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The latest in a long line of scandals

Phil Hammond, who exposed the Bristol heart scandal in Private Eye, fears many of the Kennedy inquiry’s recommendations will be repeated by Robert Francis and that they arrive too late

I didn’t sleep well the night before the Kennedy inquiry report was published 12 years ago. I’d given evidence without any legal representation, been vaguely threatened with a custodial sentence for refusing to reveal my sources and then received a Salmon letter informing me the report may criticise me for breaking the story of the Bristol heart scandal in the pages of Private Eye, rather than going through “the correct channels”.

‘The lessons from Mid Staffs were needed to inform Lansley before he launched into his vast, untested reforms’

As it turned out I wasn’t criticised, I suspect because the inquiry had discovered the General Medical Council, the Department of Health, the Royal College of Surgeons and the Society of Cardiothoracic Surgeons were all well aware of what was happening in Bristol, but they didn’t do anything about it.

Without Private Eye, the actions of a courageous whistleblower called Stephen Bolsin and a very determined group of campaigning relatives, the truth may well have remained hidden forever, and many more babies could have died or suffered brain damage unnecessarily.

What kept me awake after the inquiry was wondering whether it was all worth it. Despite the report’s sensible and well reasoned 198 recommendations, and the BMJ quoting Yeats (“All changed, changed utterly”), I wasn’t convinced the good would outdo the harm.

Missed chances

I met parents whose marriages dissolved with the guilt of thinking they hadn’t done their best for their babies, and two fathers committed suicide. Much of this anguish may have been prevented if Bristol had been just another of the NHS’s dirty secrets. So I was determined to ensure some good came out of the inquiry.

I teamed up with some fabulous parents lead by Maria Shortis, and became a patron of her charity, Constructive Dialogue for Clinical Accountability. We visited child heart surgery units around the UK and had open and honest discussions about how complex surgery could be delivered more safely in fewer, larger, better resourced units.

An expert advisory group was brought into oversee this change and made recommendations to the Labour government, which were ignored. Further attempts have, for various reasons, been further delayed. Twelve years after Ian Kennedy’s report and 21 years after the scandal was exposed, we still haven’t safely and sustainable reorganised child heart surgery. So what hope is there for the Francis inquiry to succeed?

Whatever Robert Francis recommends, my fear is it’s three years too late. The lessons from Mid Staffordshire were needed to inform Andrew Lansley before he launched into his vast, untested reforms in 2010. Reorganisations on this scale are invariably dangerous for patients, as was Labour’s desire to make every hospital a self-governing foundation trust, a policy pursued by the coalition.

Mid Staffordshire should never have been forced down that route. It was too small and simply not up to the task, just as child heart surgery in Bristol was not fit for purpose 20 years ago. Both sacrificed lives to balance the books and satisfy political edicts.

Bristol happened on the Tory watch but, as with Mid Staffordshire, it took a change of government to order a public inquiry. This took so long it post-dated Labour’s NHS Plan and so none of its recommendations were included. The chance to rebuild the NHS around transparency, humanity and safety was lost, despite all the extra funding.

Same old story

It’ll be depressing to see how many of the recommendations in the Kennedy report are repeated by Mr Francis. Kennedy complained that the NHS has been “littered” with previous inquiries that were “consigned to gather dust on shelves”. Yet many of them made precisely the same criticisms of the structure, organisation and resourcing of the NHS that he made.

In 1965, a letter to The Times complained about the shocking treatment of “geriatric patients in mental hospitals” and the casual attitude of the Ministry of Health in dealing with these problems.

‘You’d need a career death wish to blow the whistle in public on unsafe care’

In 1967, an investigation and book called Sans Everything concluded that the NHS hierarchy denies problems and dismisses complaints as unfounded, even when supported by strong evidence. There is a tendency to lie low and hope the criticism will fade, and complainants are discredited and victimised. This is as good a summary of the Bristol and Mid Staffordshire inquiries as you could find.

Joan Higgins, professor of health policy at the University of Manchester, has analysed the dozens of NHS inquiries and has found that the same issues keep recurring: services working in isolation with inadequate leadership, no clear systems for quality of care and accountability, poor communication and complete disempowerment of staff and patients.

Time to deliver

Those who work inside the NHS just get desensitised to it all. The DH gets frustrated at the “resistance to change” in the service, but with burnout and depression affecting around 20% of the NHS workforce it’s hard to see where the change is going to come from.

The culture of fear, blame and bullying in the NHS is as prevalent now as ever, and you’d need a career death wish to blow the whistle in public on unsafe care.

‘It is up to all of us to improve the NHS. If Sir David releases his infamous grip, doctors and nurses must step up to the mark’

Part of the responsibility lies with NHS Commissioning Board chief executive Sir David Nicholson and his command and control team, whose talent for sticking to budget, keeping waiting lists down and hitting politically driven targets is matched with an ability to “manage” bad news, suppress dissent and deliver only good news to Downing Street.

Sir David is no George Entwistle and is unlikely to go unless Mr Francis decides he was willfully blind to the deaths at Mid Staffordshires, rather than just asleep at the wheel.

Ultimately it is up to all of us to improve the NHS. If Sir David releases his infamous grip, doctors and nurses must step up to the mark to motivate and inspire those around us. Labour made some big improvements in NHS care, but they didn’t deliver a universal safety culture in times of plenty.

Making the NHS safe and humane when so many organisations are on the brink of going under is a huge task. In the gap between Bristol and Mid Staffordshire we’ve learned that large, distant regulators and centralised management doesn’t deliver safety. More regulation would be a mistake.

Great care comes from motivated front line staff with good training and humane working conditions who listen to patients and aren’t afraid to speak up when they spot a problem. It’s time for a bottom-up revolution rather than more top-down pressure. We need a bidet, not a shower, to get out of this mess.

Dr Phil Hammond is a hospital doctor, journalist, broadcaster and comedian

Readers' comments (6)

  • Dear Phil your article above explains the situation very well. Nothing will change. The reality is that like the Bristol fiasco not only did patients die but their relatives also suffered with broken marriages,suicide etc Its this part of this ugly mess that no one ever sees and the people who get away with such bad management go on to bigger and better things to wreck other people lives.

    It is so unfair to the patients and relatives.

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  • So, why did / will the Royal Colleges not apparently take a positive stand?
    Why did they not empower & protect their members to do the right thing on behalf of their patients?
    All the well informed & wise reports in the world will deliver nothing if the professionals delivering the care are afraid of delivering good care.

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  • The Royal Colleges are just as full of cover ups as some so called enquiries. They have no spine, any of them. They bottle everything, even stopping the recent H&S care bill. Greedy doctors only interested in their fat pensions and salaries.

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  • It is accurate to point out that none of these major lessons are part of the current reorganisation of the NHS.
    Lots of new services in primary care are being set up with no meaningful governance. One doctor covering a population of 350,000 tells you all you need to know about the safety of out of hours services in primary care. Staffing of hospital wards is set at the bare minimum.
    One thing has changed in that the blame game in the future will include criminal proceedings. Martin Yeates may be the last CEO to decline to appear at a major enquiry and I understand this option is not available when charged in the criminal courts.

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  • Depressingly accurate as ever. The spin cycle to blunt the effect of the Francis report has already begun: witness the wheedling article written by Sir John Oldham in the HSJ this week.

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  • We need to recognise that to deliver care to the clincial standards hospitals will need to reorganise and some will have to close .
    This will be uncomfortable ..but we are delivering an Edwardian model of health care which makes hospital care essential and claiming to be better .
    The bar in General Practice needs to be raised and all providers need to understand that we are all responsible to patient care and that the model of health care needs to change. All providers will need to undergo a painful recognition that they cannot continue to protect their self interst .

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