When the system protects itself: The NHS's problem with accountability

By Ehsan Ibrahim

Martha Mills, seen here in 2017, tragically died following the "gross negligence" of a senior consultant and professor at Kings College London, Prof. Richard Thompson, who later received no sanction for his role in her death. Image: Mills/Laity family photograph/PA

The National Health Service, or NHS, has always been considered one of Britain’s

greatest institutions - a lifeline for millions and a symbol of community. Behind the white coats, however, is a disturbing question: when things go horribly wrong, does the NHS defend or hold its members to account?

This question has been revived anew following campaigning by the parents of 13-year-old Martha Mills, who tragically died of sepsis in July 2021 following a number of blunders by King’s College Hospital, London. Last week, a tribunal confirmed that a senior doctor responsible for Martha’s care had committed “particularly brazen” blunders when he failed to react to multiple warning signs marking Martha as high risk. To many people's astonishment, after the tribunal, the Medical Practitioners Tribunal Service ruled that Professor Richard Thompson, the doctor in question, would not face disciplinary sanction, and instead he received praise for his “otherwise exemplary career.”

The ruling reinforces a long-held belief that senior NHS staff evade accountability too easily, protected by an inherent “culture of impunity” that exists within the organisation.

Allegations of professional wrongdoing being quietly ignored is not new in the NHS. For years, senior doctors have been accused of "closing ranks" and protecting one another from scrutiny. Campaigners argue that Martha's case is not a tragic one-off, but is part of a broader pattern of prioritising the protection of professionals over patient safety.

The data suggest this is, sadly, true. The General Medical Council (GMC) finds, on average, 28 doctors guilty of misconduct a year, but evidence from the Patient Safety Watch (PSW) suggests that there may be more than 15,000 "preventable deaths" among people in NHS care each year. The discrepancy between these figures raises difficult questions: are these isolated failures or is there something fundamentally wrong with how the NHS investigates itself, and is there a practical alternative?

Likewise, inquiries into maternity care scandals, for example, those at Shrewsbury and

Telford, have demonstrated concerning failures in accountability. Even more concerningly, one piece of evidence, amongst the growing calls for the conviction of nurse Lucy Letby to be overturned is the fact that hospitals like The Countess of Chester, where Letby worked, are massively underfunded, ill-equipped and stretched beyond their limits. This potentially results in more junior members of staff, such as nurses like Letby, facing sanction for more systematic failures of management where senior staff are protected from sanction.

Advocates for the NHS are correct to highlight the incredible pressure under which the

system is working, however, this does not excuse the failure of accountability. There is undoubtably chronic vacancies, severe under-funding, and a immense pressure to perform as healthcare professionals. Human error is inherent within the health service; but the question of whether it is rooted in poor conditions or negligence is essential when determining who, or what, is at fault. In the case of Martha Mills, for example, she died on a ward that was extremely well funded and supposedly world-leading. The issue of accountability, thereby, becomes even more challenging as the line between acceptable error and professional negligence is blurred.

"if the NHS remains unwilling to face the uncomfortable truths about power dynamics, accountability and their right to professional privilege, the same question will keep coming up - often, tragically, too late."

Skeptics claim an independent oversight function, such as the GMC or Medical Practitioners Tribunal Service, is inherently biased due to their close relationship with a medico-corporate medical establishment to which they make a contribution to.

Furthermore, whistle-blowers within the NHS report being gagged or sidelined when raising patient safety concerns. A British Medical Journal report from 2024, found that nearly forty percent of NHS workers experience "fear or reprisal" as well as mutism about patient safety concerns.

In reaction to Martha's death, campaigners and politicians have successfully advanced the idea of "Martha's Law," which creates a legal right for patients (or family members) to seek an urgent second opinion when they feel that their concerns are being disregarded. Supporters believe that with a legally enforceable patient's right to what is essentially a second opinion, families would be able to push back against the way the medical hierarchy - in this case, the doctor - can often dominate the conversation, and they would be able to do so before it was too late. Since the law was passed it has been invoked on 1500 occasions, with 300 of those resulting in patients care being changed or upgraded. Despite this success it is important to remember that it should not have taken the painful and unnecessary death of a 13-year-old to bring about change.

Creating the conditions for effective cultural change will, however, not be as easy as

legislation, and critics have cautioned that unless we address the clear problem of long-standing institutional defensiveness - and whether there will be major investment to

mitigate the current NHS staffing and resources crisis - any reforms will be largely symbolic.

No parent should find themselves in the tragic situation of losing a child in the same way that Martha Mills' parents lost her. But Martha's death has amplified a much bigger question: with the pervasive culture of self-protection within the NHS, will they be able to make meaningful changes, or, are there so many barriers in place that they will only be able to make superficial, symbolic changes, at best?

The government may legislate and new regulations might be created, but if the NHS remains unwilling to face the uncomfortable truths about power dynamics, accountability and their right to professional privilege, the same question will keep coming up - often, tragically, too late.

Image: Mills/Laity family photograph/PA