| By Steve Black The medical establishment and its leadership are sometimes very resistant to change, even when presented with clear, solid evidence, leading to serious harm, writes Steve Black I’m old enough to remember when most shoe shops had strange, unused, high-tech devices relegated to the corners of the shops. Those devices were designed to X-ray children’s feet to ensure a better fit. This sounds insane by today’s standards, and it was. The first warning that they should be eliminated occurred in the early 1950s, but they were only finally scrapped in the UK in the 1970s. But a related and far more serious story emerged around the same time. A young epidemiologist, Alice Stewart , working with almost no funding, sought to find an explanation for the anomalous rise in leukaemia in 2–4 year olds in the UK. There were many hypotheses, but one huge factor stood out: obstetric X-rays on their pregnant mothers. An initial report was published in The Lancet in 1955 ( here , if you have access) to some acclaim. The results were good enough to encourage better data collection. That data was utterly unequivocal: foetal X-ray exposure vastly increased the risk of childhood leukaemia ( BMJ 1958 ). Huge American studies in the next few years confirmed her results. However, X-raying pregnant mothers continued until the early 1980s in the US and England. Margaret Heffernan argues that this refusal to admit the reality occurred because of wilful blindness in the medical establishment. Nobody wanted to admit that a standard, common medical procedure was actually harmful. Even famous epidemiologist Richard Doll (now remembered for discovering the link between smoking and lung cancer) wrote a rapid, shoddy, refutation of Ms Stewart’s initial results (he recanted, but only in 1997). I tell this story for two reasons. One: the medical establishment is sometimes very resistant to change even in the face of strong evidence (consider this when reading their conclusions about what is wrong with the NHS). Two: wilful blindness is disturbingly common and frequently a major cause of serious harm. Ms Heffernan’s book on the topic is highly recommended (it covers many medical and other crises where many people knew a problem existed but persisted in ignoring it until it was too late, like the financial crisis that nearly broke the work economy in 2008). The pushback to the government’s description that the NHS is “broken” is a contemporary example of wilful blindness. Many commentators have expressed the concern that the description might have negative effects on patients and the service. Victoria Atkins (the last SoS) pushed back for this reason in a Centre of Policy Studies discussion at the Conservative Party Conference (see twitter X link to the session). But it seems very clear the pushback started when some senior NHS leaders briefed the media to say they found the “broken” claim to be “political” and “exaggerated”. The person who did this briefing displays the same mindset of those that claimed the NHS didn’t have a productivity problem in late 2023 but was silent six months later when the NHS England finance director presented a board report that said the problem was serious (see the HSJ story and my comments in May this year). I think the wilful blindness to the real state of NHS productivity is merely the tip of the gallium-berg (chemistry lesson of the day: gallium, like water, also expands on freezing, forming “bergs”, but is opaque, so hard to see the extent of what is below the surface). Key people in the NHS leadership are utterly resistant to admitting how bad things are, not least because they might need to admit they haven’t fixed it while they have been in charge. Admitting the situation is bad is trouble enough. Admitting they should have known how bad is worse as it poses the question: why didn’t you act earlier? This is a classic cause of wilful blindness. I would probably be just annoyed by the pushback on the broken NHS claim if that were the only evidence of the extent of wilful blindness in the NHS leadership. It isn’t. And I’m not just annoyed; I’m mad (perhaps as mad as Howard Beale ). Here is a short summary of a story I’ve covered in more detail before . The Darzi report accepted, for the first time in an official NHS publication, that the RCEM’s estimates of the mortality caused by long waits in accident and emergency were credible. They estimate that perhaps 14,000 extra deaths every year are caused by long A&E waits for admission (compared to the situation if all were admitted in <5hr). I think the RCEM claim is a conservative underestimate, not least because I was one of the co-authors of the original EMJ paper that provided the evidence they used in their calculation. That paper was published in January 2022. The response of the NHS leadership was not to investigate the claim or update the data analysis (which NHSE are uniquely able to do quickly) but to suppress it. In a hearing in front of the health select committee , where Adrian Boyle of the RCEM gave a solid account of the evidence, NHSE leaders sought to deny, minimise or undermine the relevance of the evidence and denied that it was their job to reanalyse the data. As far as we know, NHSE has not commissioned any update or reanalysis to test the original claims. To me, this is solid, unequivocal evidence of wilful blindness. Perhaps one diagnosis Lord Darzi missed was that, even when presented with clear, solid evidence, many of the NHS leadership are wilfully blind to it. Like Mr Doll on the childhood leukaemia evidence. The NHS cannot afford anyone in a leadership position to be blind to the real state of the service. The NHS is broken, and it won’t be fixed until this is admitted. |
