The vulnerability of public spaces: challenges for UK hospitals under the 'new' terrorist threat

This article considers the challenges for hospitals in the United Kingdom that arise from the threats of mass-casualty terrorism. Whilst much has been written about the role of health care as a rescuer in terrorist attacks and other mass-casualty crises, little has been written about health care as a victim within a mass-emergency setting. Yet, health care is a key component of any nation's contingency planning and an erosion of its capabilities would have a significant impact on the generation of a wider crisis following a mass-casualty event. This article seeks to highlight the nature of the challenges facing elements of UK health care, with a focus on hospitals both as essential contingency responders under the United Kingdom's civil contingencies legislation and as potential victims of terrorism. It seeks to explore the potential gaps that exist between the task demands facing hospitals and the vulnerabilities that exist within them

Not by error, but by design: Harold Shipman and the regulatory crisis for health care

The case of Harold Shipman sent shock waves of revulsion and disbelief though UK society and through the NHS. The notion that a doctor could repeatedly, systematically and callously murder patients in his care shattered the assumptions that many held about health care professionals. As terrible as Shipman's actions were, they raised quite fundamental questions about how a doctor could kill patients over such a long period without being detected and stopped. As such, Shipman served to surface a much wider sense of malaise within the health service. To see the actions of Shipman as generating a crisis for health care might be somewhat misleading, although there is little doubt that it was a crisis for the community of Hyde. What the Shipman murders do illustrate, along with a number of other events concerning problem doctors, are the difficulties facing a health service that, until the turn of the millennium, had failed to adequately address the problems of rogue doctors. Shipman proved to be one of a number of trigger events that illustrated the fragility of the regulatory system that was in place to deal with medicine and, more importantly, it illustrated the importance of societal assumptions in the generation and incubation of that ‘crisis’. This paper seeks to examine some of the these issues as part of a wider debate concerning the nature of crisis within government and the manner in which learning after the event can serve to prevent the incubation of further crises