Reducing the risk of NHS disasters

Area of Science:

• Healthcare Management
• Medical Ethics
• Legal Reform

Background:

• Healthcare failures, exemplified by the Letby case, highlight systemic issues beyond individual criminality.
• Current public inquiries often struggle to reform poor leadership and culture, focusing on what is regrettable but lawful.
• Progress in informed consent demonstrates a successful shift from undesirable to unlawful practices through addressing epistemic injustice.

Purpose of the Study:

• To propose using public inquiries to identify and rectify epistemic injustices within healthcare systems.
• To explore how lessons from informed consent reform can be applied to broader healthcare leadership and legal practices.
• To advocate for making certain systemic failures, termed 'management feudalism' and 'legal chokeholds,' unlawful.

Main Methods:

• Analysis of public inquiry structures and their limitations in addressing systemic healthcare failures.
• Examination of the concept of epistemic injustice and its role in healthcare, particularly concerning patient consent.
• Proposal of remedies including democratizing management, reforming legal ethics, and adapting legislation and litigation strategies.

Main Results:

• Identifies 'management feudalism' and 'legal chokeholds' as key areas of epistemic injustice in healthcare.
• Suggests that addressing epistemic issues can enhance social power for patients and transform clinician-patient relationships.
• Proposes that public inquiries can be more effective by targeting these injustices to drive lawful change.

Conclusions:

• Public inquiries should evolve to target epistemic injustices, moving beyond mere condemnation to establishing new legal standards.
• Applying principles of informed consent and addressing epistemic relationships can improve healthcare leadership and legal practices.
• Shifting healthcare leaders from authoritarianism to consent and lawyers from secrecy to candor is crucial for public trust and safety.