Della Reynolds believes Jeremy Hunt and his administration are responsible for the culture of blame that permeates through the health service. 

When a national scandal, such as Gosport breaks into the public domain, the Secretary of State responsible will act in three predictable ways.

Firstly, shock, as the facts come to light, as if coming from a point of total ignorance.

Secondly, a call for swift action in the 'lessons will be learnt' scenario.

Third, and most importantly, point a finger at a scapegoat to draw attention away from the Minister's own responsibilities.

Jeremy Hunt (the Health Secretary since 2012) is an expert at such tomfoolery. Without hesitation he has identified the main culprit of the Gosport scandal as the 'blame culture'.  He thinks that the blame culture led to over 450 early deaths under NHS care over a protracted time period with no-one discovering for two decades.

It is clear to any right-minded person that it was the very opposite – a lack of blame or lack of accountability which allowed the doctor to continue to use inappropriate levels of medication to shorten lives, a lack of accountability which allowed NHS managers to ignore the warnings given by the nurses, a lack of accountability from regulating bodies to properly investigate concerns, and a lack of accountability from the Parliamentary Health Service Ombudsman (PHSO) who investigated just three complaints in this time period, all without uphold.

No flags raised here by the same Ombuds who also failed to spot the scandal at Mid Staffs, Morecambe Bay, and Southern Health.  The PHSO upholds just 5% of all the complaints submitted each year, which gives the NHS and government departments a 95% clean bill of health. 'Nothing to see here', could be their motto.

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So how can a 'blame culture' thrive alongside a 'lack of accountability' culture? Just who is blaming whom?

The NHS is a top-down monolith; Jeremy Hunt sits at the pinnacle. He and his Whitehall buddies shape the policy, the structure, the working conditions, the pay and the funding. All the key aspects of running a health service lie in the hands of ministers and civil servants. They are not accountable in any regard for this work: they make 'discretionary political decisions' that are not investigated by the Ombudsman under existing legislation, that are not covered by Freedom-of-Information requests due to the 'chilling effect,' and that are not under the scrutiny of investigative journalists due to the monopolies of the mainstream media.

So, Whitehall's insiders don't have to worry about a blame culture ? in fact it rather serves to help them, because they can blame those further down the line for anything which goes wrong.

NHS executives and middle managers pick up hefty salaries for passing down the missives from the ministers without question and for keeping shtum about any problems arising. There are no regulatory systems to hold managers to account, so they don't have to worry too much about the 'blame culture' either.

Managers get blamed when they step out of line and get sued by the state in the guise of NHS legal teams. Take Gary Walker  – the CEO of United Lincolnshire Hospitals Trust. Mr Walker's crime was to put patients first and ignore inappropriate instructions from above. Mr Walker reposts that he prioritised scarce resources on emergency care despite pressure from above to meet targets on non-emergency treatment "whatever the demand". He said that managers in the trust had been told their "careers rested on delivering the targets" and were neglecting patient care.

Similarly, Dr Chris Day has recently been hung out to dry for the crime of reporting unsafe staffing levels.

Our front-line staff, doctors, and nurses can be investigated by their professional bodies under 'fitness to practice' directives. They are the ones caught between a rock and a hard place as they deliver services which are often under-funded, understaffed and unsafe. They are the ones who need the protection of government through changes to regulation and effective legal protection for whistle-blowers.  Jeremy Hunt is perfectly placed to end the so-called 'blame culture' by fully enacting the recommendations from the Mid Staffs inquiry but has consistently failed to do so, as monitored by Minh Alexander, an NHS consultant psychiatrist and whistleblower.

It matters not that the uphold rate is low for professional misconduct investigations. The process itself is designed to generate fear as the wheels slowly turn on a tortuous process that is conducted largely under a veil of secrecy. Who among us is brave enough to risk losing their mental and physical health, home and family by enduring years of investigation which requires the professional to seek their own, expensive legal advice? There are many instances of appalling treatment against NHS whistle-blowers, delivered by the state machinery and with the benefit of bottomless legal funding from the public purse. (The case of Dr Raj Mattu is typical of the destructive process.)

Jeremy Hunt: the buck starts and ends with you, because any 'blame culture' emanates directly from your department. Start with the man in the mirror if you really want to see change.

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