Clapping the NHS during the pandemic may have had “dangerous” consequences by insulating it from criticism, the health ombudsman has suggested.
Rebecca Hilsenrath warned against treating the health service as a “national religion” as she called on its leaders to radically overhaul the culture and listen to those it fails.
She also accused the NHS of “doubly traumatising” those who had lost loved ones by refusing to even acknowledge the harm caused.
Ms Hilsenrath’s office has submitted evidence to an investigation of the NHS, led by Prof Lord Darzi, which is due to be published next month.
It shows a near 50 per cent rise in complaints about the NHS to the ombudsman – the highest authority for unresolved grievances – since 2020/21.
‘National mood has changed’
The independent investigation was ordered by Wes Streeting when he became Health Secretary last month, after he came to the conclusion that “the NHS is broken”.
Ms Hilsenrath told The Telegraph: “There is an argument I have heard that clapping for the NHS during the pandemic was quite a dangerous thing to do … because no organisation can be a national religion, and no organisation should be beyond constructive criticism.”
“I don’t think that it is helpful for any organisation to be treated as religion,” she added, suggesting the “national mood has changed” since the gratitude seen in the pandemic, with a significant upsurge in complaints.
Ms Hilsenrath, who previously led the Equality and Human Rights Commission, said the failure of the health service to listen to those it had let down meant it was not learning the lessons of deadly errors.
She raised particular concern about a surge in maternity investigations, saying too many lives were lost as a result of failures to listen to women in labour.
In the last year, the ombudsman for England has investigated almost twice as many maternity cases as the previous year, in every case because the NHS had failed to probe sufficiently, new figures show.
Evidence submitted to the investigation, and shared with The Telegraph, show 27,479 complaints about the NHS in England to the Ombudsman in 2023/24, with two in three at least partly upheld.
This is 47 per cent up on the 18,727 received in 2020/21, and almost double the 14,615 complaints recorded in 2011/12
“I think it does speak to a change in attitude towards the NHS and a far lower degree of happiness with services,” Ms Hilsenrath said.
She added she did not think the service should be treated as a religion, but nor did she subscribe to the view expressed by Mr Streeting that it is “broken”.
She said: “I don’t think that’s really helpful. We have to have an honest conversation about what’s really going on and how it needs to do better.”
Ms Hilsenrath said she could understand why the health service had won applause during the pandemic.
“Of course, people were enormously grateful for the extraordinary efforts that people in NHS went to during that time, including risking their own personal safety,” she said.
“I also know that the national mood has changed since then, and I think it’s incredibly difficult as an NHS worker to consistently read about the failings in your service, and how you’re letting people down.”
To go from being clapped to being derided in such a short space of time left NHS workers “in a place of risk” she said.
She went on: “There is a lack of consistency, as you see completely brilliant things happening in some places, not in others. I think we ask a lot of NHS leaders, sometimes we get it back but we don’t always. And of course, the ultimate price for failure is tragedy.
“We ought to be able to have an adult conversation, which doesn’t detract from the dedication and the brilliance that I talked about, but recognises that things need to be better.”
Ms Hilsenrath said she was particularly worried about the recent trends in maternity, with 28 investigations by the ombudsman in 2023/24, compared with 15 the previous year.
Despite a “phenomenal” succession of maternity inquiries, including a 2022 investigation intoShrewsbury and Telford Hospital NHS Trust, which found more than 200 avoidable deaths in the previous two decades, the situation appears to be worsening, Ms Hilsenrath said.
Two thirds of units are rated as inadequate or requiring improvement for safety by the Care Quality Commission (CQC).
In a recently upheld complaint, Carly Hardwidge, a 33-year-old mother, told clinicians seven times that she couldn’t feel her baby moving.
Ms Hardwidge also repeatedly told midwives she was experiencing pain, contractions, water leakage and had blood-stained discharge.
The ombudsman found staff at Royal United Hospitals Bath NHS Foundation Trust failed to properly investigate her concerns or refer her to an obstetrician on multiple occasions before her daughter was stillborn in December 2018.
Ms Hilsenrath said: “The catalogue of failings by the Trust in this case is truly shocking and it led to the devastating loss of a baby.
“Once again, we see a patient’s concerns dismissed and not taken seriously. The lack of continuity of care meant nobody took a holistic view of what was happening. Ultimately, this led to the tragic avoidable death of a baby girl.”
Ms Hilsenrath also said it was vital that reform of the NHS focuses on changing the way it works, not on the funding.
“Above all .. its got to be about culture. And if we get bogged down in money and structures, ultimately we’ll end up back where we are now, because it’s got to be about culture and behaviours.
“An NHS that isn’t listening isn’t learning, and that’s what takes you into repeat behaviors, and that’s the single critical thing that we see. And I’m afraid we see it over and over again.
“When big things go wrong and terrible things happen you get the NHS saying ‘never again’, but actually it’s just not true.
“Being patient-centric lies at the heart of that, because until the NHS listens more with people when things go wrong and before they go wrong, of course, those mistakes will continue to be made.”
‘Culture starts from the top’
She said the NHS had failed to act on previous recommendations to improve its leadership, and change its behaviours.
“Culture starts from the top, so we need leaders who aren’t just looking at numbers, but also looking at the culture within their organisation, and that’s on two levels. So partly it’s about patients, and partly it’s about staff, and can they speak out when things are going wrong.”
The case of the Nottingham killer illustrates failings which are common across the NHS, Ms Hilsenrath added.
Valdo Calocane was sectioned under the Mental Health Act four times, but discharged, despite his family raising concerns about his state of mind.
He went on to stab three strangers to death on the street.
Ms Hilsenrath said the failure of staff at Nottinghamshire Healthcare Foundation Trust to listen to concerns about Calocane showed that the “tragic and appalling case” had wider lessons for all services.
Care Quality Commission ‘not fit for purpose’
Mr Streeting has ordered a review of all safety organisations, after an interim review found that the CQC was “not fit for purpose”.
Ms Hilsenrath, who reports to Parliament, said: “The regulatory landscape is an urgent need of reform. It’s very crowded, it’s very fragmented. I’ve actually, genuinely lost count of how many bodies there are in the health and social care regulatory space, but it’s over 130.
“There’s a vast amount of duplication. It’s very difficult for regulators in health to speak with a clear and united voice, because there’s just so many of them, and they all have slightly different but overlapping roles.
“The organisations in question, the NHS, tend to get faced by multiple recommendations which all come from different people, and … of course, it’s a grossly inefficient way to run anything.”
A Department of Health and Social Care spokesman: “The NHS is broken but we are determined to get it back on its feet so it can be there for all of us when we need it.
“We will be honest about the challenges facing the health service and will work to tackle them.
“The Independent investigation into the NHS by Lord Darzi is a step towards identifying and solving these problems as we create an NHS fit for the future.”
