Care Quality Commission's David Prior attacks NHS culture

Health regulator David Prior said the NHS could ultimately go bust if change did not happen

The head of the health watchdog says the NHS in England has a culture that "doesn't listen" and he has been "shocked" by behaviour he has seen.

Care Quality Commission chairman David Prior said a rift between managers and clinicians was jeopardising safety and blocking improvements in care.

He said the NHS could go bust without "serious change" and called for more competition to drive up standards.

The government said it was trying to eradicate poor care and back openness.

'Ritual humiliation'

The NHS has suffered a series of damaging scandals over recent years and Mr Prior warned that lessons from them had yet to be learned.

Last year an inquiry into Stafford Hospital found that years of abuse and neglect had led to the unnecessary deaths of hundreds of patients.

Writing in the Sunday Telegraph, Mr Prior said: "Parts of the NHS have developed a culture that doesn't listen - or worse, that stigmatises and ostracises those who raise concerns or complaints.

"Too often, it delights in the ritual humiliation of those deemed to fail, tolerates and institutionalises outdated working practices and old-fashioned hierarchies, and can almost encourage 'managers' and 'clinicians' to occupy opposing camps."

He said he "loved" the NHS "and yet am too often shocked by some of the behaviour I see".

Mr Prior said lessons could be learned from the "open" and "constantly learning" organisations in the US.

Waiting targets

He called for successful hospitals to take over failing hospitals and community services, and for better care outside hospitals, and for larger "centres of excellence" with savings from shared services such as pathology labs and radiology.

"Without serious change, the NHS will deliver poor care, and ultimately go bust," he said.

And he called for changes to the way the NHS is held to account - particularly an end to trusts being "blindsided" by waiting time targets "that miss the point, skew priorities and have unintended consequences".

Katherine Murphy, chief executive of the Patients Association, agreed with Mr Prior.

She said: "There is a culture in the NHS where process comes before humans.

"For years we've tried to highlight concern about poor care. We're often seen as a nuisance for highlighting these issues.

"The behaviour and culture that was allowed to grow in Mid Staffordshire is no different from that in many trusts in many parts of the country today."

Certainty 'right'

Julie Bailey, of campaign group Cure the NHS, who was behind moves to get the Stafford inquiry set up, said Mr Prior was "speaking the truth" and something urgent needed to be done.

She said: "We have to face up that the NHS is in a crisis. We need to do something about it. I sat through every day of the public inquiry and that's exactly what came out. The NHS doesn't belong to the public any more.

"There's something badly wrong with the culture of the NHS."

Dr Mark Porter, chairman of the BMA Council, said Mr Prior's opinions mirrored what the organisation had been told by "doctors frustrated by working in an NHS that needs change".

"At Mid Staffordshire we saw how patient safety can suffer because of a combination of managerial obsessions and disengaged and disillusioned clinical staff," he said.

"We can no longer tolerate managers and clinicians seeing themselves as being on opposing sides. Only by stepping out of our traditional roles can we ensure that patients continue to receive the excellent care they deserve."

The Department of Health said it was "focusing on poor care like never before" and was turning around "14 hospitals that are in special measures".

A spokesman said: "We are clear that targets must never come before clinical need - and based on clinical advice, we have scrapped a number of them.

"However, it's right that patients have certainty about how long they can expect to wait for medical treatment when they are ill.

"In fact, despite the NHS treating more people than ever waiting times are low and stable and there are 35,000 fewer patients waiting longer than 18 weeks than in May 2010."