May 19 2024

This week, according to this report in the Sunday Times, the government will finally announce payment of compensation to the victims and their families of the blood contamination scandal. The scandal started in the 1970’s. Three-quarters of the victims are dead. No-one has been held accountable. Other countries facing the same issue have managed to pay compensation and hold some of those responsible accountable. Inordinate delays after scandals seem to be an example of British exceptionalism at its worst. Given the glacial progress of the British state when it comes to acknowledging, let alone remedying its failures, the subpostmasters can – presumably – expect proper compensation sometime in the 2050’s.

The report by retired judge, Sir Brian Langstaff, will detail the how’s and why’s in excruciating and painful detail. We can add this report to many similar others about the NHS. Take these, for example:

– the Francis Report into the Mid-Staffordshire Trust.

– Northwick Park Hospital: 2 inquiries into maternal deaths 2002 – 2005, then baby deaths. Its maternity unit was described in 2020 as “a risk to patient safety“.

– Morecambe Bay: deaths of babies in its maternity unit between 2004 – 2013. James Titcombe, whose son, Joshua, died because of inadequate care, is the Alan Bates of this scandal, having campaigned tirelessly since on patient safety.

– Shrewsbury and Telford: a 2017 inquiry described care so poor that 15 women and 40 babies died.

– East Kent Hospitals: serial failings here – a damning 2016 inquiry leading to 23 recommendations, only 2 of which were implemented; 24 maternity investigations from 2018 onwards; a prosecution in 2021 for serious failures in care leading to the death of a week old baby. Over a 4-year period 130 babies suffered brain damage as a result of poor birth care.

– Nottingham University Trust: between 2010 – 2020 babies suffered brain damage or still births; mothers and babies died with the unit described as “chaotic” and “dangerous“. An independent review has been established.

– And, finally, an All Party Parliamentary Report on Birth Trauma, published last week, stated that good care for pregnant women “is the exception rather than the rule“. Remarkably, this report was not the lead story in newspapers.

Columns will be written about how it is that such negligence, malpractice, cruelty and indifference can happen in a seemingly civilised society in the late 20th and early 21st century. It is the right question but put the wrong way round. Why wouldn’t these behaviours be found among people who consider themselves professional and civilised?

As CS Lewis put it:

“The greatest evil is not now done in those “sordid dens of crime” that Dickens loved to paint. It is not done even in concentration camps and labour camps. In those we see its final result. But it is conceived and ordered (moved, seconded, carried and minuted) in clean, carpeted, warmed and well-lighted offices, by quiet men with white collars and cut fingernails and smooth-shaven cheeks who do not need to raise their voice.”

It is easy to be cruel to someone when they are only a name on a document, simply the object of a process.

We can see the truth of this every day in the Post Office Inquiry. The only change to C S Lewis’s aperçu is that women have shown themselves to be quite as capable as men of these failings. Jane McLeod, the former General Counsel at the time of the Bates litigation, which blew open the whole scandal despite the Post Office’s expensive and extensive efforts to suppress it, has added cowardice to the list of misbehaviours highly trained, well-remunerated professionals (with a Code of Conduct whose spirit they are meant to follow) are capable of.

There are common themes which are found in all such scandals, whether in the NHS or the Post Office or any organisation you care to name: organisations and managers who find it hard to take criticism or learn lessons or listen to whistleblowers, who become obstinately wedded to one view, regardless of the evidence and who become defensive when challenged, whether from arrogance or a belief that because their purpose is noble, so must the practice be. Add to this, indifference to the human beings the organisation deals with – often seen as a nuisance, unjustified grumblers, on the make or simply obstacles to be processed and got out of the way.

Alisdair Cameron, the Post Office’s CFO, described this attitude well in a November 2020 document entitled “What Went Wrong”. He added:

“We should have been tackling these issues 10 years ago.”

This is a statement which can be safely said to apply to pretty much every scandal you’ve ever heard of, those you haven’t and those yet to come.

Theresa May, who set up the blood contamination inquiry in 2017, said this:

“I think what you get is a sense that it is more important to maintain the institution as a blameless institution than it is to accept a mistake and to look for the truth, the justice and accept the mistake. And the problem is, of course, with that it means that when the truth does come out, the institution looks even worse.”

Quite. Sir Wyn Williams could do no worse than use that as the opening paragraph of his report, when he finally comes to write it.

Photo by Hush Naidoo Jade Photography on Unsplash

April 26 2024

In which inquiry into which institution (and, for a bonus point, when) were the following failings reported?

– warnings or concerns raised by junior staff were ignored or hidden away

– senior staff and colleagues were aware but turned a blind eye

– complainants, both internal and external, were treated as troublemakers

– a tendency to close ranks against those raising concerns

– missed opportunities: all too many moments when something could have been said, should have been said but was left unsaid

– retaliation (or threats of it) against staff

– a culture of deference: both to senior staff and to the institution

– viewing the protection of the institution’s perceived reputation as more important than dealing with its failings.

No: not the Post Office Inquiry – though all these factors, and plenty more – outright lying (by omission, at the very least), a veritable epidemic of amnesia, an inability to read or understand any sort of written document and a quite remarkable failure to understand that work in a paid job involves actually doing things, ideally useful ones – could, on the evidence of the last fortnight, be added to the list.

No – all these were the findings of an inquiry into the Gosport War Memorial Hospital in 2018 where over very many years 450 patients had their lives shortened because of the unjustified actions of clinical staff. It is a reminder that such behaviour is not a one-off, not confined to any one atrociously run institution.

That affair had something else in common with the Post Office matter. 12 different sorts of investigations over 27 years failed to uncover the full facts or lead to effective action. How can this be? Well, different bodies with different agendas, powers, without access to all the information and sometimes lacking the relevant skillset do not result in the ideal investigative set up.

But in truth, institutions do not always really want to know about their failings. Such investigations, reviews, audits and reports are often designed to create the impression of feverish activity while uncovering nothing and giving the desired – but usually false – reassurance. So it was with Gosport Hospital – and so it was with the Post Office.

And so it has been in pretty much every other scandal, failing or other disaster: whether it is at a Boeing, a police force (too many to mention), NHS trusts (again too many to mention), charity, government department or any of the bodies where serious problems have been uncovered. The same problems, the same human failings recur in very different organisations and sectors. They recur in how mistakes happen or problems arise and, crucially, in how such organisations and those working in them respond to such mistakes and problems when they do happen.

Not if. When. Things do go wrong. But this is rarely the reason scandals happen. They happen because of how those organisations, their leaders, staff working in them and those advising them behave in response to failure, problems and mistakes.

Of all the WTF moments at the Post Office Inquiry in recent days, the revelation that the Post Office’s response to the suicide of a subpostmaster (Martin Griffiths, under stress because of discrepancies he blamed on Horizon and after having been made to repay money stolen by robbers who beat him up) was to appoint a media lawyer to advise it as he lay dying in hospital and then to “drip feed” compensation payments to his widow to buy her silence is one of the worst. The cynicism, the exploitation of grief and weakness, the bullying, the determination to avoid scrutiny, to prevent the facts – even when a tragedy happens – coming out are bad enough. That this was done by senior executives with the help and advice of professionals, none of whom seem ever to have asked themselves whether what they were doing was right makes it infinitely worse.

One of the key executives involved – Angela Van Den Bogerd – gave evidence at the 2019 “Common Issues” trial in the Bates litigation. Mr Justice Fraser said of her that she had sought to mislead him and, in future, he would only accept evidence from her if it was “clearly and incontrovertibly corroborated by contemporaneous documents“. This is the judicial equivalent of “Liar, liar, Pants on fire.” There was no investigation by the Post Office into her conduct following that trial, no adverse effects for her at all. On the contrary, she received a bonus for her work.

Organisations and professionals behaving like this show us who and what they really are. They have no reputation worth preserving.

September 13 2023

“In our time, political speech and writing are largely the defence of the indefensible.”

So wrote Orwell in 1946.

Today has given us 2 examples of how language is used to obscure the indefensible. But not from the political world. For a change.

Example No 1

The  announcement by BP that its CEO, Bernard Looney, left because, when providing answers in an earlier investigation about his relationships with colleagues, “he now accepts that he was not fully transparent in his previous disclosures. He did not provide details of all relationships and accepts he was obligated to make more complete disclosure.”

“Not fully transparent”. In old money: “He lied”
“Obligated to make more complete disclosure.” = “He should have told us the whole story”

These carefully crafted phrases are now the latest in a sequence of phrases which all mean the same – in substance – but which increasingly try to avoid actually saying it.

• It started with “lie”.
• It then proceeded to “economical with the truth” (used in 1986 by the then Cabinet Secretary to Mrs Thatcher, Sir Robert Armstrong, in the British government’s doomed attempt to stop Spycatcher – Peter Wright’s colourable account of MI5’s activities – being published). This was greeted with well-deserved derision but at least had the merit of using the word “truth”.
• “Economical with the actualité” was then used by Alan Clark in the Matrix Churchill arms to Iraq trial in 1992. Quite why a Tory politician famous for telling his civil servants in Defence – presumably as a joke – that British missiles should be aimed at the real enemy, France (or so he records in his diaries) should dress up this phrase in French is not made clear. Unlike Mr Looney, though, Alan Clark was all too transparent, indecently so, about all his liaisons.
• “Clarification”: a simple word meaning, in reality, an admission that what was said before was completely untrue. Or that what is being said now is exactly the same as what you said before even though it is the complete opposite. Often used to “clarify” a “full and frank disclosure” which has turned out to be anything but.
• Now we have not being “fully transparent”.

Example No 2

This letter from a recently retired consultant anaesthetist, Dr Peter Hilton was published in today’s Times, in response to this article yesterday about sexual harassment and rape within the surgical profession.

Sir, This “snowflake generation” of young doctors, largely female and selected on mainly academic excellence, clearly did not do their homework. Medical training and practice is brutal and demanding, with long hours, and bullying happens. Sexually inappropriate comments and actions do occur. It is stressful. All I can say is that if they want to make a success of this rewarding career then they should toughen up. Perhaps four A*s at A-level are not the answer to all the problems they will face.

There are – quite apart from the implication that stress explains sexual assault and bullying – a number of problems with the language used in this letter.

• The female doctors “did not do their homework”. Quite what they were supposed to do is not explained. Imagine that last question from the interview panel: “Is there anything you’d like to ask us?” “Well, yes, there is, actually. How stressful is this job? I’d like to know how much sexual assault and sexually inappropriate comments I should expect?”
• The use of the word “inappropriate”. It is a word best used for minor social solecisms or impoliteness. Using it to describe behaviour amounting to crimes is a way of obscuring the truth, of diminishing the seriousness of what is happening, above all, of showing contempt for those to whom it is done.
• The convenient use of the passive voice. “Bullying happens”. “Sexually inappropriate comments and actions do occur”. It just “happens” does it? A sort of ethereal bullying with no actors responsible for it, then. Bullying – like those “sexually inappropriate actions” – does not just occur or happen. It is done by people – often men or people in a position of power – to other people – often women or people lower down the hierarchy or younger or not in a position to resist. It is a choice by those doing it. It is – does this really need saying in 2023? – wrong.
• Finally, the exhortation that “they should toughen up”. Ah yes, sexual assault as a character-building experience.

When language like this is chosen, it is designed to obscure some – usually pretty unpleasant – reality. But it is unintentionally revealing of the author.

What conclusions to draw?

Mr Looney will now be reflecting that, as so frequently happens, it is the cover up – not the misbehaviour – that gets you. He will realise that when asked questions in an investigation, it pays to be truthful in your replies.

The public are left no clearer as to what actually went wrong at BP. But that’s OK because BP has moved on, its announcement having been carefully finessed by lawyers and communications professionals.

The doctor’s letter will likely not have been, despite him being a published author (“It’s Been a Gas? The life of an Anaesthetist” – available online, 1-star rating, which seems all too appropriate for something written by an expert in rendering you unconscious).

Some free advice.

• There are letters/emails you write, usually when irritated, angry, upset or just tired, especially late at night or when you’ve been very busy, which may perfectly express how you feel. Then.
• But once written, you read (or get someone else to read) them and, having got all this off your chest, you go to bed. The following day you press the delete button.
• If you absolutely have to send them, check with someone else how the letter comes across. You may – to be as charitable as possible – have not expressed yourself well.
• If you send in haste, in fury, without a sense check, you will make a fool of yourself – or worse.

This was one of those letters.

Photo by Scott Graham on Unsplash