go to extraordinary lengths to sweep issues of public concern under the carpet.

And as it’s hospitals they’re dealing with, these are often matters of life and death.

Reputation management is an offshoot of public relations whose purpose is to protect organisations from getting a bad press for having done something badly wrong. Whistleblowers who seek to do exactly the opposite are the reputation manager’s arch nemesis.

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Most big companies employ specialists to manage and massage the way they are presented to the public and there’s nothing wrong with that in principle. But when their work extends to publicly-funded institutions in which we all own a stake it becomes problematic, for as shareholders we have a right to know what is really going on.

Staff on a NHS hospital ward. PIC: Peter Byrne/PA WireStaff on a NHS hospital ward. PIC: Peter Byrne/PA Wire
Staff on a NHS hospital ward. PIC: Peter Byrne/PA Wire

What has been going on in the NHS is so big a disgrace that it can only be a matter of time before ITV turns it into a drama. It has cost many senior doctors their careers – and goodness knows, we don’t have doctors to spare. Worse still, countless families have been denied the dignity of knowing how their loved ones died, all because managers thought it more important to protect the reputation of the health trust that pays their wages.

Stories of consultants victimised and even struck off for attempting to highlight systemic failings within their departments have been circulating for years and last month the outgoing NHS ombudsman Rob Behrens (no relation) put some of them on the record. There was, he said, a cover-up culture within the health service that made crucial documents disappear and caused robust denials to be issued in the face of overwhelming evidence.

This fixation with protecting the reputation of the ‘brand’ came from the top down, said Behrens, with NHS leaders and ministers setting the tone for the whole organisation.

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No-one knows this better than Martyn Pitman, an obstetrician who was sacked for raising concerns that midwifery errors at a hospital in Winchester had caused avoidable tragedies. His managers, fearful the public would find out, dismissed his concerns and subjected him to what he calls “brutal retaliatory victimisation”. Of course they did; it was easier for them to take out the whistleblower than address the problems. It’s exactly what happened at the Post Office.

Pitman has the support of the British Medical Association but some other whistleblowers have been hung out to dry completely. Peter Duffy, a consultant urologist who had been named Doctor of The Year, became the victim of a deranged witch-hunt when he reported unprofessional behaviour by three fellow medics. Rather than investigate, his managers accused him of racism and hounded him out of his job.

He won compensation at a tribunal but when he published a book about his experiences, the NHS hired private investigators and released spurious emails in a further attempt to discredit him. That, said Duffy, was a tactic straight out of the anti-whistleblower playbook.

Private investigators don’t work for nothing and it beggars belief that our health service could simply divert money intended for patient care into bankrolling them at the expense of a doctor’s reputation.

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The same goes for other types of PR – which shouldn’t be necessary at all in a sector whose purpose of saving lives and healing the sick ought to be its own best publicity.

But self-promotion is a consequence of the ‘internal market’ set up within the NHS in the 1990s which saw health trusts introduced. They were supposed to give patients more choice but they really just created unnecessary competition. And that’s what fuels this obsession with reputation preservation.

The NHS now sees public relations as a magic potion that can wash away stains as readily as a box of Omo. And it’s applied most often in the least efficient corners of the service – as with the mental health trust in East Anglia that was named worst in the country yet which spent £800,000 on an external PR firm.

How did that work out for them? A review which concluded it had lost track of its figures for patient deaths turned out to have been edited to remove criticism of the trust’s leaders – a revelation that made the reputational damage greater than ever.

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The crisis of confidence within the health service, among its staff and, more importantly, the rest of us, is a ticking time bomb for the next government and will raise fundamental questions about the NHS internal market – because what’s the point of health trusts if no-one trusts them?

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