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Michael White: Life, fate and the Francis legacy

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There are faint echoes of Stalin’s deadly regime in the command and control culture that blighted Mid Staffordshire.

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When Robert Francis’s final report on the disaster at Mid Staffordshire Foundation Trust finally emerged in daylight I happened to be halfway through Vasily Grossman’s epic novel, Life and Fate. The long-banned and still neglected Russian masterpiece about the Stalinist era is the 20th century’s answer to War and Peace.

Between them Stalin and Hitler murdered upward of 15 millions civilians, so any comparison between their villainy and up to 1,200 avoidable deaths in gentle Staffordshire is a bit of a stretch. That said, we can still recognise faint outlines of an over-centralised command system in which local managers and apparatchiks strived to meet targets which the centre demanded, overriding merely human considerations in the process. All too often fear and self-interest drove the totalitarian chain of command, box-ticking, buck-passing and ultimately irresponsible.

‘Fear and self-interest drove the totalitarian chain of command, box-ticking, buck-passing and ultimately irresponsible’

Grossman, a famous war correspondent from Stalingrad through concentration camps to Hitler’s bunker (where he pinched souvenirs), believed that human kindness and compassion trump all systems. So he would have been delighted that the heroes of Mid Staffs humiliation were Julie Bailey and her allies in Cure the NHS, ordinary citizens who would not be cowed.

Conspiracy of silence

No one else from the trust board to the department, via assorted regulators and management tiers, escaped Francis QC’s strictures, MPs included, I should add. In his admired Commons speech David Cameron (who can rise to the big occasion), noted Francis’s comment that too many simply pass on complaints, keen to embrace quasi-religious “everything OK in the NHS” complacency. I remember a Staffordshire MP telling me in 2009 how even consultants had been scared to speak out. But did that MP do better?

As right wing critics were quick to protest, Cameron (“I love the NHS”) was happy to embrace Francis’s conclusion that NHS culture was the chief culprit and to reject tabloid demands for management scapegoats (I think that’s spelt “Nicholson”) or even Labour ex-ministers like Andy Burnham who signed off on Mid Staffs’ FT status in 2008.

But nor was I persuaded by complaints on the left that Cameron and health secretary Jeremy Hunt seek to use Francis to promote their “ideological” agenda of choice and competition. Certainly some Tory MPs - Bracknell’s GP/MP Phillip Lee is one - see more privatisation as the answer. And I doubt if linking nurses’ pay to care quality, as ministers propose, is the answer. Money-driven values were surely part of the culture problem.

In any case management crises like this are not a binary private/public, good/bad issue. Winterbourne View was a private sector scandal, the Bristol paediatric shame a public sector one (reforms still not implemented, Francis-sceptics noted), the News of the World phone-hacking abuse (it killed no one but caused much pain) an example of blind-eye negligence and cover-up as startling as Mid Staffs in its way. The bankers’ bust? Failure all round.

As to the future, statements of regret and contrition have flowed from all concerned as Mr Hunt ponders. Obama expert Don Berwick has been brought in, decent Ann Clwyd MP (whose husband died horribly in a Welsh hospital) appointed to advise. NHS Medical director Sir Bruce Keogh is chasing those five outlier hospitals with high death rates, although insiders have been warned about them for years - as they were 51 times about Mid Staffs.

Contrary to tabloid complaints there will be disciplinary and criminal retribution. All sorts of good ideas may - may - flow from Francis. I like the mandatory “family and friends” question to hospital staff and hope that whistleblowers can at last be properly protected. In New Zealand they cannot be punished unless their complaint is proved to be malicious. Last word to Reform, the pro-market lobby which (to my surprise) generously reminded supporters that good NHS hospitals manage finance and care very well. It’s not a binary issue.

Michael White writes about politics for The Guardian

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