Justice Delayed ….

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

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