Like so many other health authorities, one of our local primary
care trusts finds itself severely over-budget, and is proposing to
reorganise its services to reduce its deficit. Part of this plan is
to reduce or relocate some of the services provided at a local
One member of the service user group has decided to challenge
the individuals who make up the management structure of the PCT to
admit personal responsibility for any unnecessary suffering or
death that might arise from withdrawing services from that
particular unit – or resign.
The gist of his argument is that no one is forced to stay in
post and take particular decisions or actions. Each individual
always has the option to refuse or resign rather than implement
policies that will cause harm to other people.
In a letter to me, he states that front-line staff and service
providers are held personally responsible for the services they
provide, and, for the most part, they accept that responsibility –
they are frequently held to account for mistakes as well as for
professional decisions. Then he argues: “On the other hand we have
the politicians and managers… (who) will go to extreme lengths in
an attempt to avoid or disown any personal responsibility when
their decisions and actions are challenged… Even when given a
direct order… human beings are still personally responsible.
‘Following orders’ was rejected as a defence as long ago as 1945 by
the Nuremberg Tribunal.”
There are precedents for politicians resigning on a matter of
principle: Robin Cook over the Iraq war, for example. There are
even examples of heads of services resigning after catastrophic
failures in their organisations, such as the Cambridgeshire police
chief after the Soham case.
But these are different to expectations that health service
managers – or governing bodies – take personal responsibility, or
resign over specific cases. How could one trace legal
responsibility back to one individual for setting the budget in the
What’s your opinion?