Spotting the Fail: What Failing Teams Look Like (Before It All Falls Apart)

There are certain telltale signs of failure.

Increasing edema.

Eye-rolling in a relationship.

Scotland drawing Moldova in a qualifying round.

Failure, whether in medicine or out, rarely starts with fireworks. It’s subtle, insidious, and—more often than not—deniable.

And that’s what makes spotting it in healthcare so dangerous. Because when the system goes, it won’t be in one catastrophic moment. The NHS doesn’t crash like a train—it fails like a heart. Slowly. Relentlessly. With compensations and warning signs everyone learns to ignore.

Failure in Slow Motion

I get asked a lot: “What happens if the NHS fails?”

And the real answer?

Nobody knows.

The NHS isn’t a business that can go bankrupt. It’s not a shop that can close overnight. If it shut its doors tomorrow, people would die by the thousands. The lights will never switch off completely—but they might dim so gradually, you don’t realise you’re in the dark.

Much like heart failure, there are stages to this. Signs. Symptoms. And a lot of us are in the middle of it right now.

The Fixed Mindset Test

You can spot a failing team—maybe even a failing specialty—by its mindset.

A growth mindset:

You’re innovating. Studying. Auditing. Looking ahead. Saying yes (maybe too often). Pushing your edges and backing it up with data.

A fixed mindset:

You’re firefighting. Infighting. Playing it safe. New ideas are threats, not tools. Managers multiply. Panels proliferate. People say “flow” a lot.

It’s all a bit… rigid. And behind that rigidity is fear.

We’ve seen this in action—teams that resist change tend to collapse into micro-control, risk aversion, and tribal protectionism. It’s not stubbornness. It’s survival.

Death by Bureaucracy

Here’s another dead giveaway: decisions driven more by process than by patients.

Let’s take psychiatry—not because it’s the only example, but because it’s so stark right now. Psychiatry services are overrun, underfunded, and left holding the bag for society’s crumbling scaffolding.

You call for help with a suicidal patient.

Reception picks up.

You leave a message.

You get another number.

Then another.

That one doesn’t pick up.

Back to reception.

Start again.

The system that was built to help is so burdened by risk management, triage, service pathways, and eligibility criteria that it forgets the person in the middle. Discretion gets replaced with bureaucracy. Compassion gets processed out of the flowchart.

And while psychiatry is the canary, it’s not alone in the mine. Primary care is throwing up similar barriers. Acute specialties too. Even A&E is flooded—not just by patients, but by decision-makers and metrics and ever-expanding administrative strata.

Spot the Signals

The NHS isn’t a monolith. It’s a constellation of teams—each with their own culture, politics, and pulse.

Here’s how to spot the ones in decline:

• Morale dips.

• Ideas stall.

• Blame culture creeps in.

• Management expands.

• Flow pathways multiply.

• Referral hoops increase.

• Mistakes get hidden, not fixed.

It’s not about bad people. It’s about pressure. Culture degrades under stress. And once it does, safety, honesty, and innovation go with it.

So What Do We Do?

This part’s murky.

Because fixing the NHS isn’t like mending a car. It’s not just more funding (though that would help). It’s a societal shift. It’s asking: What kind of care do we want? What are we willing to lose?

It’s about making hard choices—between equity and efficiency, between personalised care and mass delivery, between immediate fixes and long-term investment.

And right now? We’re making the wrong ones.

You want brilliant, motivated clinicians to work in places others avoid? Then you need to offer them time, money, or meaning.

But we don’t.

And we won’t.

Because a culture of learning has been replaced by a culture of survival.

So instead, we fight to slow the failing.

We spot the signs.

We call them what they are.

And we try not to shut up, even when we’re told it’s “too complicated.”

Stay Upright.

You’ll feel the wobble before the fall.

— DW