National enquiries are commonplace in the wake of ‘scandals’ and major disasters. These enquires end up implying that the outcome was ‘a problem waiting to happen.’ With the putative victims and the country in a state of outrage, the leader of the enquiry cannot just say that life is full of problems, and that the organisation in which the problem occurred was just doing its best. Approbation would detach from the organisation onto the person of the chair of the enquiry. Yet, logically, an enquiry that focusses on just one organisation is in no position to opine on whether that organisation is any worse than the average of other organisations providing that service. Sorry to say it out loud, but they are all ‘problems waiting to happen.’ Society seems to need a victim – somebody must suffer. We think the inquisition of medieval times has not disappeared, it has merely been superseded.
Take maternity care. An apparent excess of intra-uterine deaths in place A results in an enquiry. In many cases, the mother had discerned a reduction of foetal movements, but maternity staff had not enquired into this point. The enquiry may result in new guidance requiring regular scrutiny of foetal movements. Then the guidance becomes self-fulfilling – in any case, where the baby dies in late pregnancy, the maternity unit will be criticised for non-compliance with the guideline. Yet the research evidence is equivocal about the value of routine enquiry into foetal movements. This is just one example – the rule book continues to create guidelines to the point that, if something goes wrong, it is highly likely that this or that guideline will have been breached. Worse, attention is deflected from other issues in care. In the last analysis, who knows, national enquires may do more harm than good.
This topic needs careful examination. It is no good just asking for more resources to improve the quality and safety of care – anaemic economic growth and increasing health demands mean that we must become more efficient in both how we use and how we allocate resources. There must be a point where asking the service to do more and more actually defeats good intentions.[1]
Richard Lilford, ARC West Midlands Director
Reference:
- Meddings J, Saint S, Lilford R, Hofer TP. Targeting Zero Harm: A Stretch Goal That Risks Breaking the Spring. NEJM Catal Innov Care Deliv. 2020; 1(4).