Thursday, 7 February 2013

The report with no names

It is 4000 pages long, Robert Francis QC's final report of his inquiry into the shortcomings of the Mid Staffordshire NHS Foundation Trust. Its findings, I gather, make more than disturbing reading. The one positive reaction I had from hearing and reading news reports was to be glad that Mr Francis had not entered the populist "name and shame" game. Instead he had looked at the endemic institutional reasons that such widespread deficient care had been able to take place.

In his accompanying letter to the Secretary of State, he outlined some.
The report has identified numerous warning signs which cumulatively, or in some cases singly, could and should have alerted the system to the problems developing at the Trust. That they did not has a number of causes, among them:
•A culture focused on doing the system’s business – not that of the patients;
•An institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern;
•Standards and methods of measuring compliance which did not focus on the effect of service on patients;
•Too great a degree of tolerance of poor standards and of risk to patients;
•A failure of communication between the many agencies to share their knowledge of concerns;
•Assumptions that monitoring, performance management or intervention was the responsibility of someone else;
•A failure to tackle challenges to the building up of a positive culture, in nursing in particular but also within the medical profession;
•A failure to appreciate until recently the risk of disruptive loss of corporate memory and focus resulting from repeated, multi-level reorganisation.

Scapegoating is such an easy game to play. One can understand why aggrieved parties should want a scalp. But it is a deeply primitive and unattractive instinct. One only has to remember the hue and cry which led to Ed Balls shamefully ensuring the unfair dismissal of Sharon Shoesmith, Haringey's head of children's services, after the Baby P affair to see an egregious example of the sort of thing. By and large those who go into the caring professions do so for the right reasons. When they fail, there are almost certainly reasons beyond themselves to blame, such as time restraints, staff shortages and multi-agency involvement.

Robert Francis is to be congratulated in not falling into the trap of blaming individuals or denigrating professionals. It's to be hoped that his report sets a trend - and that the media and lawyers do not pursue a witch-hunt.

Wednesday, 6 February 2013

A great day... for the world?

In an email to me yesterday, a good friend wrote about my "letters, blogs, diaries, lectures, diatribes, declamations or acclamations". I replied, "Diatribes - moi?" But let me break the habit of a lifetime to let off steam after yesterday's vote in the House of Commons to redefine the English language and the natural law.

In an item on The World at Ten on Radio 4 in the evening, there was a vox pop from a pub in Soho. One comment struck me. "It's a great day for gays, for Britain and for the world" (my italics). Well, it will certainly have momentous, and unforeseen unintended, consequences for this country, I predict. But isn't it time we got a realistic perspective on our own global importance? Along with other former colonial powers, we lost our colonies in the last century. Only we still cherish the illusion that we are a "great" power. We still presume we have so much to teach these benighted nations, who've only just emerged from the jungle or the desert. Hello! 

Isn't it time that we acknowledged that we have at least as much to learn from those on whom, let's be honest, we still look down as we ever taught them? Let's look at ourselves from outside. It would not be hard to paint a picture of a country whose media are corrupt, whose police are compromised, whose financial institutions are irresponsible, whose politicians are venal and whose aspiring leaders persistently and dishonestly deny perverting the course of justice. It might perplex the onlooker how one small off-shore island presumes to judge and intervene in other nations' internal struggles, when it would vociferously and violently resist the same happening in reverse. It might puzzle him how a country planning to spend billions of pounds on upgrading its nuclear weapons' system takes such a morally superior position over others who attempt similarly to defend themselves. 

It really is time that we abandoned the notion that we are a "great" nation - and by that I don't mean that we have to give up our national pride; but it needs to be proportionate; it needs to be real. We are not morally superior. I was unexpectedly moved last week watching the programme Make Me a Muslim, in which thoroughly secular model, Shanna Bukhari, set out to discover why more young British women are converting to Islam. The answer was not uniform, but it seemed to be a symptom of a profound dissatisfaction with our apparently enlightened culture, and something that occurred to me was whether our national unease with Islam was partly a reaction to its implied critique of this country's morality, or lack of it. Of course we dress up our Islamophobia in the guise of "It's only the terrorists we mind," but I wonder.  

Our politicians are not cut from a better cloth than all others. Our institutions are not intrinsically better than others' institutions. The realisation that we are an "ordinary" nation would save us much in terms of expenditure, of unrealistic ambition and popular discontent. I gather Chris Bryant MP was heard to say in Parliament yesterday, "The world has moved on." That may not be the best reason for redefining language and law, but is an excellent reason for reviewing and realigning our global perspective. What happens in the Commons does not shake the world.