Abstract

PurposeThe purpose of this paper is to explore whether official inquiries are an effective method for holding the medical profession to account for failings in the quality and safety of care.Design/methodology/approachThrough a review of the theoretical literature on professions and documentary analysis of key public inquiry documents and reports in the UK National Health Service (NHS) the authors examine how the misconduct of doctors can be understood using the metaphor of professional wrongdoing as a product of bad apples, bad barrels or bad cellars.FindingsThe wrongdoing literature tends to present an uncritical assumption of increasing sophistication in analysis, as the focus moves from bad apples (individuals) to bad barrels (organisations) and more latterly to bad cellars (the wider system). This evolution in thinking about wrongdoing is also visible in public inquiries, as analysis and recommendations increasingly tend to emphasise cultural and systematic issues. Yet, while organisational and systemic factors are undoubtedly important, there is a need to keep in sight the role of individuals, for two key reasons. First, there is growing evidence that a small number of doctors may be disproportionately responsible for large numbers of complaints and concerns. Second, there is a risk that the role of individual professionals in drawing attention to wrongdoing is being neglected.Originality/valueTo the best of the authors’ knowledge this is the first theoretical and empirical study specifically exploring the role of NHS inquiries in holding the medical profession to account for failings in professional practice.

Highlights

  • The purpose of this paper is to explore whether official inquiries are an effective method for holding the medical profession to account for failings in the quality and safety of care

  • To the best of the authors’ knowledge this is the first theoretical and empirical study exploring the role of National Health Service (NHS) inquiries in holding the medical profession to account for failings in professional practice

  • Medical elites increasingly subject “ordinary” practitioners to greater peer surveillance and control as they seek to maintain collective regulatory privileges, albeit in a new and more transparent form. In this complex and changing context, it has been argued that a more dynamic approach to professional misconduct is needed: an ecological perspective (Abbott 1998, 2005), consistent with a “bad cellars” metaphor, in which misconduct is understood in the fast-changing political and economic contexts that are morphing the traditional institutional arrangements of the medical professions and that are impacting on their powers to promote and regulate appropriate professional behaviour (Muzio et al, 2016)

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Summary

Paper type Research paper

Introduction: professional failures in medicine Notwithstanding sustained critique (Dingwall and Lewis, 1983; Andrew, 2010) “the professions” remain an enduring and important part of the institutional landscape in modern societies (Noordegraaf, 2012). Medical elites increasingly subject “ordinary” practitioners to greater peer surveillance and control as they seek to maintain collective regulatory privileges, albeit in a new and more transparent form In this complex and changing context, it has been argued that a more dynamic approach to professional misconduct is needed: an ecological perspective (Abbott 1998, 2005), consistent with a “bad cellars” metaphor, in which misconduct is understood in the fast-changing political and economic contexts that are morphing the traditional institutional arrangements of the medical professions and that are impacting on their powers to promote and regulate appropriate professional behaviour (Muzio et al, 2016). As the counsel for the patients put it to the inquiry: “for the main part, we do not say these are system failures, they are personality failures” (Vol 2, pp. 801-802)

Inquiry reports
Department of Health
Both the system and those
Sexual abuse of
Harold Shipman was a GP Criminality
Local confidence in the Trust and important factor
The most important remedying
Secretary of State for Health in
Findings
Further reading

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