I used to think that, if people only knew about something going badly wrong, they would mobilise against it.
But I grew up under the lingering influence of World War 2. We were the brave little island that had held out against the evils of fascism and set up free universal secondary education and a National Health Service. We were the dragon-slayers. We were the good guys.
Postwar childhood games, played out on overgrown bomb sites, always involved shooting down the bad guys to emerge victorious.
It took me a very long time to realise that knowledge alone doesn’t stop bad things happening. You need courage, spirit and commitment to confront monsters.
After reading Kara2008 (whobyf1re.wordpress.com) this morning I got to thinking about LB and all the others killed or damaged by health professionals in one way or another. I’d bet each one of us has experience of family, a friend or colleague affected. There is a stack of anecdotal evidence around. There is research evidence too. Think of the data circulated to hospital trusts about death rates. Think of the number of civil cases instituted against them.
We all know at every level that something is badly, systemically wrong and also that nobody, apart from a handful of lowly scapegoats, has been called to account.
As a teacher I had to call various culprits to account. I remember one stubborn, little red-haired toughie, who had stolen some money from my purse. I usually kept it locked in my filing cabinet but I had been called out of my office suddenly and hadn’t stopped to turn the key.
I saw the set of her jowl and knew it was pointless to rage or accuse. The evidence was incontrovertible, but she would never back down. Then my anger and frustration lifted. I felt very sad for both of us. I asked her to imagine that she had done it. We would think about it as a purely hypothetical situation and consider the possible outcomes.
I can’t remember the detail, but at one point she protested that if she was able to walk away uncondemned, nobody would know anything bad about her.
“But that’s not true, is it?” I pointed out. “Somebody would know, wouldn’t they? Think about it!”
She thought. “I would know,” she said at last.
And that was the thing that mattered most. Not the money. Not the punishment. Not her admitting anything. It was her looking honestly at herself and deciding what path she wanted to walk down. Did she want live a life based on feeling clever and pleased with herself for doing somebody else down and getting away with it? It was her choice to make.
And, this morning, it seemed to me that, at an individual and systemic level, the NHS has reached a similar point.
For a range of reasons, individuals collaborate or collude with bad practice and organisations block or stifle concerns, protests and avoid the investigation of incidents.
Yet I can’t believe that the majority of workers in the system are happy about it. I can’t believe that the majority of managers are workplace psychopaths. I can’t even believe that the majority of elected representatives in the Commons are smugly complacent about it.
So why is it happening?
I said at the start that you need strength, spirit and commitment to change bad things and it is clear that many within the system are too worn down to do it on their own. There are outstanding pockets of good practice, scattered examples of excellence, honourable individual practitioners, but as a whole the NHS is failing.
We have to help it envisage the way ahead, not just as a financial and organisational spreadsheet, but as a moral choice. Who really wants a shoddy, showy business, lacking integrity, getting away with minimum standards by the skin of its legal teeth?
We on the receiving end have already tried to highlight the need for an honest look at realities, rather than spin.
We’ve tried “consulting” nicely and so far it hasn’t worked.
I fear it is going to take a conviction for corporate manslaughter to strengthen the good guys, inside and outside the system.
In the sixty odd years from post war optimism and good intentions, it has come to this.
It should make us all very sad.